Colposcopy

Overview

A colposcopy is a test to look closely at the cervix (the opening to the womb from the vagina) using a special microscope called a colposcope. It is usually done after an abnormal cervical screening (smear) test to check for abnormal cells that could lead to cervical cancer.

Yes, colposcopy is a common test for follow-up after an abnormal cervical screening. In the UK, about 1 in 20 screening tests leads to colposcopy.

It is usually for women and people with a cervix aged 25 to 64 who have had an abnormal cervical screening result, or sometimes for unexplained symptoms like bleeding after sex.

Symptoms

Common symptoms

• The procedure is done to check for abnormal cells, so you may not have any symptoms at all.
• If you have symptoms, they could include bleeding after sex, bleeding between periods, or an unusual discharge.

Causes

Main causes

• The test is done to find out why your cervical screening result was abnormal.
• Your smear test may show changes in cells (dyskaryosis) that can be low-grade (mild) or high-grade (more significant).
• Colposcopy helps check if the changes are due to human papillomavirus (HPV) infection or precancerous cells.

Risk factors

• Being infected with high-risk types of HPV.
• Having a weakened immune system.
• Smoking.
• Long-term use of the contraceptive pill (more than 5 years).

When to see a doctor

See a doctor urgently if:

• After a colposcopy with biopsy, if you have heavy bleeding, severe pain, or signs of infection.

Book a routine appointment if:

• If you get a letter inviting you for cervical screening – attend as advised.
• If you have symptoms like bleeding after sex or between periods, see your GP or sexual health clinic.
• If your screening result is abnormal, you will be offered a colposcopy appointment.

Diagnosis

Colposcopy is both a diagnostic procedure and a way to guide treatment. The doctor uses the colposcope to view the cervix and may apply a solution (like vinegar) to make abnormal areas more visible. If areas look abnormal, a small sample (biopsy) is taken and sent to a lab.

Tests that may be done

• Colposcopy (visual examination with a colposcope).
• Cervical biopsy (tiny tissue sample, usually painless but can cause mild cramping).
• Sometimes an HPV test is done on the same sample.

What to expect at your appointment

You will be asked to lie on a couch with your knees bent and apart, like during a smear test. The doctor will insert a speculum (a smooth plastic or metal device) to hold the vagina open. Then a light and microscope are positioned just outside you. A liquid may be applied to your cervix. If a biopsy is taken, you may feel a short pinch. The whole thing usually takes 10–20 minutes. You can go home straight after and return to normal activities, though you may have some spotting.

Treatment

If the colposcopy shows abnormal cells that need treatment, the doctor can often treat them straight away or at a follow-up visit. Treatment removes the abnormal cells to prevent them turning into cancer.

Self-care at home

• After a biopsy, avoid heavy lifting, swimming, or using tampons for about 4 weeks, or as advised by your doctor.
• You may have some light spotting for a few days – wear a sanitary pad.
• Pain can be managed with over-the-counter pain relief such as paracetamol (follow the instructions on the packet).
• Do not have sex for at least 4 weeks after a biopsy or treatment, to allow healing.

Medical treatments

Treatments for abnormal cervical cells include LLETZ (large loop excision of the transformation zone) – a small wire loop that cuts away the abnormal area – or cone biopsy (a small cone-shaped piece removed). These are usually done under local anaesthetic and take only a few minutes. Rarely, a treatment called cryotherapy (freezing) or laser therapy may be used. Your doctor will recommend the best option based on your results.

When is surgery considered?

If the abnormal cells are high-grade or if further examination shows a risk of cervical cancer, surgery such as a cone biopsy under general anaesthetic may be needed. In very rare cases, a hysterectomy might be discussed, but this is not common.

Living with this condition

After colposcopy and treatment, most people can go back to normal activities the next day. You may need to avoid sex, swimming, and tampons for a few weeks. Your doctor will tell you exactly how long. You will have follow-up appointments to make sure the abnormal cells have been fully removed.

Lifestyle tips

• If you smoke, quitting can reduce your risk of abnormal cells returning.
• Keep a healthy weight and eat a balanced diet rich in fruits and vegetables.
• Practice safe sex to reduce the risk of HPV – condoms can help but do not fully prevent it.

Diet and exercise

A healthy diet with plenty of vegetables, fruit, and whole grains supports your immune system. Regular exercise, such as brisk walking 30 minutes most days, also helps overall health. No special diet is needed after colposcopy.

Mental health and emotional wellbeing

Waiting for colposcopy results can be stressful. It is normal to feel anxious. Talk to your partner, family, or a friend. If anxiety affects your daily life, consider speaking to your GP or a counsellor. Remember that most abnormal results are not cancer and treatment is highly effective.

Prevention

While colposcopy itself cannot be prevented, the need for it can be reduced by preventing the abnormal cells that lead to it.

Vaccines

The HPV vaccine protects against the types of HPV that cause most cervical cancers and abnormal cells. It is offered to girls and boys aged 12–13 in the UK. If you are older and haven't been vaccinated, ask your doctor if it is suitable for you.

Screening programmes

Regular cervical screening (smear tests) can detect abnormal cells early, often before they need colposcopy. Attend your appointments when you are invited.

Complications

If left untreated

• If the abnormal cells are not treated, they could progress to cervical cancer over time (usually many years).
• Untreated high-grade changes have a higher risk of becoming cancer.
• Low-grade changes often clear on their own, but they need follow-up to make sure they go away.

Long-term outlook

The outlook after colposcopy is very good. Most abnormal cells are caught early and treatment is simple and effective, preventing cancer from developing. Even if cancer is found early, treatment has high success rates. Regular follow-up is key to staying healthy.

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