Colposcopy: why it is done, what happens and what the results mean

What is a colposcopy?

Colposcopy means examining the cervix with a colposcope, a lighted optical instrument similar to binocular magnifying glasses, positioned outside the body about twenty centimetres away. It magnifies the image and reveals changes that cannot be seen with the naked eye. The vagina and vulva can be examined in the same way.

It is not a screening test but a diagnostic test: it follows an abnormal first test to find out whether there is a lesion, where it is and how far it extends. It is part of the prevention approach described on our Gynaecological cancer care page.

Why have I been referred for a colposcopy?

The most common reasons, according to the guidelines of the French National Cancer Institute (INCa) updated in 2025, are:

• a smear test showing abnormal cells (ASC-US with a positive HPV test, LSIL, ASC-H, HSIL, AGC);
• a positive HPV test with abnormal cytology, or an HPV test that is still positive one year after a first positive test;
• follow-up after treatment of a cervical lesion;
• an abnormal-looking cervix during an examination, or unexplained bleeding after sex.

It does not mean cancer is suspected: most often, the aim is to find a precancerous change or to confirm there is none.

The time between the abnormal result and the colposcopy depends on the abnormality: a few weeks for a high-grade result, a little longer for a minor change. Remember to bring the smear or HPV test report, and reports of any previous cervical tests and treatments.

What happens during a colposcopy?

1. Positioning: as for a smear test, you lie on your back with your knees apart and a speculum is inserted.
2. Plain inspection of the cervix with the colposcope.
3. Applying dilute acetic acid (vinegar): abnormal areas temporarily turn white. You may feel a slight tingling.
4. Applying Lugol's iodine (Schiller test): healthy tissue stains brown, while abnormal areas stay pale. Mention any iodine allergy before the test.
5. Biopsies if an area looks suspicious: one or more small pieces of tissue, a few millimetres in size, are taken with forceps. This causes a brief pinch or a cramping feeling.

The test usually takes 10 to 20 minutes and is done without anaesthesia. The doctor then describes the transformation zone (whether it is fully visible or not) and the appearance of any lesions using standardised international terminology.

How should I prepare?

• Book the test outside your period, ideally in the first half of your cycle.
• Avoid sex, pessaries and vaginal creams in the 48 hours before.
• After the menopause, a few days of local oestrogen treatment may be offered to make the examination easier.
• During pregnancy, colposcopy is possible and safe.

What should I expect after a colposcopy?

You can return to your normal activities straight away. After biopsies:

• light bleeding or brownish discharge (from the iodine or a product used to stop bleeding) is normal for a few days;
• use pads rather than tampons, and avoid sex, baths and swimming for a few days, as advised;
• mild period-like pain may occur.

Complications are rare. See a doctor promptly if you have bleeding heavier than a period, a fever or worsening pain.

Is colposcopy different in pregnancy, after menopause or with a weak immune system?

During pregnancy

Colposcopy can be done at any stage of pregnancy. The cervix is larger and has more blood vessels, which changes its appearance. The main aim is to rule out invasive cancer, which is exceptional. Biopsies are only taken if a high-grade lesion or cancer is suspected, and they pose no risk to the pregnancy. Precancerous changes are monitored, then reassessed 6 to 8 weeks after the birth.

After the menopause

As hormone levels fall, the transformation zone moves up into the cervical canal and often becomes invisible. The colposcopy is then called "type 3". Using local oestrogen for a few days before the test can improve visibility. If the examination remains incomplete despite an abnormal smear, a sample from the canal or a diagnostic cone biopsy may be needed.

In women with a weakened immune system

With HIV infection, a transplant or immunosuppressive treatment, lesions are more common and sometimes more extensive, also affecting the vagina and vulva. Colposcopy is then part of closer follow-up, agreed with your doctor.

After treatment of the cervix

After a cone biopsy (conisation), healing changes the appearance of the cervix. A follow-up colposcopy is mainly useful if the HPV test stays positive.

What do colposcopy and biopsy results mean?

The final result comes from examining the biopsies under the microscope (pathology), usually within one to two weeks.

If the transformation zone is not fully visible, for example after the menopause, the examination may be completed by a sample from the cervical canal or, depending on the case, a diagnostic cone biopsy. The different grades are explained in our article on precancerous changes of the cervix.

Why is colposcopy useful?

• It pinpoints lesions and avoids random sampling.
• It helps distinguish what needs treatment from what can simply be monitored, and so avoids unnecessary cone biopsies.
• It guides treatment by showing the extent of the area to remove.
• It provides follow-up after treatment.

The quality of the examination depends on the colposcopist's experience; professional societies recommend specific training. Arrangements at the practice: colposcopy is performed at the practice, with an average waiting time for an appointment of one week to 10 days (except during holiday periods).

Frequently asked questions

General information article: it does not replace a medical consultation. In an emergency, call 15 or 112 in France, or your local emergency number.