Cervical Biopsy: Types, Procedure, Recovery, Risks and Complications

A cervical biopsy is a minor surgical procedure that is done to take a sample of a small amount of tissue from the cervix, which is a cylindrical-shaped structure that connects the vagina and the uterus. Cervical biopsy is done after an abnormality is detected in the routine or Pap smear, which includes the presence of human papillomavirus or precancerous cells.⁽¹⁾ Certain HPV types put a person at risk of cervical cancer and are the most common cause of this type of cancer.⁽²⁾

A cervical biopsy is performed to diagnose and treat certain conditions including cervical warts and polyps.

There are three different methods that are used to remove tissue from the cervix and these include:

• Colposcopic (Punch) Biopsy: This method involves removing small pieces of tissue from the cervix with the help of biopsy forceps. The cervix is also stained with dye to make it easier for the doctor to look for any abnormality.
• Cone Biopsy: This involves using a scalpel or laser to remove large, cone-shaped tissues from the cervix. It is performed under general anesthesia.
• Endocervical Curettage: In this procedure, cells are removed from the endocervical canal (area between uterus and vagina). It is done with the help of a curette (a handheld instrument).

Which type of procedure is used depends on the reason behind the biopsy and the medical history.

A cervical biopsy is recommended if the initial cervical cancer screening result is abnormal and the patient is experiencing unusual symptoms which include painful intercourse and unusual vaginal bleeding in between menstrual periods. A biopsy also helps in removing genital warts and polyps.

Indications for cervical biopsy include:

• An abnormal Pap smear
• A positive test for human papillomavirus
• Detection of abnormalities during a pelvic examination
• Abnormal imaging suggestive of cervical cancer
• Symptoms of cervical cancer in a person

A cervical biopsy is scheduled 1-week post menstrual cycle as it helps in getting a clean sample. The doctor should be informed about any medication the person is taking. If taking any blood-thinning medication, they should be stopped as they may increase the risk of bleeding. Usage of medicated vaginal creams, douches, or tampons should also be avoided.

Those undergoing cone biopsy are advised to stop eating 8 hours before the procedure as it is done under anesthesia.

Before the cervical biopsy procedure, the doctor suggests taking Tylenol or any other pain killer. One should also carry sanitary napkins along as light bleeding is experienced after the cervical biopsy procedure.

During the cervical biopsy procedure, the doctor starts with a vaginal examination and then gives local anesthesia to numb the area. A speculum is inserted to keep the vaginal canal open. The cervix is washed with a solution of vinegar and water. The cervix is swabbed with iodine to help the doctor identify the abnormal tissues, this is known as Schiller’s test. The abnormal tissue is then removed with the help of forceps, scalpel, or a curette. A slight pinching sensation is felt while removing the tissue. After the cervical biopsy procedure, the cervix is dabbed with absorbent material to reduce the bleeding.

If a punch biopsy is performed the patient can go back home right after the cervical biopsy procedure. Other procedures may require the person to stay in the hospital overnight.

Mild cramping and spotting are experienced while recovering from the procedure. There may be mild cramping and bleeding for a week after which there may be a clear discharge for up to 3 weeks. Recovery from cone biopsy takes the longest which is as long as 4-6 weeks.

There may be restrictions in certain activities, depending on the type of biopsy. The restrictions include avoiding the following:

• Lifting objects heavier than 10 pounds
• Sexual intercourse
• Using tampons and douches
• High-intensity exercise

It is important to inform the doctor if there is pain in the abdomen, fever, chills, heavy bleeding, and foul-smelling discharge. These could indicate infection.

The risks and potential complications of cervical biopsy include:

• Light bleeding that can occur after any of the three biopsy methods⁽³⁾
• Cramps
• Pain
• Infection
• Cervical canal narrowing
• Cervical scarring due to premature birth or miscarriage.

A cervical biopsy is an important procedure after an abnormal Pap or pelvic examination. It is important to know all about the test before going ahead with it. The recovery may take several weeks and if the test confirms cancer, the next steps to be taken are reviewed right away.