Screening & Gynecologic Cancer

What Is a Colposcopy? Why It's Done, What It Feels Like and Results

By the Find Her Doctor editorial team · Updated November 1, 2026 · 5 min read

A colposcopy is a short office exam that lets a clinician look at your cervix up close with a lighted magnifying instrument called a colposcope. It's usually done after an abnormal Pap test or a positive HPV 16 or 18 test. If any area looks abnormal, small tissue samples (biopsies) are taken. The whole exam usually takes 10 to 20 minutes.

It's a diagnostic test, not a treatment, and it's not a cancer diagnosis. Its job is to find out whether precancer is there and, if so, how serious it is. Most results come back normal or low grade.

If you've just been told you need one, you probably have two questions: will it hurt, and should I be scared? Briefly: some pinching and cramping, and usually no.

Why you might need one

• A Pap result of ASC-US or LSIL with a positive HPV test
• A Pap result of ASC-H, HSIL or AGC
• A positive test for HPV 16 or HPV 18, even with a normal Pap
• A positive HPV test that hasn't cleared after a year
• Something unusual seen on your cervix during an exam

Your clinician decides using ASCCP risk-based guidelines, which weigh your current results and history. More in abnormal Pap smear results and HPV test vs. Pap smear.

Before the appointment

For 24 to 48 hours beforehand, many offices ask you to skip:

• Vaginal sex
• Tampons
• Douches or vaginal medicines

A few more things:

• Tell the office if you might be pregnant. Colposcopy is safe in pregnancy, but biopsies are handled differently.
• Check about your period. Light bleeding is usually fine. Heavy bleeding can make the cervix hard to see, so call and ask whether to reschedule.
• Ask about pain relief. Some clinicians suggest an over-the-counter pain reliever about an hour before. Ask what's right for you.
• Bring a pad for spotting afterward.
• Eat something. Some people feel lightheaded with cramping on an empty stomach.

Step by step: what happens in the room

1. You lie on the exam table with your feet in stirrups, just like a Pap test.
2. A speculum goes in.
3. The colposcope stays outside your body, about a foot away. Think of binoculars on a stand. Many people expect a camera to go inside; it doesn't.
4. The clinician dabs a mild vinegar solution (acetic acid) on the cervix. It may sting a little, and you might notice the vinegar smell. Abnormal areas often turn white. An iodine solution may also be used.
5. If an area looks abnormal, small biopsies are taken. Your clinician may also sample cells from inside the cervical canal, called an endocervical curettage (ECC).
6. A paste or solution may be applied to stop bleeding.

How much does it hurt?

The looking part feels like a Pap test. Biopsies usually feel like a quick pinch or a sharp cramp. The ECC can cause a stronger cramp for a few seconds. Most people call it uncomfortable but manageable. Slow breaths help, and it's fine to ask the clinician to tell you before each biopsy, or to pause.

Afterward

If no biopsy was taken, you can go right back to your day.

If biopsies were taken, it's common to have:

• Mild cramping for a day or two
• Light spotting for a few days
• Dark brown or black, coffee-ground-like discharge if a bleeding-control paste was used. It looks alarming the first time you see it. It's normal.

Your clinician will tell you how long to avoid sex, tampons and douching, usually a few days up to a week. Most people go back to work the same day.

Understanding your results

Results often come back within one to two weeks and are reported as CIN (cervical intraepithelial neoplasia) or the newer LSIL/HSIL terms.

If it's CIN 2 or CIN 3

Most people with CIN 2 or CIN 3 have the abnormal tissue removed, most often with a LEEP procedure. Other options include a cone biopsy or ablation (freezing or heat). Treatment is very effective at preventing cervical cancer. This is exactly what screening is for: catching changes years before they could become cancer.

For people in their early to mid-20s with CIN 2, or those planning a pregnancy, close observation may be an option because CIN 2 often regresses. Talk through the trade-offs with your clinician.

If the colposcopy is normal but HPV is still positive

Very common. A normal colposcopy means no precancer was seen or found on biopsy at that time. Because HPV can linger, you'll usually need repeat HPV-based testing in about a year. If HPV clears, you can eventually return to routine screening. If abnormal results continue over time, your clinician may repeat the colposcopy or, in some cases, recommend an excisional procedure for a better sample.

Colposcopy in pregnancy

It's safe. The goal is to rule out cancer. Biopsies may be taken if cancer is suspected, but ECC isn't done, and treatment of precancer is usually postponed until after delivery.

Questions to ask

• Why are you recommending a colposcopy for me?
• Will you take biopsies, and how many?
• How will I get my results, and when?
• What happens if the biopsy shows CIN 2 or CIN 3?
• If I'm planning a pregnancy, how might treatment affect it?

Write them down before you go. It's easy to forget everything once your feet are in stirrups.

When to call your provider

After a colposcopy, call your clinician right away for:

• Heavy bleeding, such as soaking a pad in an hour
• Fever or chills
• Severe pelvic or belly pain
• Foul-smelling discharge

Also call if you haven't heard about results within the time frame you were given. Don't assume no news is good news; results occasionally fall through the cracks, and follow-up is what makes screening work.

If your biopsy shows cancer or adenocarcinoma in situ, you'll usually be referred to a gynecologic oncologist. To find a gynecologist who does colposcopy, search our directory or browse gynecologists in Manhattan and other areas of New York.

Frequently asked questions

Sources

• ACOG — Colposcopy (FAQ)
• ASCCP — 2019 Risk-Based Management Consensus Guidelines
• National Cancer Institute — Understanding Cervical Changes
• MedlinePlus — Colposcopy-Directed Biopsy

This article is for general education and is not medical advice. It does not replace an evaluation by a licensed clinician who knows your history. If you think you have a medical emergency, call 911.