Abnormal Pap Follow-up

If your pap exam shows abnormal results, your doctor may order a follow-up exam called colposcopy, a procedure that uses an instrument with a magnifying lens and a light, called a colposcope, to examine the cervix and vagina for abnormalities. The colposcope magnifies the image many times, allowing the physician to see the tissues on the cervix and vaginal walls more clearly. In some cases, a cervical biopsy, a small sample of tissue, may be taken for further examination in the lab.

A colposcopy procedure may also be used to diagnose and assist in the treatment of the following conditions:

  • Bleeding
  • Polyps (benign growths)
  • Genital warts, which may indicate infection with human papilloma virus (HPV), a risk factor for developing cervical cancer
  • Diethylstilbestrol (DES) exposure in women whose mothers took DES during pregnancy, as DES exposure increases the risk for cancer of the reproductive system

There may be other reasons for your physician to recommend colposcopy.

Preparing for Colposcopy

Your physician will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.

Generally, no prior preparation, such as fasting or sedation, is required. If a biopsy is performed and requires regional or general anesthesia, you may need to fast for a certain number of hours before the procedure, generally after midnight.

If you are pregnant or suspect that you are pregnant, you should notify your physician. Be sure to provide your physician with a list of all medications (prescribed and over-the-counter) and herbal supplements you are taking. Also notify your physician if:

  • You are sensitive to or are allergic to any medications, latex, tape, iodine, and anesthetic agents (local and general).
  • You have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.

You should not use tampons, vaginal creams or medications, douche, or have sexual relations for 24 hours before the test. Your physician may recommend that you take a pain reliever 30 minutes before the procedure, or you may be given a sedative before the anesthesia is started. If sedation is given, you will need someone to drive you home afterwards. You may want to bring a sanitary napkin to wear home after the procedure.

Based upon your medical condition, your physician may request other specific preparations.

What to Expect

Generally, a colposcopy follows this process:

  • You will be instructed to empty your bladder prior to the procedure.
  • You will be asked to undress completely or from the waist down and put on a hospital gown.
  • You will lie on an examination table, with your feet and legs supported as for a pelvic examination.
  • Your physician will insert an instrument called a speculum into your vagina to spread the walls of the vagina apart to expose the cervix.
  • The colposcope, which is like a microscope with a light on the end, will be placed at the opening of your vagina. The colposcope does not enter your vagina.
  • Your physician will look through the colposcope to locate any problem areas on the cervix or in the vagina. Photographs with the colposcope or sketches of any areas may be made for your healthcare record.
  • Your cervix may be cleansed and soaked with a vinegar solution, also called an acetic acid solution. This solution causes any abnormal tissues to turn white and become more visible. You may feel a mild burning sensation. An iodine solution may be used to coat the cervix, which is called the Schiller test.
  • Your physician may take a small tissue sample called a biopsy. When this is done, the physician first numbs the area, but you may feel a slight pinch or cramp as the tissue is removed.
  • Cells from the inside of the cervical canal may be sampled with a special instrument called an endocervical curette. This may also cause some cramping.
  • Bleeding from the biopsy site may be treated with a paste-like topical medication or with a pressure dressing.
  • The tissue will be sent to a lab for examination.

After the Procedure

After a colposcopy procedure, you may rest for a few minutes before going home. If you have a colposcopy with a biopsy, the recovery process will vary, depending on the type of biopsy performed and the type of anesthesia (if any) used.

You may want to wear a sanitary pad for bleeding. If a biopsy was performed, it is normal to have some mild cramping, spotting, and dark or black-colored discharge for several days. The dark discharge is from the medication applied to your cervix to control bleeding.

If a biopsy was performed, you may be instructed not to douche, use tampons, or have intercourse for one week after the procedure, or for a period of time recommended by your physician.

You may also have other restrictions on your activity, including no strenuous activity or heavy lifting. You may resume your normal diet unless your physician advises you differently. Take a pain reliever for cramping or soreness as directed by your physician. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.

Your physician will advise you on when to return for further treatment or care. Generally, women who have had a cervical biopsy will need more frequent Pap tests.

Notify your physician if you have any of the following:

  • Bleeding
  • Foul-smelling drainage from your vagina
  • Fever and/or chills
  • Severe pelvic (lower abdominal) pain

Your physician may give you additional or alternate instructions after the procedure, depending on your particular situation.