After an abnormal smear

Colposcopy After an Abnormal Smear: — What to Expect, Step by Step

An abnormal Pap smear does not mean cancer. It means the cells need a closer look. Colposcopy is the procedure that gives your doctor that view — using a magnified camera to examine the cervix and decide whether a small tissue sample is needed.

Medically reviewed by Dr. C. Raghavendra Reddy, Medical Oncologist, MBBS (Gold Medal) · DNB · DM (Medical Oncology, Gold Medal) · Last reviewed September 2026

Not a diagnosis — An abnormal smear is a reason to look more closely, not a finding of cancer.
Outpatient procedure — Colposcopy is done in a clinic and takes about 15 to 20 minutes. You go home the same day.
A biopsy is not always taken — The doctor takes a biopsy only if they see an area that warrants tissue testing.
Mild discomfort, not pain — Most describe the biopsy as a brief pinch or cramp. Many feel little during the examination itself.

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Colposcopy is a close examination of the cervix using a magnified camera after an abnormal Pap smear. The doctor applies a mild solution to highlight any changed cells, then decides whether to take a small biopsy. Most women feel mild discomfort at most. The procedure takes about 15 to 20 minutes, and you go home the same day.

How is colposcopy different from your Pap smear?

Feature	Pap smear	Colposcopy
What it does	Collects cervical cells for laboratory analysis	Examines the cervix under magnification in real time
Who performs it	Gynaecologist or nurse at a clinic or health centre	Gynaecologist or gynaecologic oncologist at a colposcopy unit
How it feels	Mild pressure during the swab	Mild pressure during the examination; brief pinch if a biopsy is taken
How long it takes	A few minutes	About 15 to 20 minutes
What happens after	Laboratory result in one to two weeks	Biopsy result, if taken, in a few weeks; team contacts you directly

Is a biopsy always taken during colposcopy?

A biopsy is taken only if the doctor sees an area that looks different under magnification. If the examination shows nothing of concern, the colposcopy ends without one.

When a biopsy is taken, it is a small tissue sample removed with a pair of tiny forceps. You will feel a brief pinch or cramp. Most women say it is sharper than the smear itself but over quickly.

A small amount of dark-brown discharge in the days following is normal. This comes from a solution the doctor applies to reduce bleeding, not from the biopsy site itself.

Your team will contact you when results are ready and explain what they mean and what, if anything, happens next. Ask at your appointment whether to expect a letter, a call or a message.

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What do the terms in your colposcopy report mean?

Acetowhite: During colposcopy the cervix is rinsed with a dilute acetic acid solution. Areas that turn white under magnification are called acetowhite. This helps the doctor see where cell changes, if any, are concentrated.
Transformation zone: The area on the cervix where two types of cells meet. This is where cell changes are most likely to begin, and it is the area the colposcopist examines most closely.
Squamocolumnar junction (SCJ): The precise boundary between the two cell types within the transformation zone. Whether this junction was fully visible during the examination is noted in the report, because it affects how complete the view was.
CIN 1 / CIN 2 / CIN 3: Cervical intraepithelial neoplasia — a grading system for cell changes found on biopsy. CIN 1 describes mild changes that often resolve without treatment. CIN 2 and CIN 3 describe more significant changes that typically need treatment. CIN is not cancer; it describes abnormal cells that have not spread beyond the surface layer.
Satisfactory colposcopy: The entire transformation zone was visible during the examination. An unsatisfactory colposcopy means part of it could not be seen, which may mean a repeat examination or a different approach is needed.
Endocervical curettage (ECC): A scraping of the canal just inside the cervical opening. It is done when the transformation zone cannot be fully seen or when additional sampling is needed. The cramp it causes is often stronger than with a standard biopsy.

What happens after your colposcopy results come back?

What happens if the biopsy shows CIN 1?

CIN 1 changes are mild and often clear on their own without treatment. Guidelines from ASCCP and ESMO recommend monitoring with repeat smears or colposcopy at intervals rather than immediate treatment, because a proportion of these changes resolve over time as the immune system brings HPV under control. Your team will tell you how often you need to be reviewed. Attending every follow-up appointment is the thing that keeps you safe.

What happens if the biopsy shows CIN 2 or CIN 3?

CIN 2 and CIN 3 describe more significant cell changes that generally need treatment to remove the affected area before further change can occur. The most common approach is a procedure called LLETZ (large loop excision of the transformation zone), which removes the affected area of the cervix under local anaesthetic as a day procedure. Your gynaecologist will explain the specific approach recommended for your result and what recovery looks like.

What happens if no biopsy was taken?

If the colposcopist saw nothing that needed sampling, you will be given the result of the examination and advice on follow-up. This may mean returning for a repeat smear at a set interval rather than being discharged. An examination without a biopsy does not automatically mean everything is normal — your team will explain what they found and what monitoring is appropriate for you going forward.

Can I return to normal activities after colposcopy?

The examination itself, without a biopsy, rarely causes any after-effects. You can usually return to normal activities the same day. If a biopsy was taken, your team may advise avoiding tampons, sexual intercourse and swimming for a short period while the biopsy site heals. Follow their specific instructions, because they depend on how many samples were taken and the condition of the cervix at the time.

Will this affect my ability to get pregnant?

A standard colposcopy examination does not affect fertility. If a LLETZ procedure or other treatment is recommended following your biopsy result, raise this question with your gynaecologist before agreeing to treatment. Some procedures can have a small effect on the cervix that is relevant in pregnancy. This concern should not prevent you from having recommended treatment, but it is a reasonable and important question to put to your team so you can make an informed decision.

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Common questions

Frequently asked questions

What does it mean if my Pap smear was abnormal?

An abnormal Pap smear means the laboratory found cells on the cervix that look different from normal. The vast majority of abnormal smears are caused by HPV, a very common viral infection, and do not indicate cancer. The smear identifies that something needs a closer look; it does not tell you what that something is. Colposcopy is the examination that answers that question.

Is colposcopy painful?

The examination itself — the magnified camera looking at the cervix — is generally no more uncomfortable than the smear that prompted it. If a biopsy is taken, you will feel a brief, sharp pinch or cramp. Most women describe it as manageable and over quickly. Taking an over-the-counter painkiller an hour before your appointment, if your doctor has said this is safe for you, can help reduce cramping.

Can I bring someone with me to the appointment?

Yes, and many women find it helpful. You can bring a family member or a friend into the examination room if the unit allows it — call ahead to confirm. Having someone with you while you wait, and to help you remember what the doctor said afterwards, is useful. You may feel mild cramping after the procedure, and having company for the journey home can be reassuring.

Do I need to prepare for colposcopy?

Your unit will give you specific instructions. In general, avoid vaginal creams or pessaries in the day or two beforehand, as these can affect the examination. If you are having a period on the day of the appointment, contact the unit — the examination is usually better done when you are not menstruating, and they may ask you to rebook. Wear comfortable clothing, as you will need to undress from the waist down.

How long does it take to get the biopsy result?

Results generally take a few weeks, depending on the laboratory. Your team will contact you when the result is ready. If you have not heard after a few weeks, it is reasonable to call and ask — do not assume no news is good news. Ask at your appointment how you will be told the result, so you know whether to expect a letter, a call or a message.

What if I am too frightened to attend?

This is an understandable reaction and one that many women share. Delaying or avoiding colposcopy means a potential cell change goes unmonitored — that is the real risk, not the examination itself. If fear is the barrier, tell the unit when you book. Many colposcopy units have staff who regularly support anxious patients before and during the procedure. The examination is short, and the information it gives your doctor is what keeps you safe.

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