Colposcopy: Procedure, Provider, and What to Expect

What Is Colposcopy?

A magnified, illuminated examination of the cervix, vagina, and vulva using a colposcope (binocular microscope on a stand). Performed by a gynecologist or trained advanced practice provider.

Indications

• Abnormal cervical screening (Pap/HPV): ASC-US, LSIL, HSIL, AGC.
• Visible cervical/vaginal lesion.
• DES exposure in utero.
• Persistent high-risk HPV.

Procedure Steps

1. Speculum insertion (like Pap test).
2. Acetic acid (3–5%) applied → acetowhite lesions appear.
3. Lugol's iodine (Schiller's test) may be used: healthy glycogen-rich epithelium stains brown; abnormal areas remain pale.
4. Biopsy of suspicious areas (cervical, vaginal, vulvar) using biopsy forceps or endocervical curette.
5. Monsel's solution or silver nitrate for hemostasis.

Patient Experience

• 5–15 minutes; mild cramping/pinching with biopsy.
• Pre-procedure: avoid vaginal products, intercourse 24h prior; consider NSAID 1h before.
• Post: spotting/discharge few days; no tampons/intercourse 1 week if biopsy.
• Results in 1–2 weeks; guides next steps (LEEP, cone, surveillance).

Key Point

Colposcopy is diagnostic, not therapeutic (except incidental ablation). It's the bridge between screening and treatment.