Colposcopy explained: What happens and what to expect

Article produced in association with Spital Clinic

Each year in England, approximately three million women take part in cervical screening.

While the majority receive a reassuring result, a proportion are referred for further investigation following an abnormal finding or a positive human papillomavirus (HPV) test.

For these women, the next step is a colposcopy.

Despite being a widely performed procedure, colposcopy remains poorly understood by many of the women referred for one, often because they receive limited information between the letter of referral and the appointment itself.

What Is a Colposcopy?

A colposcopy is a close examination of the cervix carried out by a specialist gynaecologist or colposcopist.

It uses an instrument called a colposcope, a magnifying device that remains outside the body and allows the clinician to view the surface of the cervix in detail.

Unlike a cervical smear, which takes a cell sample for laboratory analysis, a colposcopy is a direct, real-time visual assessment.

The procedure is explained in detail on the NHS colposcopy page, which covers what to expect before, during and after the appointment.

Colposcopy is most commonly recommended following an abnormal smear result, a positive HPV test, or unexplained symptoms such as irregular or post-coital bleeding.

It may also be used to monitor previously treated cervical cell changes.

Why Colposcopy Is Central to Cervical Cancer Prevention

Cervical cancer is the fourth most common cancer in women globally.

According to Cancer Research UK cervical cancer data, around 3,200 women are diagnosed with cervical cancer in the UK each year.

The vast majority of cases are linked to persistent infection with high-risk HPV strains.

Critically, cervical cancer develops slowly, typically over 10 to 15 years from normal tissue through progressive cell changes classified as cervical intraepithelial neoplasia (CIN) to invasive cancer.

Colposcopy allows clinicians to identify and classify these changes before cancer develops.

The grading system for CIN runs from CIN1 (mild cell changes, often resolving without treatment) through CIN2 (moderate) to CIN3 (severe, high risk of progression). Identifying the grade accurately determines whether monitoring or active treatment is recommended.

What Happens During a Colposcopy Appointment

The procedure typically takes between 15 and 20 minutes and is carried out as an outpatient appointment without general anaesthetic.

The patient lies on a couch with their feet in supports, in a position similar to a smear test. A speculum is gently inserted to allow the clinician to view the cervix.

A solution of diluted acetic acid is applied to the cervical surface, which temporarily turns any abnormal cells white, making them visible against the surrounding tissue. Iodine solution may also be used.

If abnormal areas are identified, the colposcopist may take a small tissue sample, called a biopsy, for laboratory analysis.

This is a brief procedure and may cause a momentary sensation of pressure or cramping. Biopsy results are usually available within two to three weeks.

NHS vs Private Colposcopy

NHS colposcopy services are available following GP referral or cervical screening notification. Waiting times, however, can vary significantly by region and current service demand.

For women seeking faster access, private colposcopy is available through specialist clinics. According to RCOG guidance on cervical screening and colposcopy, timely assessment and follow-up are important components of cervical health management.

Spital Clinic, based in Spital Square in the City of London, offers private colposcopy with appointments available on short notice, including morning, afternoon and evening slots throughout the week.

The clinic also offers cervical smear testing and gynaecological consultations, allowing women to manage their complete cervical health pathway in a single setting.

After the Colposcopy: Possible Outcomes

There are several possible outcomes following a colposcopy. If no abnormality is found, the patient is typically returned to routine cervical screening.

If low-grade changes are identified, monitoring with a follow-up appointment in 6 to 12 months is usually recommended. High-grade changes, classified as CIN2 or CIN3, usually lead to treatment.

Treatment for high-grade CIN is most commonly carried out using large loop excision of the transformation zone (LLETZ), a procedure performed under local anaesthetic as an outpatient.

LLETZ has a high success rate and most women return to their usual activities within a few days.

Who Should Consider a Private Colposcopy Referral

• Women who have received an abnormal cervical screening result or HPV-positive test and want prompt specialist assessment
• Those awaiting an NHS colposcopy appointment and experiencing significant anxiety about the delay
• Women with unexplained vaginal bleeding, persistent discharge or post-coital bleeding
• Those with a personal or family history of cervical disease who want regular specialist monitoring

A colposcopy referral is not a diagnosis. It is the next step in a well-established clinical pathway that has been responsible for reducing cervical cancer rates in the UK.

The earlier abnormal changes are identified, the more straightforward the management options.

Disclaimer: This article is produced for informational purposes only and does not constitute medical advice, diagnosis or treatment.

Clinical guidance referenced reflects published NHS, NICE and RCOG standards as at March 2026.

Individual circumstances vary; readers are advised to consult a qualified healthcare professional before acting on any information in this article.

This piece was produced in association with Spital Clinic, which provided background clinical information for editorial purposes.

Hyperlinks to external sources are included for reference only and do not represent an endorsement of any product, service or organisation.