A second look at the pain of colposcopy

In a recent column, I described a procedure called colposcopy, in which a woman’s cervix is examined and, if necessary, biopsied to look for evidence of cancer.

During the procedure, the cervix is washed with a vinegar solution and then examined with a magnifying glass. The vinegar solution makes it easier to see areas of the cervix that may be undergoing cancerous change. I described the procedure as “generally safe and painless … but you may experience some mild cramping or a little discomfort.”

A few readers wrote me to strongly disagree with my wording. One said that the vinegar wash burned. All said a biopsy of the cervix was painful.

Needless to say, I have not myself experienced a colposcopy. So I asked three gynecology colleagues here at Harvard about their experience. Two are women, one is a man. Here is what they told me:

All three colleagues agreed that their patients had never reported severe pain when the vinegar was applied. Instead, they said that some women described a brief (a few seconds) stinging sensation. How many women? One female gynecologist said “many” have brief stinging. The other female gynecologist said “very few.” The male gynecologist said “only 5 percent.”

What did my colleagues say about pain when a biopsy is performed? All three agreed that there was brief (again, just seconds) pain. Their patients said it felt like a “pinch.”

When I asked my colleagues whether they gave patients any medicine before the procedure to reduce the pain they might experience, the two female gynecologists said they advised their patients to take one dose of over-the-counter ibuprofen an hour before the procedure.

All of my colleagues said that a small fraction of their patients are more sensitive to pain than others. For these patients, the gynecologists recommended some sort of pain medicine and a relaxing drug, such as midazolam (Versed), a few hours before the procedure.

One of the female gynecologists told me she had very few patients who asked that anesthesia be used to knock out any pain the procedure might cause. She said that regional anesthesia — injection of a drug to numb the nerves leading to the cervix — was safe, but injecting the drug itself was about as painful as the colposcopy itself. On rare occasions, she had used general anesthesia (the kind that makes you unconscious) when the patient appeared to have experienced pain with a past procedure and was reluctant to have it again without anesthesia.

So here’s my conclusion from the letters I received and from the discussions I had with my gynecologist colleagues:

Most women who have a colposcopy experience a few brief seconds of discomfort. Prescribing one dose of ibuprofen about an hour before the procedure makes sense. When a patient has had severe discomfort or pain in the past — an experience they do not want to repeat — it’s reasonable to give a more potent pain medicine and intravenous sedative just before the procedure.

My thanks to the readers who asked me to take a second look into this issue.