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After an abnormal smear

Colposcopy and Directed Biopsy: — What Happens Step by Step

An abnormal smear result is frightening to receive. Colposcopy is the examination your doctor has arranged to see clearly what is there — and most women find it far less difficult than they expected.

Medically reviewed by Dr. Mohammed Imaduddin, Surgical Oncologist, MBBS · MS (General Surgery) · M.Ch (Surgical Oncology) · Last reviewed September 2026

  • Not a treatment — Colposcopy is a diagnostic examination. It looks at the cervix; it does not remove tissue or treat anything on its own.
  • A biopsy is not always taken — Your gynaecologist takes a small tissue sample only if they see an area that looks abnormal and needs laboratory confirmation.
  • Most women describe it as uncomfortable, not painful — The biopsy causes a brief sharp sensation. The examination itself feels similar to a smear test.
  • You leave on your own — There is no sedation or general anaesthetic. Most women return to work the same day.
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A colposcopy is a detailed examination of your cervix using a lighted magnifying instrument. Your gynaecologist looks for areas of abnormal cells. A biopsy is taken only from areas that look concerning — not from every patient. Most women describe the sensation as pressure or a brief sharp cramp rather than severe pain.

What is colposcopy, and why has your doctor referred you?

Colposcopy is a detailed examination of your cervix using a lighted magnifying instrument called a colposcope. Your gynaecologist looks at the cervix directly, rather than relying only on the cell sample collected during a smear.

You have been referred because your smear result showed some cell changes. Colposcopy is the step that determines exactly what those changes are and whether they need any action.

Most abnormal smear results turn out to be low-grade changes that the body clears on its own. Being referred for colposcopy does not mean your doctor believes you have cancer.

What do the medical words used during colposcopy mean?

Colposcope
A lighted magnifying instrument used to examine the cervix in detail. It is positioned outside the body and does not go inside you.
Transformation zone
The area of the cervix where cell changes are most likely to occur. This is what your gynaecologist examines most closely.
Acetic acid wash
A dilute vinegar solution applied to the cervix during the procedure. It makes abnormal cells temporarily appear white, helping the doctor identify areas that need closer attention.
Directed biopsy
A small tissue sample taken from a specific area that looks abnormal. The word 'directed' means it targets that spot rather than sampling the cervix randomly.
CIN (Cervical Intraepithelial Neoplasia)
A grading of abnormal cell changes on the cervix. CIN is not cancer — it describes the degree of change and guides decisions about monitoring or treatment.

Is a biopsy always taken during colposcopy?

No. A biopsy is taken only if your gynaecologist sees an area that looks abnormal and needs laboratory confirmation. If the cervix looks normal under the colposcope, no biopsy may be needed at all.

When a biopsy is taken, it is a very small pinch of tissue from one or two specific spots. It is not a procedure that removes large amounts of tissue.

Your team will tell you before you leave whether a biopsy was taken and when you should expect the result.

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Is colposcopy painful, and what will the procedure feel like?

The examination itself feels similar to a smear test — pressure and mild discomfort, but not usually pain. Most women are surprised it is less difficult than they expected.

If a biopsy is taken, you will feel a brief sharp pinch lasting a few seconds. Some women feel nothing beyond additional pressure.

After the procedure, light spotting and mild cramping are normal for a day or two. A dark brownish discharge is also expected — it comes from the solution applied to your cervix during the examination and is not a sign that something has gone wrong.

What should you do to prepare for your colposcopy appointment?

  • Avoid sexual intercourse for the day before your appointment.
  • Do not use tampons, vaginal creams, or pessaries for the day before.
  • You can eat and drink normally on the day.
  • Bring a sanitary pad — light spotting after the procedure is common.
  • If you are pregnant, or think you may be pregnant, tell your doctor before the procedure begins.
  • If your period starts on the day of the appointment, call the clinic — you may need to reschedule.
  • You can bring someone with you if you would find that helpful.

What else do people ask about colposcopy?

What happens if the biopsy result shows CIN?

CIN describes abnormal cell changes on the cervix and is not cancer. Low-grade changes (CIN 1) often resolve without treatment, and your team may recommend a period of monitoring rather than acting immediately. Higher-grade changes (CIN 2 or CIN 3) are usually treated to prevent further progression. The treatments available are straightforward outpatient procedures, and your gynaecologist will explain what is recommended for your specific result and what it involves.

When will I get my biopsy result?

Laboratory results take a few weeks, though the exact timeframe varies between centres and laboratories. Your team will tell you what to expect before you leave the appointment. Your gynaecologist may share an initial impression on the day, but the laboratory result is the definitive answer. If you have not heard within the timeframe you were given, call and ask rather than continuing to wait.

Can I have colposcopy if I am pregnant?

Yes. Colposcopy can be performed during pregnancy and should not be delayed if your smear result warrants it. Your gynaecologist may choose not to take a biopsy unless it is essential, because the cervix bleeds more readily in pregnancy. Treatment for any abnormal cells is almost always deferred until after delivery. Tell your doctor you are pregnant — or think you may be — before the procedure begins, so they can adjust their approach accordingly.

Will colposcopy affect my ability to get pregnant?

The examination itself does not affect fertility in any way. A small directed biopsy has no impact on future pregnancies either. If treatment for CIN is recommended at a later appointment, your gynaecologist will discuss any implications for the cervix at that point. Today's appointment is diagnostic only, and fertility is not a concern from the colposcopy procedure itself.

Is there anything I should not do after the procedure?

For a day or two after colposcopy, avoid sexual intercourse, swimming, and tampons. This gives the cervix time to settle, particularly if a biopsy was taken. You can shower normally and return to work the same day if you feel well. Heavy bleeding, fever, or discharge with an unpleasant smell are not expected — contact your gynaecology team promptly if any of these occur.

What if I find the procedure too difficult to continue?

Tell the doctor or nurse immediately — you can pause or stop at any point. If you have had a difficult experience with pelvic examinations before, mention it before the procedure begins so the team can talk you through each step and take extra care. Asking to stop or slow down is completely expected and will not affect the quality of your care or your place on any waiting list.

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Common questions

Frequently asked questions

What does an abnormal smear result actually mean?

It means some cells collected from your cervix looked different under laboratory testing — not that you have cancer. Abnormal smear results are common, and the majority turn out to be low-grade changes that the body clears on its own. Colposcopy is the next step to understand exactly what the change is and whether it needs any action.

What is the difference between colposcopy and a smear test?

A smear test collects a sample of cells from the cervix for laboratory analysis — the doctor does not look at the cervix in detail during a smear. A colposcopy is a direct examination using a magnifying instrument, so your gynaecologist can see the cervix closely and identify exactly where any abnormal area is. A biopsy can then be taken from that specific spot.

Will I be treated at the same appointment?

Usually not. Most colposcopy appointments are diagnostic — the doctor examines the cervix, takes a biopsy if needed, and you return once the result is known. In some situations, if a clearly abnormal area is identified, a decision about treatment may be made at the same visit. Your team will tell you which approach applies before or at the start of your appointment.

Can I drive myself home after colposcopy?

Yes. There is no sedation or general anaesthetic involved, so driving is not restricted. Most women leave within the hour and return to normal activities the same day. If you feel lightheaded or crampy immediately after the procedure, rest for a few minutes in the clinic before leaving.

When can I have sex after colposcopy?

If only an examination was done with no biopsy, you can usually resume when you feel comfortable. If a biopsy was taken, most gynaecology teams advise waiting until the spotting and discharge have fully settled. Follow the specific advice your team gives you at the appointment, as it may vary depending on what was done.

How long does the colposcopy appointment take?

The examination itself is brief. Allow more time for the full appointment, which includes a discussion of your smear result beforehand and an explanation of findings afterwards. Waiting time varies between centres, so ask the clinic what to expect when you confirm your appointment.

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