Colposcopy: What to Expect and How to Prepare
So you’ve been told you need a colposcopy. Now what?
We get it — hearing that can feel overwhelming. You might be panicking, Googling, or just quietly freaking out. But here’s the thing: colposcopies are incredibly common, and you’re not alone. Even though it might feel like you’re suffering in silence, thousands of people have this exact procedure every day — and we’re here to walk you through it, demystify the experience, and help you feel more in control.
Why Do I Even Need This?
Colposcopies are usually recommended after an abnormal Pap smear. And while that can sound scary, it’s actually just the next step in keeping you safe and healthy.
If your Pap was the medical equivalent of your vague best friend texting “girl I have tea 🍵,” then a colposcopy is Nancy Drew showing up with a flashlight, a notepad, and a plan to figure out exactly what’s going on.
Pap smears are great at flagging something might be off — but they don’t give us the full picture. A colposcopy helps us zoom in and figure out if there are actual problem areas on your cervix and what (if anything) needs to happen next.
Okay… But What Is a Colposcopy?
A colposcopy is a close-up look at your cervix using a special device called a colposcope (basically a microscope with a light — it stays outside your body). Think of it as a set of glamour shots for your cervix — we’re trying to see if and where any abnormal cells are hiding out.
If anything looks suspicious, your provider may take tiny biopsies (samples of tissue) to send to a lab. This helps us figure out how significant the changes are, and how aggressive (or not) we need to be in managing them.
What Happens During the Procedure
Here’s what to expect, step by step:
- Consent & Setup: Your provider will explain the procedure and answer any questions. Then you'll undress from the waist down and lie back just like you would for a Pap smear.
- Speculum Insertion: A speculum is used to gently open the vaginal walls, giving access to the cervix.
- Solutions Applied: The provider applies acetic acid (yep, think vinegar) and sometimes an iodine solution (Lugol’s) to the cervix. These liquids don’t harm the tissue — they just help abnormal areas show up more clearly, kind of like using a blacklight to find hidden ink.
- Colposcope Time: The provider looks through the colposcope. At most, it can feel like a long, awkward silence — so feel free to play some music or spiral about your situation-ship.
- Biopsies (if needed): If any areas look off, small samples may be taken. That’s the part you’re most likely to feel.
- ECC (Endocervical Curettage): In some cases, your provider may also take a sample from the cervical canal. This helps check for any abnormalities higher up that aren’t visible from the outside. While this isn’t a biopsy, the scratch can also be painful or cause intense cramping.
- Stopping the Bleeding: To stop any bleeding, they might use silver nitrate (small wooden sticks) or Monsel’s (a thick paste) on the biopsy areas. These aren’t harmful, but it can look weird later (think coffee ground-like discharge) - but don’t worry, this is normal.
How Much Pain Are We Talking?
If you’re getting a biopsy - experiences can vary a lot.
Some patients feel nothing more than mild pressure or a cramp (lucky them!), while others describe sharp or intense pain — especially if their cervix is particularly sensitive.
And for some people, even a small cervical biopsy can trigger a vasovagal reaction — meaning your nervous system goes into fight-or-flight mode. You might suddenly feel hot, clammy, lightheaded, nauseous, or even faint.
None of these reactions are "wrong." Your experience is valid no matter what it is — and providers should be prepared for the worst, even if most people do okay.
If you’ve had a difficult pelvic exam before, or if you’ve had a colposcopy in the past that was painful, tell your provider ahead of time. It can help them adjust their approach and avoid re-traumatizing you.
What Can Be Done About Pain?
Let’s call it what it is: pain during gynecologic procedures is real, and it's about time we stopped pretending it’s no big deal.
There are options to help manage discomfort — but they’re not always offered unless you ask:
- Before the procedure, it’s encouraged to take an NSAID like ibuprofen. Even if it seems minor, taking an anti-inflammatory beforehand can help reduce cramping and prevent a stronger pain response. Every little bit helps — but this doesn’t replace the other pain options your doctor should talk to you about.
- Your provider might also be able to prescribe a stronger pain reliever (narcotic) or an anxiety-reducing medication (benzodiazepine) ahead of time. The best time to ask about this is when your Pap results come back and you're being scheduled for the colposcopy — that way you have time to get the medication and pick it up before your appointment.
During the procedure, they can offer:
- Lidocaine spray or a small injection to numb the cervix
- Distraction techniques or breathing support
- A heating pad
Other helpful techniques:
- Bring a support person you trust to be there with you
- Bring headphones or listen to music
- Coughing during each biopsy can help distract from the sensation
Can I Just Go to Sleep for It?
Yes. You can have a colposcopy (or even treatment like LEEP) done under anesthesia — usually in an operating room or surgical center. But here’s the catch: it’s not always easy to schedule or get insurance to cover it. That’s often why it’s not offered up front.
That said, it’s 100% a valid option, and you are not weak or dramatic for wanting it. You’re advocating for appropriate care - and if this feels right for you - ask for it!
And yes — we agree: if men had to get their penises biopsied, 100% of them would be asleep for it. Don’t be afraid to ask for the same level of comfort.
How to Prepare
- Avoid anything that might obscure the view the day before the procedure — such as internal ejaculation or vaginal creams/suppositories
- Try to schedule around your period if you’d prefer not to be bleeding during the procedure. Most of the time, the provider can work around a light/moderate flow - but if you have a heavy flow, it might need to be rescheduled.
- Eat normally. No fasting is required.
- If you are taking stronger pain medicines or going to sleep for it - make sure to have someone who can bring you home.
Aftercare
What to expect:
- Mild cramping or spotting is normal
- Slight dark brown discharge is normal.
- If you had a biopsy, avoid vaginal sex, tampons, pools, or baths for 48 hours to let your cervix heal.
Call your provider if you experience:
- Heavy bleeding (soaking a pad in under an hour)
- Foul-smelling discharge
- Fever or chills
- Severe pain that doesn’t improve
Note: If you’re having a LEEP procedure, your recovery instructions will be different — check out our separate article for that.
Common Questions
Does it hurt?
It can — but not always. Everyone's experience is different. Don’t hesitate to speak up if you're nervous about pain.
Will it affect my fertility?
Nope. A colposcopy and biopsy don’t remove enough tissue to affect fertility.
Will I get results right away?
If you had a biopsy, it usually takes 1–2 weeks to get results.
Can I go back to work afterward?
Most people can — but if you’re feeling too crampy or tired, don’t be afraid to ask your doctor for a work note. You deserve to rest if you need to.
The Bottom Line
You deserve clear answers and compassionate care. A colposcopy might sound intimidating, but it’s a powerful tool — not just to check for problems, but to help prevent more serious ones later.
If you're nervous, that makes sense. If you want comfort meds, extra support, or a different plan entirely, that's your right. This isn’t about being tough — it’s about being treated like your experience matters. And it does..
