Colposcopy With a More Thoughtful Approach

A colposcopy should do two things well.

It should carefully evaluate the cervix.

And you should understand what is happening while it is being done.

At Beyond the LEEP, we take both seriously.

Our approach combines standards-based cervical evaluation, appropriate biopsy when needed, clear explanation, thoughtful pacing, and attention to your comfort throughout the procedure.

Colposcopy — $350 + pathology fees, usually $50–$100

no membership required.

Schedule a Cervical Dysplasia Consultation

What is a colposcopy?

A colposcopy is a magnified examination of the cervix used to evaluate abnormal cervical screening results.

You may be referred for colposcopy because of:

  • An abnormal Pap smear
  • A positive high-risk HPV test
  • HPV16 or HPV18
  • ASC-US, LSIL, ASC-H, or HSIL cytology
  • Previous cervical dysplasia
  • Follow-up after treatment
  • A cervical abnormality seen during another examination

During the procedure, a speculum is placed in the vagina so the cervix can be seen.

A colposcope stays outside your body. It acts like a high-powered magnifying system that allows us to examine the surface of the cervix much more carefully than during a routine pelvic examination.

Solutions are applied to the cervix that temporarily change the appearance of abnormal tissue and help identify areas that may need biopsy.

A colposcopy is primarily a diagnostic examination.

The goal is to answer a more important question:

Is there cervical precancer here—and if so, where is it and how significant might it be?

What happens during a colposcopy?
BEFORE WE START
First, we talk
We review why you were referred, what your Pap and HPV results showed, whether you have had previous cervical procedures, and what you should expect during the examination. If you have had a painful or difficult pelvic examination or colposcopy before, tell us. That information matters.
EXAMINATION
We carefully examine the cervix
A speculum is inserted to visualize the cervix. The colposcope remains outside the vagina while we examine the cervix under magnification. Acetic acid is applied to make areas of abnormal epithelium easier to identify. Depending on the clinical situation, additional solutions may also be used.
BIOPSY
We biopsy when the examination indicates we should
If an area appears abnormal, a small sample of cervical tissue may be taken and sent to pathology. Not every patient needs a biopsy. When biopsy is indicated, the number and location of samples depend on what is seen and the underlying clinical risk.
ENDOCERVICAL SAMPLING
Sometimes we need information from inside the cervical canal
The visible surface of the cervix is only part of the story. In selected patients, endocervical sampling may be recommended to evaluate cells or tissue within the cervical canal that cannot be adequately assessed by looking at the outer cervix alone. This is not necessary for every patient.

Why a careful colposcopy matters

Colposcopy is not simply about finding the single area that “looks worst.”

The visual impression during colposcopy is useful, but it does not perfectly predict what pathology will show.

That is why biopsy technique matters.

ASCCP Colposcopy Standards recommend targeted biopsy of abnormal areas and, when multiple abnormal areas are present, generally recommend at least two and up to four targeted biopsies to improve detection of cervical precancer. (?PubMed)

At the same time, random biopsies are not routinely necessary when the cervix appears completely normal in appropriately low-risk situations. (?PubMed)

In other words:

Good colposcopy means taking enough tissue to answer the clinical question without performing unnecessary biopsies simply because a patient is on the table.

Our Approach to Comfort
  • Know what is happening before it happens

    We explain the procedure before we begin and tell you what we are doing as we proceed.

    You should not be wondering what instrument is being used or whether a biopsy is about to happen.

  • Small details can make a large difference

    Speculum choice, positioning, lubrication, pacing, and communication all affect the experience.

    We choose the equipment and approach based on the patient rather than assuming the same setup works for everyone.

  • Pain management is a conversation

    The evidence for pain control during cervical biopsy is not perfect, but current ACOG guidance recommends discussing pain-management options with patients undergoing office gynecologic procedures rather than assuming that no intervention is necessary.

    For colposcopy-directed cervical biopsy, topical or local anesthetic may be reasonable to discuss in selected patients, although studies have shown mixed results and injections themselves can also cause discomfort.

    The right approach depends on the procedure, the patient’s previous experience, expected anxiety and pain, and what needs to be accomplished clinically.

    Read ACOG Guidance

Colposcopy Pricing

Colposcopy

$350

Pathology

Usually approximately $50–$100, depending on the number and type of specimens submitted.

You do not need to be a Hitchcock Family Medicine member.

Members receive additional discounts on cervical dysplasia services.

We believe you should understand both what we are doing and what it will cost before the procedure begins.

Frequently Asked Questions
How long does a colposcopy take?
The actual examination is usually fairly brief. We schedule enough time to review why you are there, explain the procedure, perform the examination without rushing, and talk through what happens next.
Does the colposcope go inside me?
No. The speculum goes into the vagina just as it does during a Pap smear. The colposcope remains outside the body and magnifies the view of the cervix.
Will I definitely have a biopsy?
No. Biopsy depends on your underlying risk and what we see during the examination.
How many biopsies might you take?
That depends on what the cervix looks like. When several abnormal areas are visible, ASCCP standards recommend multiple targeted biopsies—generally two to four—to improve detection of high-grade disease. The goal is not to take a predetermined number. It is to adequately sample the clinically relevant areas.
Can I take something for pain beforehand?
Many patients can use an over-the-counter pain medication before colposcopy, but what is appropriate depends on your medical history and medications. If you are particularly worried about pain, contact us before the appointment so we can discuss the plan rather than waiting until you are already in the procedure room.
Can I drive myself home?
Most patients can drive themselves after a routine colposcopy and cervical biopsy. If your individual plan includes medication that could impair driving, we will tell you beforehand.
Can I go back to work afterward?
Most patients can return to normal activities after a routine colposcopy. If biopsy is performed, mild cramping or spotting may occur.
Can I have sex afterward?
If no biopsy is performed, there may be little or no restriction. After cervical biopsy, we may recommend avoiding vaginal intercourse, tampons, or other vaginal insertion for a short period while the biopsy sites heal. Your specific instructions will depend on what was done.
How long will pathology take?
We will tell you the expected pathology turnaround at the time of your procedure and how you will receive your results. Just as importantly, we will tell you what the possible results mean and what each result would likely lead to next.
What happens if the biopsy shows CIN2 or CIN3?
CIN2 and CIN3 are managed differently. Some appropriately selected patients with CIN2 may be candidates for close surveillance. CIN3 should be treated. We will review the pathology in the context of your entire cervical history before recommending the next step.
What if I am extremely anxious about the procedure?
Tell us before we start. Anxiety and previous procedural experiences can meaningfully affect pain perception and the overall experience of an office gynecologic procedure. Current ACOG guidance specifically recommends that pain and anxiety management be individualized according to the patient’s expectations and previous experiences. There is no award for silently enduring a procedure. We would rather know what you are worried about so we can talk through what is realistic and what options may help.
What if my last colposcopy was terrible?
Tell us. We want to know what happened, what was painful, what made the experience difficult, and what you are most worried about happening again. A previous difficult procedure should inform how we approach the next one.

Need a Colposcopy?

You do not need to be a Hitchcock Family Medicine member, and you do not need to arrive already knowing what your results mean.

If you’ve been told you need a colposcopy—or you have an abnormal Pap or HPV result and aren’t sure what the next step should be—start with the information you already have.

You bring the results. We’ll help you understand what comes next.

Schedule a colposcopy
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