I’d never heard of a colposcopy until I received a referral letter after a recent smear test telling me that I needed one. A colposcopy is a diagnostic procedure that allows a doctor or nurse to look for abnormalities on the cervix, and it’s usually recommended if your cervical screening shows changes in cells caused by HPV, which can eventually lead to cervical cancer. (It’s very rare to have cancer discovered during a colposcopy – this only happens in around 1% of cases.)

The test is similar to a smear test in that it involves having a speculum inserted into your vagina. The colposcopist then puts a special liquid on your cervix to help them identify any abnormal cells, before taking a look with a colposcope (a microscope with a light attached). You might get the all-clear at this stage, or they may perform a biopsy, which involves taking a small sample of cells for testing. If abnormal cells are detected, you may be advised to have them removed, which is usually done via LLETZ (large loop excision of the transformation zone). This involves having your cervix numbed with a local anaesthetic and a heated wire loop is used to remove the abnormal tissue. If a large amount of tissue needs to be removed, you’ll be put under general anaesthetic so it can be removed during a cone biopsy, in which a cone-shaped portion of your cervix is removed.

Obviously, this all sounds rather hideous, which might explain why so many people are swerving their colposcopy appointments. According to the NHS, only 71.8% of colposcopy appointments were attended in the year from 1 April 2023 to 31 March 2024, and an even lower number attended their follow-up appointments. It’s totally normal to feel anxious about someone poking around in such a sensitive area, but attending your appointment could potentially save your life.

“Colposcopies play a vital role in the early detection and prevention of cervical cancer,” explains Dr Shazia Malik, consultant OBGYN and UK medical director at Daye. “The significance of attending these appointments becomes clear when we consider that cervical screening, including follow-up colposcopies, currently prevents 70% of cervical cancer deaths in England. If everyone attended their appointments regularly, this figure could rise to 83%.

“From an NHS perspective, each missed appointment means that a slot that could have been used for another patient goes unused, potentially delaying diagnosis and treatment for others.”

To prepare you, we asked nine women to share their experiences, to give you a well-rounded and honest idea of what happens during a colposcopy. I’ll start with mine because sharing is caring, sister.

“The biopsy felt like a small scrape”

Lisa, 38

“I’m used to lying on a bed for smear tests, but I had to put my bare butt on a special chair with my legs in stirrups for the colposcopy, and I kept feeling like I was going to slide off. The doctor asked if I wanted to see what was happening on the screen, which I was excited about until he exclaimed ‘Meet your cervix!’ and turned the screen around to reveal… my bumhole. I couldn’t stop laughing.

“The colposcopy was no more uncomfortable than having a smear, and the biopsy felt like a small scrape. I was given a sanitary pad to wear afterwards and experienced period-like cramping and light bleeding/discharge for a few days, which then rolled into the start of my period – fun. The worst part was that I couldn’t use my menstrual cup as it would interfere with the cervix healing, so I had to waddle around in sanitary towels, which I haven’t used since I was a teenager. I got the results back recently, which said the biopsy was ‘insufficient for diagnosis’ so I have to go for another smear and colposcopy in six months’ time.”

“It wasn’t painful, just uncomfortable”

Sophie, 32

“My colposcopy referral letter contained a leaflet with all the info I needed, so I felt prepared, even though I was nervous – anything to do with cancer can be alarming. The doctor explained why I was there and what would happen before I took off my trousers and underwear to sit on the examination chair. The doctor found abnormalities, so took a biopsy to rule out anything. It wasn’t painful, just uncomfortable, like a smear test. I received my results a couple of weeks later, which showed I had a ‘low-grade abnormality called CIN1’. I was told the changes were mild and usually resolve on their own, so I was invited for a colposcopy check-up and cervical screening in six months’ time. I was less nervous about the follow-up colposcopy, and thankfully, my result showed HPV only, so I was discharged from the colposcopy clinic and advised to have a smear test in 12 months.”

“It was one of the most positive experiences I’ve had with the NHS”

Ella, 35

“I was a little apprehensive about my colposcopy appointment but the nurses were extremely nice and immediately put me at ease by cracking jokes and answering all the questions I had. My results showed that I had the least risky of the funky cells and I was called for another check in 12 months, by which point everything was fine. Obviously, it can seem terrifying to have something probe your vagina, but this was genuinely one of the most positive experiences I’ve had with the NHS; I felt really relaxed, safe and comfortable.”

“I was in too much pain to ask for more information”

Emma, 26

“I think the NHS is wonderful, but my experience was horrific. It took place in a portacabin outside the hospital, and the woman was so rude and didn’t explain much. She didn’t have any sympathy for me when I said I was in pain, even when I began to cry. When she said that she needed to do a biopsy, she didn’t explain why or what that involved and I was in too much pain to ask. It felt like it went on forever, and she had to keep inserting to get what she needed, making me bleed a fair bit. It took about four weeks to get results back, and I’ll need to go back next summer for another biopsy as my cells have changed yet again.”

“The experience was fine”

Becca*, 39 

“My first colposcopy was very frightening; I was convinced that I had cancer. It was some time ago now, but I do remember the experience being fine. I was referred for further colposcopies as the irregular cells are still present. The medical team still continues to observe the cells to check they haven’t progressed into cancer. I also have to have smear tests more regularly now.”

“The speculum was inserted with no warning”

April, 33

“I was sent for a colposcopy a couple of years ago after a routine smear test, but I received no information about it at all. On the day, I had no idea what was happening, and the speculum was inserted without warning, which was a bit of a shock. I had to return for a second appointment, which felt like the same uncomfortable procedure but this time with a painful, pinching feeling. I later found out this was because they’d performed a biopsy. The result of this was being invited for a smear in 12 months’ time, by which time everything had resolved.”

“My experience put me off having casual sex”

Billie, 35

“I had a horrendous experience at a private hospital when I was 33. The colposcopy itself was fine but the biopsy part was horrendous. They said it would be painless, but it was honestly the most pain I’ve ever experienced. Afterwards, I was shaking and trying to get dressed behind the curtain with blood running down my legs. I had bleeding and cramps for a few hours after the biopsy and it was painful for a few days afterwards.

“It was so horrendous that I complained but my medical negligence claim was rejected as I couldn’t prove long-term impact. And then I was sent a bill for £800. My results came back clear, thankfully, but my experience has had a huge impact on my sex drive. I used to really enjoy having casual sex but I’m now so afraid of getting HPV and having to go through this again that I’m too scared to.”

“It felt like my insides would fall out of my vagina”

Jen, 43

“The nurses and doctor were brilliant on the day, explaining exactly what was going to be done, and I had a nurse at the head end of the bed to reassure me. I felt light-headed as the bed was tilted up, so they waited until I was comfortable again before proceeding.

“I had a loop excision then and there to get rid of the abnormal cells, and the worst part was the enormous needle they used to numb the area. Thankfully, aside from that, I didn’t feel a thing. Afterwards, it felt like my insides would fall out of my vagina and there was a little discomfort with a bit of spotting, but nothing drastic. I felt wobbly for a day and that was it. I was then advised to have smears every six months for a few years to keep an eye on things.”

“The anaesthetic stung a bit the procedure was totally painless”

Anna, 35

“I’ve had evidence of HPV on my last three smears, which I have annually, so the NHS said they wanted to do a colposcopy as a precaution. I was worried but was reassured that the chances of finding anything further were low. I’d been told in advance that I’d have a male doctor with a female nurse. He put me at ease and explained very clearly what to expect, and the nurse was a nice, friendly presence. The first bit was just like a smear so I was used to that. They asked if I wanted to watch on the screen when they did the colposcopy, which was interesting – they pointed out the things they could see and reassured me that they didn’t think it was anything bad.

“Then they went in for a biopsy and put some local anaesthetic on the area, which stung a bit but the procedure itself wasn’t painful at all. The nurse gave me a pad as bleeding afterwards is normal, but I hardly experienced any. There were no cramps or pain at all. I received the all-clear in a week and was advised to go back to having cervical screening every three years.”

It’s normal to feel nervous about your impending colposcopy, especially if you’ve never had one before, but there’s a number of things you can do to put your mind at ease. Check out these tips from Miss Mez Aref-Adib, consultant gynaecologist at London Gynaecology.

Watch informative videos

The BSCCP has helpful resources online that explain what happens during a colposcopy.

Take a friend

Having someone supportive by your side can help you feel more relaxed and you can look forward to doing something fun after the appointment.

Bring headphones

Listening to your favourite music can make the appointment feel less daunting.

Pop a paracetamol

If you find speculums uncomfortable, consider taking paracetamol beforehand, although it’s usually not necessary.

Ask questions

Don’t hesitate to voice any concerns or queries – your colposcopy team knows this can be an anxious time and is there to help.

* Name has been changed
Images: Getty