Colposcopy During Pregnancy

Ivor Benjamin, MD
Last Modified: November 1, 2001

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Question
Dear OncoLink "Ask the Experts,"
I have a question. I am 13 weeks pregnant, my nurse practitioner said I have abnormal cells from my pap. She has explained to me that I should get a colposcopy. Is this safe for me to have while I am pregnant? I have looked into the procedure and I am not feeling comfortable enough to want it done.  
Thank you
Ms. F


Answer
Ivor Benjamin, MD, Former co-Editor-in-Chief of OncoLink, responds:

Dear Ms. F,
Colposcopy is a detailed examination of the uterine cervix, vagina and external genitalia (vulva, urethra, perineum and anus) via the aid of an illuminated low-power microscope (colposcope). A colposcopic examination is performed to investigate an abnormal Pap test and/or other abnormalities seen in this area of the body.

One or more small biopsies are routinely performed during a colposcopic examination. The reason for this is that the Pap test is a screening test that evaluates individual cells but is unable to determine the location from where these abnormalities come. Therefore, a coloposcopically directed biopsy provides tissue (histology) that could lead to an accurate diagnosis that may or may not support the abnormal finding on the Pap test.

In general, colposcopy is a low-risk procedure. Most often it may be associated with a "pinch" during the biopsy (lasts a few seconds) followed by cramping (lasts a few hours) and bloody vaginal discharge (like a period, lasting a few days). Typically, no anesthesia or "numbing medicine" (i.e. lidocaine) is used for the biopsy. The reason for this is that the "pinch" from the needle stick to inject the pain medicine is approximately equal to the pain of the biopsy.

For a patient in early pregnancy, similar side effects may be encountered. However, naturally cramps and/or bloody discharge during pregnancy may suggest a problem with the pregnancy. Therefore, when these typical side-effects from colposcopy occur during pregnancy, it is unclear what is causing them. However, if the symptoms occur immediately after the colposcopy, there is probably nothing wrong with the pregnancy. In general, colposcopy with biopsy do not increase the risk for miscarriage (pregnancy loss).

Two special comments related to colposcopy during pregnancy are worth mentioning:

  1. Endocervical curettage should NOT be performed in pregnant patients.
  2. Cone biopsy or LEEP (a larger biopsy of the cervix requiring anesthesia) that is performed as a treatment carries a much higher risk of miscarriage than colposcopy with biopsy.
Lastly, remember that colposcopy with biopsy is a diagnostic procedure. It is not a treatment. The purpose is to "find the lesion" that lead to the abnormal Pap test and help to guide what additional treatment (if any) may be needed.

Best of luck!