A cervical biopsy is a procedure to remove tissue from the cervix to test for abnormal or precancerous conditions, or cervical cancer.
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The cervix is the lower, narrow part of the uterus. It forms a canal that opens into the vagina.
Cervical biopsies can be done in several ways. The biopsy can remove a sample of tissue for testing. It can also be used to completely take out abnormal tissue. It can also treat cells that may turn into cancer.
Types of cervical biopsies include:
Punch biopsy. This procedure uses a circular blade, like a paper hole puncher, to remove a tissue sample. One or more punch biopsies may be done on different areas of the cervix.
Cone biopsy. This procedure uses a laser or scalpel to remove a large cone-shaped piece of tissue from the cervix.
Endocervical curettage (ECC). This procedure uses a narrow instrument called a curette to scrape the lining of the endocervical canal. This is an area that can’t be seen from the outside of the cervix.
A cervical biopsy may be done when abnormalities are found during a pelvic exam. It may also be done if abnormal cells are found during a Pap test. A positive test for human papillomavirus (HPV) may also call for cervical biopsy. HPV is a type of sexually transmitted infection. Certain types of HPV can cause cervical cancer and other less common types of genital cancers. A cervical biopsy is often done as part of a colposcopy. This is also called a colposcopy-guided cervical biopsy. A colposcopy uses an instrument with a special lens to look at the cervical tissues.
A cervical biopsy may be done to find cancer or precancer cells on the cervix. Cells that appear to be abnormal, but are not yet cancerous, are called precancerous. These abnormal cells may be the first sign of cancer that may develop years later.
A cervical biopsy may also be used to diagnose and help treat these conditions:
Noncancerous growth (polyps) on the cervix
Genital warts. These may mean that you have an infection with HPV. HPV is a risk factor for cervical cancer.
Diethylstilbestrol (DES) exposure if your mother took DES during pregnancy. DES raises the risk for cancer of the reproductive system.
Your healthcare provider may have other reasons to recommend a cervical biopsy.
Some possible complications may include:
Infection
Bleeding
In addition, cone biopsies may increase the risk for infertility and miscarriage. This is because of the changes and scarring in the cervix that may happen from the procedure.
Tell your healthcare provider if:
You are allergic to or sensitive to medicines, iodine, or latex.
You are pregnant or think you could be pregnant. Some types of cervical biopsies can be done during pregnancy, but others cannot.
If possible, a cervical biopsy will be scheduled about 1 week after your period.
You may have risks depending on your specific health condition. Be sure to talk with your provider about any concerns you have before the procedure.
Certain things can make a cervical biopsy less accurate. These include:
Menstruation
Acute pelvic inflammatory disease
Acute inflammation of the cervix
Your healthcare provider will explain the procedure and you can ask questions.
You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
You usually do not need to stop eating or drinking before a simple cervical biopsy. If your biopsy needs anesthesia, you may need to fast for a certain number of hours before the procedure. This is usually after midnight.
Tell your provider if you are pregnant or think you may be pregnant.
Tell your provider if you are sensitive to or are allergic to any medicines, latex, tape, or anesthetic medicines (local and general).
Tell your provider about all medicines you are taking. This includes prescriptions, over-the-counter medicines, and herbal supplements.
Tell your provider if you have had a bleeding disorder. Also tell your provider if you are taking any blood-thinning medicines (anticoagulants), aspirin, or other medicines that affect blood clotting. You may need to stop taking these medicines before the test.
You should not use tampons, vaginal creams or medicines, or douche for 24 hours before the procedure.
You should not have sex for 24 hours before the procedure.
Your healthcare provider may tell you to take a pain reliever 30 minutes before the procedure. Or you may be given medicine to help you relax before the anesthesia is started. You will need someone to drive you home afterward.
You may want to bring a sanitary pad to wear home after the procedure.
Follow any other instructions your provider gives you to get ready.
You may have a cervical biopsy in a healthcare provider’s office, as an outpatient, or during a hospital stay. Some biopsy procedures only need local anesthesia. Other need regional or general anesthesia. The way the test is done may vary depending on your condition and your healthcare provider's practices.
Generally, a cervical biopsy follows this process:
You will need to undress completely or from the waist down and put on a hospital gown.
You will be told to empty your bladder before the procedure.
You will lie on an exam table, with your feet and legs supported as for a pelvic exam.
Your healthcare provider will put an instrument called a speculum into your vagina. This will spread the walls of the vagina apart to reach the cervix.
Often the healthcare provider will use a colposcope. This is an instrument with a special lens like a microscope to help see the cervical tissues. The provider will put colposcope at the opening of your vagina. It will not enter your vagina.
Your healthcare provider will look through the colposcope to find any problem areas on the cervix or in the vagina.
He or she may clean and soak the cervix with a vinegar solution (acetic acid solution). This solution helps make the abnormal tissues turn white so they are easier to see. You may feel a mild burning sensation. An iodine solution may be used to coat the cervix. This is called the Schiller test.
The type of biopsy done will depend on the size and shape of the abnormal cells, as well as where they are.
The healthcare provider may numb the area using a small needle to inject medicine.
He or she may use forceps (tenaculum) to hold the cervix steady for the biopsy. You may feel some cramping when the tenaculum is put in place.
The amount of tissue removed and where it is removed depend on the type of biopsy. For a simple cervical biopsy, one or more small samples of tissue will be removed using a special type of forceps. When this is done, you may feel a slight pinch or cramp. Cells from the inside of the cervical canal may be removed with a special tool called an endocervical curette or an endocervical brush. This may also cause some cramping.
For a cone biopsy, the provider may use a loop electrosurgical excision procedure (LEEP) or the cold knife cone biopsy procedure. With the cold knife cone biopsy, a laser or a surgical scalpel may be used to remove tissue. This procedure needs regional or general anesthesia.
Bleeding from the biopsy site may be treated with a paste-like topical medicine. The provider may also use a probe (electrocauterization) or stitches (sutures) to stop the bleeding.
After a cone biopsy, the provider may pack the cervix with a pressure dressing. Your provider will tell you how to remove this packing.
The provider will send the tissue to a lab for testing.
Your recovery will depend on the type of biopsy done and if you had anesthesia.
If you have regional or general anesthesia, you will be taken to the recovery room to be watched. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room or discharged to your home. If you had the procedure done as an outpatient, you should plan to have someone drive you home.
After a simple biopsy, you may rest for a few minutes after the procedure before going home.
You may want to wear a sanitary pad for bleeding. It is normal to have some mild cramping, spotting, and dark or black-colored discharge for several days. The dark discharge is from the medicine put on your cervix to control bleeding.
Take a pain reliever for cramping as recommended by your healthcare provider. Aspirin or certain other pain medicines may increase the chance of bleeding. Be sure to take only recommended medicines.
You may be told not to douche, use tampons, or have sex for 1 week after a biopsy, or for a period advised by your healthcare provider.
After a cone biopsy, you should not put anything into your vagina until your cervix has healed. This may take several weeks. You may also have other limits on your activity, including no heavy lifting.
You may go back to your normal diet unless your healthcare provider tells you otherwise.
Your healthcare provider will tell you when to return for further treatment or care. Generally, women who have had a cervical biopsy will need more frequent Pap tests.
Tell your healthcare provider if you have any of the following:
Bleeding
Foul-smelling drainage from your vagina
Fever and/or chills
Severe lower abdominal pain
Your healthcare provider may give you other instructions after the procedure, depending on your situation.
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If your doctor finds an abnormal result after a routine Pap smear or pelvic exam, they may recommend a cervical biopsy. Undergoing a cervical biopsy involves removing a small piece of tissue that can help rule out or confirm cancer.
Having this procedure doesn’t automatically mean you have cervical cancer.
Read more about what a cervical biopsy entails, and everything you need to know about the possible risks, recovery, and more.
A cervical biopsy is a surgical procedure in which a small amount of tissue is removed from the cervix. The cervix is the lower, narrow end of the uterus located at the end of the vagina.
A cervical biopsy is usually done after an abnormality has been found during a routine pelvic exam or Pap smear. Abnormalities can include the presence of the human papillomavirus (HPV), or cells that are precancerous. Certain types of HPV can put you at risk for developing cervical cancer, and is the most common cause of this type of cancer worldwide.
A cervical biopsy can find precancerous cells and cervical cancer. Your doctor or gynecologist may also perform a cervical biopsy to diagnose or treat certain conditions, including genital warts or polyps (noncancerous growths) on the cervix.
Three different methods are used to remove tissue from your cervix:
The type of procedure used will depend on the reason for your biopsy and your medical history.
Your doctor may recommend a cervical biopsy if your initial cervical cancer screening results are abnormal and if you’re experiencing unusual symptoms, such as painful intercourse or unusual vaginal bleeding between menstrual periods. A biopsy may also help remove genital warts or cervical polyps.
Additionally, your doctor will ask you about your personal and family medical history to see if you’re at a higher risk of developing cervical cancer. They may also feel your lymph nodes to see if there’s any unusual swelling.
Schedule your cervical biopsy for the week after your period. This will make it easier for your doctor to get a clean sample. You should also make sure to talk with your doctor about any medication you take.
You may be asked to stop taking medications that could increase your risk of bleeding, such as:
Avoid using tampons, douches, or medicated vaginal creams for at least 24 hours before your biopsy. You should also avoid having sexual intercourse during this time.
If you’re undergoing a cone biopsy or another type of cervical biopsy that requires a general anesthetic, you’ll need to stop eating at least 8 hours before the procedure.
On the day of your appointment, your doctor may suggest you take acetaminophen (such as Tylenol) or another pain reliever about 30 minutes before you come to their office. You may experience some light bleeding after the procedure, so you should pack some sanitary pads.
It’s also a good idea to bring a family member or friend along so they can drive you home, especially if you’re given general anesthesia. General anesthesia may make you drowsy after the procedure, so you shouldn’t drive until the effects have worn off.
The appointment will begin as a normal pelvic exam. You’ll lie down on an exam table with your feet in stirrups. Then your doctor will give you a local anesthetic to numb the area. If you’re undergoing a cone biopsy, you’ll be given a general anesthetic that will put you to sleep.
Your doctor will then insert a speculum (a medical instrument) into the vagina to keep the canal open during the procedure. The cervix is first washed with a solution of vinegar and water. This cleansing process may burn a bit, but it shouldn’t be painful.
The cervix may also be swabbed with iodine. This is called Schiller’s test, and it’s used to help your doctor identify any abnormal tissues.
The doctor will remove the abnormal tissues with forceps, a scalpel, or a curette. You may feel a slight pinching sensation if the tissue is removed using forceps.
After the biopsy is finished, your doctor may pack your cervix with absorbent material to reduce the amount of bleeding you experience. Not every biopsy requires this.
Punch biopsies are outpatient procedures, which means you can go home right after the surgery. Other procedures may require you to remain in the hospital overnight.
Expect some mild cramping and spotting as you recover from your cervical biopsy. You may experience cramping and bleeding for as long as a week. The bleeding may also transition to clear discharge for up to 3 weeks. Overall, complete recovery from a cone biopsy is the longest, and may take 4 to 6 weeks.
Depending on the type of biopsy you’ve undergone, certain activities may be restricted. For example, heavy lifting of objects weighing more than 10 pounds, sexual intercourse, and the use of tampons and douches are not allowed for several weeks after a cone biopsy. Running and other high-intensity activities are also discouraged during recovery.
You may have to follow the same restrictions after a punch biopsy and ECC procedure, but for only 1 week.
Let your doctor know if you:
These symptoms can be signs of an infection.
The need for a cervical biopsy outweighs any potential risks. However, you should discuss the potential complications with your doctor, such as:
Also, a cone biopsy may cause temporary menstrual changes, where your next period may be heavier than usual. It may also occur later than your normal cycle.
Your doctor will contact you about your biopsy results and discuss next steps with you. A negative test means that everything is normal, and further action is usually not required until your next Pap smear.
Pap testing is usually recommended every 3 years for ages 21 to 65. Your doctor may also recommend HPV testing every 5 years. However, if you recently had a cervical biopsy, you may need repeated Pap and HPV testing sooner.
A positive test, on the other hand, means that cancer or precancerous cells have been found and further diagnosis and treatment may be needed. Imaging tests, such as CT and MRI scans may help your doctor see if cervical cancer has spread.
Your doctor may want to see you 4 weeks after your cervical biopsy to rule out any complications and to make sure you’ve recovered properly.
A cervical biopsy is an important follow-up procedure to an abnormal Pap test or pelvic exam. This outpatient procedure may also be used to help remove genital warts or cervical polyps.
Your doctor or gynecologist will provide specific instructions to prepare for one of the three biopsy options.
Full recovery may take several weeks. If cancerous cells are confirmed, they will review next steps with you right away.
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