Gynaecological biopsies: cervix, endometrium, vulva, vagina
In brief
A gynaecological biopsy removes a small piece of tissue from the cervix, the lining of the womb (endometrium), the vulva or the vagina so it can be examined under a microscope (histopathology). Unlike a smear test, which looks at individual cells, it gives a definite diagnosis of a precancerous change or a cancer. It is usually done during a clinic appointment and takes a few minutes; the result is generally available after a few days and is explained to you at an appointment.
What is a gynaecological biopsy used for?
Screening tests, such as the cervical smear or the HPV test, detect abnormalities but do not give a final diagnosis. A biopsy removes a piece of tissue, which is examined by a pathologist. This histological analysis describes the structure of the tissue and the nature and extent of any lesion.
The result guides what happens next: simple monitoring, local treatment or surgery, described on our Gynaecological surgery page. The decision to take a biopsy depends on your symptoms, the clinical examination, previous tests and your personal history.
| Type of biopsy | Where | Main reasons |
|---|---|---|
| Cervical biopsy | Cervix, during colposcopy | Abnormal smear or HPV test, visible lesion on the cervix |
| Endometrial biopsy | Lining of the womb cavity | Abnormal bleeding, especially after the menopause; thickened endometrium |
| Vulval biopsy | Skin and mucosa of the vulva | Persistent or unusual lesion, chronic itching, white patch, ulcer |
| Vaginal biopsy | Vaginal wall | Visible lesion of uncertain origin, abnormality seen at colposcopy |
How is a cervical biopsy done?
It is taken during a colposcopy: the cervix is examined with a binocular magnifier after applying acetic acid and then Lugol's iodine, which highlight abnormal areas. The doctor takes one or more small pieces from the most suspicious areas using fine forceps.
The biopsy confirms or rules out a precancerous change (dysplasia) or cancer, and gives its grade: in particular, it distinguishes low-grade lesions, which often clear on their own, from high-grade lesions, which are treated. To find out more: precancerous changes of the cervix.
The procedure is quick. Because the cervix has few nerve endings, most women feel only a brief pinch or a cramp.
What is an endometrial biopsy and why is it done?
The endometrium is the lining of the womb cavity. The biopsy is usually done during a clinic appointment, using a thin flexible tube (cannula) passed through the cervix that draws up a small piece of lining by suction. It can also be taken in a targeted way during a hysteroscopy.
Main reason: to look for endometrial hyperplasia or womb cancer in a woman with abnormal bleeding, especially after the menopause. A systematic review published in BJOG shows that an outpatient biopsy is very reliable for confirming cancer when the sample is adequate. However, a normal result does not rule it out completely: if bleeding continues, further tests are needed.
Precautions: an endometrial biopsy must not be done if you could be pregnant or if an upper genital tract infection is suspected.
It feels like a period cramp, often stronger than with a cervical biopsy, but brief.
How are vulval and vaginal biopsies done?
They are performed in the clinic or in hospital, under local anaesthesia with a small injection or a cream. The doctor uses suitable forceps or a small circular punch; a dissolvable stitch is sometimes placed.
- Vulval biopsy: it is recommended for any vulval lesion that is persistent, unusual or of uncertain diagnosis, and for itching that does not respond to treatment. It is all the more important in older women, in whom vulval cancer is more common. It also confirms certain skin conditions such as lichen sclerosus. See our article on vulval itching.
- Vaginal biopsy: it is indicated for a visible lesion of the vaginal wall of uncertain origin; it is often guided by colposcopy after applying acetic acid and Lugol's iodine.
How do I read a biopsy (pathology) report?
The report describes the tissue removed and ends with a diagnosis. Some terms come up often:
| Term | What it means |
|---|---|
| Non-diagnostic or insufficient sample | The piece of tissue does not allow a conclusion; a new sample may be needed |
| Cervicitis, inflammatory changes | Benign inflammation, with no precancerous change |
| LSIL (low-grade lesion, CIN 1) | A change linked to papillomavirus, which often clears on its own; usually monitored |
| HSIL (high-grade lesion, CIN 2 or 3) | A precancerous change of the cervix that needs treatment, often by cone biopsy |
| Hyperplasia without atypia | Benign thickening of the endometrium, usually treated with medication |
| Atypical hyperplasia | A precancerous change of the endometrium that requires specialist care |
| Lichen sclerosus | A chronic inflammatory skin condition of the vulva, which is treated and monitored |
| Carcinoma | Cancer; the report specifies its type, and further tests are then arranged |
These terms are always explained to you at an appointment, in light of your personal situation.
How do I prepare for a gynaecological biopsy?
- Tell the doctor about a possible pregnancy, any allergy (especially to iodine or local anaesthetics), or any anticoagulant or antiplatelet treatment.
- Timing: for a cervical biopsy, your period is avoided if possible; for an endometrial biopsy in a woman who still has periods, the doctor chooses a date that rules out pregnancy.
- Pain: your doctor may suggest taking a painkiller beforehand, depending on your history.
- No fasting is needed for a biopsy done in the clinic.
- Avoid sex, pessaries and douching the day before a cervical biopsy.
- Practical arrangements: the location, fees and reimbursement are explained to you at the consultation.
What happens after a biopsy and when will I get the results?
- Light bleeding or brownish discharge for a few days: this is usual. After a cervical biopsy with Lugol's iodine, orange discharge is normal.
- Mild cramps on the day of an endometrial biopsy.
- Vulva: local tenderness for a few days; keep the area clean and dry.
- You are usually advised to avoid sex, baths and tampons for a few days (specific instructions are given to you at the consultation).
The samples are analysed in the laboratory. The result is usually available after a few days; it is sent to you via Doctolib or by post (by phone if the result is urgent) and is explained to you at an appointment, together with the next steps.
When should I see a doctor after a biopsy?
Complications are rare. Contact your gynaecologist if you have:
- bleeding heavier than a period or bleeding that does not ease;
- a fever or chills;
- pelvic pain that gets worse;
- foul-smelling discharge;
- redness, swelling or discharge at the site of a vulval biopsy.
If you have very heavy bleeding and feel faint, call 15 or 112 in France, or your local emergency number.
Frequently asked questions
Does needing a biopsy mean I have cancer?
No. The purpose of a biopsy is to clarify the nature of an abnormality, which is most often benign or precancerous. It allows treatment at the right time, or reassurance.
Does a cervical biopsy hurt?
The cervix has few nerve endings. Most women describe a brief pinch or a mild cramp, with no need for anaesthesia.
Can I have a biopsy during pregnancy?
A colposcopy-guided cervical biopsy can be done during pregnancy if needed. An endometrial biopsy, however, must not be done.
Do I need time off work after a biopsy?
Usually not. After a biopsy done in the clinic, you can return to your activities the same day.
Does an endometrial biopsy hurt?
It causes a period-like cramp, often stronger than with a cervical biopsy, but brief. Your doctor may suggest taking a painkiller beforehand, depending on your medical history.
How long does it take to get the results?
The result is generally available after a few days. It is sent to you via Doctolib or by post, by phone if it is urgent, and explained to you at an appointment together with the next steps.
References
- Brun JL, et al. [Management of women with abnormal cervical cytology: Update of INCa recommendations after the implementation of HPV screening]. Gynecol Obstet Fertil Senol, 2025. doi:10.1016/j.gofs.2024.11.006 — PMID 39884805
- Clark TJ, et al. Accuracy of outpatient endometrial biopsy in the diagnosis of endometrial cancer: a systematic quantitative review. BJOG, 2002. doi:10.1111/j.1471-0528.2002.01088.x — PMID 11950187
- Edwards SK, et al. 2024 British Association for Sexual Health and HIV (BASHH) UK national guideline on the management of vulval conditions. Int J STD AIDS, 2025. doi:10.1177/09564624241311629 — PMID 39837649
Dr Olivier KadochObstetrician-gynaecologist and gynaecological surgeon in Paris (16th and 5th arrondissements). Former chef de clinique-assistant (senior registrar) at the Paris public hospitals (AP-HP); individually accredited by the French National Authority for Health (HAS). RPPS 10003957809. Background and practice locations
A question about your situation?Appointments at the practice or by video consultation, usually within one week to 10 days.
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