A colposcopy is a common procedure recommended after an abnormal Pap smear, serving as a magnified examination of the cervix, vagina, and vulva. The doctor uses a specialized instrument called a colposcope, which remains outside the body, to get a highly detailed view of the tissues. Understanding the steps can help manage expectations and reduce anxiety about this pelvic exam.
Preparing for the Exam
Preparing properly for a colposcopy helps reduce discomfort and ensures the best possible visualization for the doctor. Clinicians advise scheduling the appointment when you are not actively menstruating, as blood can obscure the view of the cervix. This timing adjustment aids in the accurate identification of abnormal cell changes.
You will also be asked to avoid putting anything into the vagina for 24 to 48 hours before the procedure. This restriction includes refraining from sexual intercourse, avoiding tampons, and pausing any vaginal medications or creams. These activities can interfere with the examination, potentially affecting test results or making the visualization of the cervix more difficult.
Managing stress beforehand is beneficial, as anxiety can increase the perception of physical discomfort. Your doctor may suggest taking an over-the-counter pain reliever, such as ibuprofen or acetaminophen, about an hour before the appointment to mitigate cramping. Utilizing deep, slow breathing techniques during the exam can help relax the pelvic muscles, which may lessen feelings of pressure.
Physical Sensations During the Colposcopy
The first physical sensation during the colposcopy is similar to a standard Pap test, beginning with the insertion of the speculum. The speculum holds the vaginal walls open so the cervix is accessible and visible. You will primarily feel pressure when the speculum is inserted and opened, rather than sharp pain, though this pressure may feel intense or uncomfortable for some individuals.
After the speculum is in place, the doctor applies solutions to the cervix to highlight abnormal cells. A vinegar-like solution, typically dilute acetic acid, is swabbed onto the cervix, making abnormal tissue turn white and easier to see under the colposcope. This application may cause a temporary, mild stinging or burning sensation that quickly subsides.
If the doctor identifies suspicious areas, a small tissue sample, known as a punch biopsy, may be taken. The cervix has few pain receptors, but tissue removal often triggers a sensation of a quick, sharp pinch that lasts only a second. The most notable discomfort usually comes immediately after the pinch, manifesting as a deep, menstrual-like cramp in the lower abdomen.
This cramping occurs because the procedure briefly stimulates the nerves and muscle tissue of the uterus, causing it to contract in response to the biopsy. While temporary, this discomfort is frequently described as the most unpleasant part of the examination. In some cases, a local anesthetic may be applied or injected before the biopsy to minimize the pinching and cramping.
What to Expect Immediately After the Procedure
Following the colposcopy, especially if a biopsy was performed, mild to moderate cramping that can persist for several hours is common. This sensation is comparable to typical menstrual cramps and is often manageable with over-the-counter pain relievers taken before the exam. Most people are able to return to their normal activities, including driving, immediately after the procedure.
Light bleeding or spotting is common, particularly in the first few days following tissue removal. This bleeding is distinct from a menstrual period and should remain light, usually requiring only a sanitary pad. If a biopsy was performed, the doctor applies a hemostatic solution, such as Monsel’s paste or silver nitrate, to the site to stop bleeding.
The application of this solution results in a characteristic vaginal discharge that is normal and temporary. This discharge is often described as thick, dark, and sometimes resembles coffee grounds, or it may appear black or gray. This discolored discharge is simply the body expelling the compound used to cauterize the biopsy site and may last for several days.
To allow the cervix to heal completely and reduce the risk of infection, doctors advise activity restrictions for about one week, or as directed. You should avoid placing anything into the vagina during this recovery period, including refraining from sexual intercourse, douching, and using tampons. This precaution ensures the small wound on the cervix has adequate time to close and heal without irritation.