So You Need a Cervical Biopsy—Here's What That Actually Means

A colposcopy is less terrifying than it sounds.
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You know the drill when it comes to Pap smears: Don the paper gown, slide to the edge of the table, etc. But what if, after an abnormal Pap smear, your doctor says they need to do a cervical biopsy? Freak out a bit? I did.

I’ve been moderately sexually active, kept up to date on Pap smears, and received the HPV vaccine. Nevertheless, I was diagnosed with HPV a few years ago, when a Pap smear turned up abnormal cervical cell changes—even though I had no noticeable signs or symptoms—and the doctors recommended a cervical biopsy. I was terrified at first (Biopsy? Cervical cancer?), but the procedure was quick and mostly painless. So if you're going through a similar situation—or just want to know what to expect in case you ever do—here's what you should know.

First of all, there's a difference between a Pap smear (also called a Pap test) and a biopsy. A Pap smear screens for any changes in cervical cells that could be precancerous or cancerous, according to the Mayo Clinic. (And, contrary to popular belief, a Pap smear doesn't test for STIs, though your doctor may give you an STI test at the same time.) During the Pap smear, the speculum is inserted into the vagina so that your doctor can gently scrape away cells from your cervix, which is located at the opening of the uterus. The cells are then examined for any abnormalities.

Pap smears can be uncomfortable, but in general they're quick and relatively painless. According to the U.S. Preventative Task Force (USPSTF), women aged 21 to 65 should get Pap tests on a regular basis (every three years). As an alternative, women aged 30 to 65 can have a combination Pap smear/HPV test every five years. That said, your personal screening recommendation may depend on your risk factors and medical history, so check with your doctor to find out what's recommended.

Here's what it means to get an abnormal Pap smear result.

If your Pap smear results come back showing any abnormal cells, that doesn't necessarily mean they found cancerous or precancerous cells. Eduardo Franco, M.D., an epidemiologist at McGill University's division of cancer epidemiology, tells SELF that an abnormal Pap result “contains cells that have abnormalities in architecture, shape, and ability." These cervical cell changes are referred to as cervical dysplasia, which can range in severity. Dysplasia can be low-grade, meaning changes will often go away on their own and treatment isn't required, Dr. Franco says, whereas high-grade dysplasia can progress to cancer over time.

Low-grade cervical changes may just signal an HPV infection, says Dr. Franco. HPV is incredibly common, and in most cases it will go away on its own, while in some cases it can lead to genital warts or cervical cancer (HPV actually is responsible for nearly all cases of cervical cancer). An estimated 79 million Americans currently have some form of HPV, and 14 million new infections occur each year, according to the CDC. While the HPV vaccine protects against several strains of the virus, many of which can cause cervical cancer, it's still possible to get HPV and cervical cancer even if you've been vaccinated.

If your Pap smear shows any cervical dysplasia, your doctor may want you to come back for a colposcopy, which is a lot less terrifying than it sounds.

A colposcopy is when your doctor examines your cervix through a microscope, at which point they may also take that cervical biopsy. “The decision to refer a woman for colposcopy is based on the Pap smear grade primarily,” Dr. Franco says. For patients 35 or older with high-grade cells, a biopsy will be referred immediately. “Doctors may be more likely to wait and see with young patients in their 20s [with low-grade cells],” he says, because those cells typically regress over time. Still, it ultimately comes down to what you and your doctor deem best for you.

While a Pap smear allows your doctor to find any cell changes on the cervix, a colposcopy examines those abnormal cells with a microscope and bright light. The colposcope, which is a large microscope, does not enter the vagina, but magnifies the cervix to view any changes. It's basically a little more involved Pap smear.

“Before the procedure, avoid putting anything into your vagina unless your doctor recommends it, including no sex, no tampons, no douching, no anything, so that your vagina will be naturally healthy and colonized with those good organisms that promote healing," Catherine Hansen, M.D., an ob/gyn in Friendswood, Texas, tells SELF. Basically you don't want to irritate it before the procedure.

Dr. Hansen also recommends that you "avoid alcohol the night before the procedure in case you need anesthetic or medication, stay hydrated, eat healthy foods that won't cause digestive upset, and get a good night’s sleep.” A lot of this also has to do with keeping yourself relaxed and comfortable for your appointment.

The entire procedure takes about 15 minutes and is usually done without anesthesia. Seated with your legs in stirrups, as in a regular pelvic exam, your doctor will insert a speculum. The colposcope is positioned 8 to 10 inches from the vagina with a bright light. Your provider may use a vinegar solution or something similar that will help highlight any abnormal areas.

“The vinegar essentially dehydrates the bad cells more than the healthy ones so the doctor can see any white patches, indicating abnormalities that would need a small biopsy," Dr. Hansen says. FYI: This solution might sting a bit for some people.

To remove a bit of abnormal tissue, your doctor will utilize cervical biopsy forceps—which have a small pincher with a long handle to reach the cervix—to take about 1mm of abnormal tissue from various sites on the cervix and send it to a pathologist. The ectocervix, or lower portion of the cervix, is where most tissue is examined for abnormal cells. Dr. Franco says that some doctors may also “do an endocervical curettage [or scraping of the cervical canal] to be sure that there is nothing inside that could be precancerous or cancerous.”

For many individuals, cramping may occur during the biopsy portion of the procedure, similar to menstrual cramping. Your doctor will warn you before removing the tissue, so you're able to prepare and take deep breaths. The feeling is often compared to an IUD insertion (however, my IUD experience was very painful and my colposcopy procedures were mild in comparison). The cramping is typically only prevalent when the tissue is being removed with the forceps. Once the tissue is taken, your doctor will put down the stirrups and you'll get dressed.

What happens after the procedure?

A panty liner is suggested as you might have some vaginal bleeding or coffee-colored discharge. Mild discomfort usually follows the procedure, so it’s recommended that you take the day off and avoid strenuous activity, as sudden movements or heavy lifting can increase pain, according to the Mayo Clinic. Your doctor will probably recommend that you rest easy for a week or so—listen to that advice.

Sex, tampons, and any form of douching should not occur for about a week as they increase the risk of infection (and really, you should avoid douching altogether).

“You must immediately call your doctor or go to urgent care if you have a fever, purulent discharge like pus, heavy bleeding, or feel lightheaded,” Dr. Hansen says. “These problems are uncommon but you will need to rule out an infection.”

The tissue taken from the biopsy is sent to a pathologist and the results should come within a week or two. While you’re waiting for the results, you’ll probably be anxious. Try to remain calm. Abnormal cells can be treated with various procedures such as LEEP, LLETZ, cone biopsy, laser treatments, and cryotherapy. Your doctor will recommend the right treatment depending on the type of abnormal cells and how advanced they are.

After your colposcopy, your physician will likely recommend that you come in once a year for a Pap test until your results are normal, according to the American Cancer Society. Once you have normal cells, you can switch back to every three years.

Here's the good news: Pap smears and colposcopies allow doctors to identify and treat precancerous lesions before they develop into cancer, which has dramatically impacted the number of people diagnosed with invasive cervical cancer. For instance, between 1955 and 1992, cervical cancer incidence and death rates dropped more than 60 percent. Still, more than 12,000 women in the U.S. are diagnosed with cervical cancer each year, according to the National Institutes of Health (NIH). But because it develops slowly, it is one of the most preventable types of cancer.

So, please, get regular Pap smears. “Remember, as scary as it seems, you are doing something important to prevent cancer and you will be glad you did,” Dr. Hansen says. Knowledge, especially when it comes to your health, is power.

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