A colposcopy is a diagnostic procedure performed to closely examine the cervix, vagina, and vulva. This examination uses a specialized magnifying instrument called a colposcope. The purpose of this procedure is to identify abnormal cells that may indicate precancerous changes or other conditions requiring further evaluation.
Colposcopy Safety and Indications
A colposcopy can be performed during pregnancy and is considered a safe procedure when medically indicated. The main purpose of performing a colposcopy in pregnancy is to rule out the presence of cancer. Healthcare providers weigh the benefits of obtaining a diagnosis against minimal risks to mother and baby.
The procedure may be necessary if a pregnant individual has abnormal Pap test results. A persistent human papillomavirus (HPV) infection or visible abnormalities on the cervix can also indicate the need for a colposcopy.
The Colposcopy Procedure
During a colposcopy while pregnant, the patient will be positioned similar to a standard pelvic exam on an examination table. A speculum is gently inserted into the vagina to hold the vaginal walls open, allowing the healthcare provider to visualize the cervix.
Cotton swabs are used to clear any mucus, and solutions like acetic acid (vinegar) are applied to the cervix. These solutions help highlight suspicious areas by causing abnormal cells to change color or appear distinct. The colposcope is positioned a few inches from the vulva, allowing the provider to examine the magnified tissues without entering the vagina.
A modification during pregnancy is the avoidance of endocervical curettage (ECC) due to the risk of disturbing the pregnancy. Biopsies are limited and performed cautiously on areas with high-grade changes to minimize potential bleeding, as the genital tract increases in vascularity during pregnancy. The goal is to identify serious changes while minimizing intervention until after delivery.
After Your Colposcopy
Following a colposcopy, especially if a biopsy was performed, it is common to experience some mild spotting or light bleeding for a few days. A dark discharge may also be observed, which is typically due to the solutions used during the procedure. If no biopsy was taken, there are usually no activity restrictions.
Patients should contact their healthcare provider if they experience heavy bleeding, severe pelvic or lower abdominal pain, or signs of infection such as fever, chills, or a foul-smelling vaginal discharge. Results from a biopsy typically indicate the presence and grade of cervical intraepithelial neoplasia (CIN), ranging from CIN 1 (low-grade) to CIN 3 (high-grade). Management of high-grade lesions or adenocarcinoma in situ (AIS) during pregnancy often involves surveillance with repeat colposcopy or Pap tests every 12-24 weeks.
Often, immediate treatment for precancerous changes is deferred until after childbirth, as many cervical changes can resolve spontaneously postpartum. A follow-up colposcopy is typically recommended no sooner than 4 to 8 weeks after delivery to allow for cervical healing and reassessment. If a lesion persists postpartum, further evaluation or an excisional procedure may be recommended.