Colposcopy: a complete guide for women in Tirana

01What is a colposcopy and why is it done?

Colposcopy is a gynaecological examination in which the doctor looks at the cervix, vagina and vulva through an optical instrument with a bright light and magnification, called a colposcope. Its purpose is to find and assess small cell changes that cannot be seen with the naked eye, especially changes caused by the human papillomavirus (HPV).

Short definition: colposcopy is the second step after screening. A Pap test and an HPV test tell you whether there may be a problem; colposcopy shows where it is, how large it is and whether a tiny piece of tissue (a biopsy) should be taken for analysis.

The colposcope does not go inside your body. It stays outside, about 30 cm away, while the doctor looks through it like a binocular microscope. Magnification usually ranges from about 6 to 40 times, according to the colposcopy manual of the International Agency for Research on Cancer (IARC).

Colposcopy is used to:

• assess an abnormal Pap test result (e.g. ASCUS, LSIL, HSIL);
• follow up a positive HPV test, especially for types 16 or 18;
• investigate symptoms such as bleeding after sex;
• check a change the doctor noticed during an examination;
• follow up women previously treated for precancerous lesions.

According to the World Health Organization (WHO), almost all cervical cancers are caused by persistent infection with high-risk HPV types, and it usually takes 15–20 years for abnormal cells to turn into cancer. That long window is exactly what makes colposcopy so valuable: it allows changes to be found and treated much earlier.

02Why might I be referred for a colposcopy?

Most women are referred for colposcopy because of a screening result, not because they have symptoms. The most common reasons are:

• An abnormal Pap test. Results such as ASCUS (atypical squamous cells of undetermined significance), LSIL (low-grade changes), ASC-H or HSIL (high-grade changes) mean some cells look different from normal. Colposcopy clarifies what is really happening on the cervix.
• A positive HPV test. When the test finds a high-risk HPV type, especially HPV 16 or HPV 18, colposcopy is often recommended even if the Pap test is normal. According to WHO, types 16 and 18 cause about 76% of cervical cancers, so they deserve closer attention.
• HPV that persists over time. If a high-risk HPV type is found again after 12 months, the infection is persisting and it is worth taking a closer look.
• Bleeding after sex or between periods. The most common causes are harmless (ectropion, inflammation, a polyp), but it should always be checked.
• Visible changes on the cervix during a gynaecological examination.
• Repeated unclear (inadequate) Pap test results.
• Follow-up after previous treatment (e.g. after LEEP or conisation).

In Albania, the national screening programme uses the HPV test as the primary test. It started in 2019 for women aged 40–50, and in January 2026 the Ministry of Health announced its extension to women aged 35–55, with a free test at health centres. If your HPV test at a health centre came back positive, colposcopy is the usual next step.

03Does being referred for colposcopy mean I have cancer?

No. Being referred for colposcopy does not mean you have cancer. Colposcopy is a clarifying examination: the vast majority of women who have one have either a normal cervix, minor changes that often go away on their own, or precancerous changes that can be treated simply and in good time.

Some facts that help put things into perspective:

• HPV is extremely common. Most sexually active people are infected at least once in their lives, and most infections are cleared by the immune system within 1–2 years.
• Low-grade changes (CIN 1) often return to normal by themselves. In a classic literature review (Östör, 1993), about 60% of CIN 1 lesions regressed without treatment.
• CIN 2 also often regresses: a systematic review in the BMJ (Tainio et al., 2018) found regression in about 50% of cases within two years, more often in women under 30.
• The progression from abnormal cells to cancer usually takes 15–20 years (WHO), so there is time for follow-up and treatment.

What does a colposcopy referral really mean? That screening is working as it should: catching changes early, when treatment is simpler and cancer can be prevented altogether. It is normal to feel anxious; the doctor will explain everything before, during and after the examination.

04How does colposcopy work? Vinegar, iodine and magnification

Colposcopy relies on three simple tools which, combined, make invisible changes visible.

1. Magnification and light. The colposcope magnifies the surface of the cervix and lights it brightly. A green filter is often used to show tiny blood vessels more clearly, because vessel changes are one of the signs the doctor assesses.
2. Acetic acid (3–5% dilute vinegar). When applied to the cervix, areas with abnormal cells temporarily turn white (called acetowhite areas). The faster, denser and longer-lasting the whitening, the more attention the area deserves. You may feel slight tingling or coolness for a few seconds.
3. Lugol’s iodine solution (the Schiller test). Healthy tissue stains dark brown, while abnormal areas stay pale or yellow. This helps outline the area that should be biopsied.

The doctor pays particular attention to the transformation zone, the part of the cervix where the inner cells meet the outer cells. Almost all HPV-related changes develop there. Under the international IFCPC terminology (2011), the transformation zone is classified as type 1, 2 or 3, depending on how fully it can be seen; this influences the choice of follow-up or treatment.

Findings are described with standard terms (e.g. minor change, major change, mosaic, punctation, atypical vessels) and, when needed, confirmed with a biopsy. The final diagnosis always comes from the histological analysis of the tissue, not from appearance alone.

05What happens during a colposcopy, step by step?

Here is what usually happens during a colposcopy at Klinika Gjata:

1. A short conversation. The doctor reviews your Pap and/or HPV results, gynaecological history, menstrual cycle, contraception and whether you could be pregnant. This is the right moment to ask any questions.
2. Getting ready. You undress from the waist down and lie on the examination couch with your legs supported, as for a Pap test.
3. The speculum. A speculum, the same instrument used for a Pap test, is gently inserted so the cervix can be seen clearly.
4. Looking through the colposcope. The colposcope is positioned outside your body and the doctor examines the cervix under magnification. If needed, a Pap test or HPV test can be taken at this point.
5. Acetic acid. The dilute vinegar is applied and the doctor waits about a minute to see whether any acetowhite areas appear.
6. Iodine (if needed). Lugol’s solution is applied to clarify the borders of abnormal areas.
7. Biopsy (only if needed). If an area needs to be analysed, one or more tiny pieces of tissue are taken. If everything looks normal, a biopsy is often not necessary.
8. Controlling bleeding. After a biopsy, a haemostatic paste or solution may be applied to stop minor bleeding.
9. Explanation. The doctor tells you what she saw, whether a biopsy was taken and what the next steps are.

The whole visit takes about 15–20 minutes, and the part with the speculum often only 5–10 minutes. No general anaesthetic is needed and you go home straight away. You are welcome to bring someone you trust if it makes you feel more comfortable.

06Cervical biopsy: what is it and does it hurt?

A colposcopic biopsy means taking a very small piece of tissue, usually just a few millimetres, from an area that looks abnormal under the colposcope. The tissue is sent to a histopathology laboratory, where it is examined under a microscope. This is the only way to determine with certainty the grade of the changes (e.g. CIN 1, CIN 2 or CIN 3).

Does a cervical biopsy hurt? Most women describe it as a short pinch or cramp lasting a second, sometimes followed by mild period-like pain. The cervix has far fewer pain-sensing nerve endings than the skin, so a biopsy is usually well tolerated without anaesthetic. The UK National Health Service (NHS) describes the sample as “pinhead-sized”.

Sometimes the doctor takes more than one biopsy, because changes may be present in several places. Studies show that taking several targeted biopsies from different areas improves diagnostic accuracy.

After-care following a biopsy:

• Light bleeding or a brown/dark discharge for 3–5 days is normal; the dark colour often comes from the haemostatic paste.
• Use pads, not tampons or menstrual cups, until the discharge stops.
• Avoid sex, vaginal douching, baths and swimming for a few days, or as long as the doctor advises.
• You can take paracetamol for mild pain.
• You can return to work and daily activities the same day or the next day.

Contact the clinic if you have:

• heavy bleeding (more than a normal period, or with clots);
• a foul-smelling discharge;
• a fever or abdominal pain that does not settle.

Biopsy results come once the laboratory has completed its analysis; the doctor will tell you the expected timeframe and call you to explain them.

07How do I prepare for a colposcopy?

Preparation is simple and helps the cervix to be seen as clearly as possible.

Timing in relation to your cycle:

• The best time is when you do not have your period, often in the days just after it ends.
• If your period starts unexpectedly, call the clinic. Light bleeding often does not prevent the examination, but a heavy flow can make it harder to interpret; we can move the appointment.

For 24–48 hours before:

• Avoid vaginal intercourse.
• Do not use pessaries, creams, gels or vaginal lubricants.
• Do not douche.
• Do not use tampons.

Tell the doctor if you:

• are or might be pregnant;
• have a coil (IUD);
• take blood-thinning medication or have a bleeding disorder;
• have allergies, especially to iodine;
• have had previous treatment on the cervix.

What to bring:

• your Pap and/or HPV test results (including earlier ones, if you have them);
• reports from previous colposcopies or biopsies;
• a sanitary pad for afterwards.

You can eat and drink normally. Wearing a dress or skirt makes the visit a little more comfortable, as you can keep part of your clothing on.

08Does a colposcopy hurt? How to make it more comfortable

For most women colposcopy does not hurt; it feels like a Pap test that lasts a little longer. The most common sensations are:

• pressure from the speculum;
• slight tingling or coolness for a few seconds when the vinegar or iodine is applied;
• a brief pinch and sometimes period-like cramping, only if a biopsy is taken.

What helps:

• Take paracetamol or ibuprofen about 30–60 minutes before the appointment, if you have no contraindications.
• Slow, deep breathing with a relaxed abdomen makes the speculum less noticeable.
• Tell the doctor if you feel pain; a smaller speculum can be used, your position adjusted or a pause taken.
• You can ask to stop at any time.
• If it helps, the doctor will talk you through each step; some women prefer quiet, and that is respected too.
• You can bring someone you trust.

After the menopause, the cervix and vagina can be drier and more sensitive. In some cases the doctor may suggest a short course of local oestrogen before the examination, so the tissue is more elastic and the transformation zone is easier to see.

If you have had difficult or traumatic experiences with gynaecological examinations, please say so at the start. The examination will be paced around you.

09Colposcopy results: what do CIN 1, CIN 2 and CIN 3 mean?

Results come in two stages: the colposcopic impression, which the doctor shares with you straight away, and the histology result of the biopsy, if one was taken, which comes after laboratory analysis.

Definitions:

• CIN (cervical intraepithelial neoplasia) means abnormal cells within the surface layer of the cervix. It is not cancer.
• LSIL (low-grade squamous intraepithelial lesion) includes CIN 1.
• HSIL (high-grade squamous intraepithelial lesion) includes CIN 2 and CIN 3.

What each result means and what happens next:

• Normal. The cervix looks normal or the biopsy shows no changes. You usually continue with routine screening or a planned check, depending on your history.
• CIN 1 / LSIL. Mild changes, usually linked to an active HPV infection. They often return to normal by themselves. Usually not treated straight away; follow-up with an HPV and/or Pap test and colposcopy in about 12 months is recommended.
• CIN 2 / HSIL. Moderate changes. In younger women, especially under 25–30 or those who wish to become pregnant, close follow-up with colposcopy every 6 months may be chosen, because about half of cases regress within two years (Tainio et al., BMJ 2018). In other cases treatment is recommended.
• CIN 3 / HSIL. Significant precancerous changes. Treatment to remove the area is usually recommended, to prevent cancer.
• AIS (adenocarcinoma in situ). Precancerous changes of the glandular cells; these need specific assessment and treatment.
• Cancer. Very rarely a biopsy shows cancer. In that case the doctor explains the next steps immediately and refers you to the specialist team.

The most common treatments for CIN 2–3 are loop electrosurgical excision (LEEP/LLETZ) or conisation. If you need treatment, Dr. Gjata will explain the options, benefits and risks for your situation, and where they are performed. The American Society for Colposcopy and Cervical Pathology guidelines (ASCCP, 2019) recommend basing decisions on each woman’s overall risk, combining the current result with her past history rather than relying on a single result.

Follow-up after treatment usually includes an HPV test about 6 months later and regular checks for several years.

10Can you have a colposcopy during pregnancy?

Yes. Colposcopy is safe during pregnancy and does not harm the mother or the baby. The NHS and international guidelines confirm this. The most important thing is to tell the doctor that you are pregnant, even in the very first weeks.

What is different in pregnancy:

• The main aim is to rule out cancer, not to treat precancerous changes.
• The cervix is softer, more swollen and has more blood vessels, so the appearance can look “exaggerated”. The doctor’s experience matters a great deal for accurate interpretation.
• A biopsy is taken only if high-grade changes or cancer are suspected. When it is done, it is considered safe, although there may be a little more bleeding.
• Endocervical curettage (sampling tissue from the cervical canal) is not done during pregnancy.
• Treatment of CIN 2–3 is usually postponed until after delivery, because these changes progress very slowly and often improve after birth.
• The next check is usually a few weeks after delivery.

If you have an abnormal Pap test or a positive HPV test and then find out you are pregnant, do not cancel the colposcopy without speaking to the doctor; she will decide the most appropriate timing.

11How is cervical cancer prevented? HPV vaccine and screening

Cervical cancer is one of the most preventable cancers. WHO estimates that in 2024 there were about 604,000 new cases and about 280,000 deaths worldwide, most of them avoidable with vaccination and screening. WHO’s elimination strategy aims, by 2030, for 90% of girls to be vaccinated by age 15, 70% of women to be screened with a high-performance test by age 35 and again by 45, and 90% of women with lesions to be treated.

The HPV vaccine:

• Protects against the HPV types that cause most cervical cancers, including 16 and 18.
• Works best when given before sexual activity starts; WHO prioritises girls aged 9–14.
• In Albania, the HPV vaccine was added free of charge to the national immunisation schedule for girls in November 2022.
• Does not cure an existing infection, but may protect against other types; ask the doctor whether it makes sense for you.

Awareness of HPV in Albania is still limited. In a 2025 study of parents in northern Albania co-authored by Dr. Elinda Gjata (Çela, Gjata et al., Journal of Infection in Developing Countries, 2025), only 5.9% of parents had knowledge about HPV and 51% wanted more information. In another survey of 473 Albanian women (Pojani et al., Vaccine X, 2024), only 7.2% had been vaccinated.

Regular screening:

• The vaccine does not protect against all types, so screening is still needed for vaccinated women.
• WHO recommends screening with a high-performance test (such as the HPV test) every 5–10 years from age 30; for women living with HIV, every 3–5 years from age 25.
• The Albanian programme offers a free HPV test for women aged 35–55 at health centres.
• At Klinika Gjata you can have a Pap test and an HPV test; the doctor will advise you on the right interval for your age and history.

12Colposcopy in Tirana: why Klinika Gjata, and what affects the cost?

Colposcopy is an examination where the doctor’s experience directly affects accuracy: knowing where to look, how to read the transformation zone and where to take a biopsy. The European Federation for Colposcopy (EFC) has set quality standards for exactly this reason.

At Klinika Gjata:

• Colposcopy is performed personally by Assoc. Prof. Dr. Elinda Gjata, MD, Dr. Sc., an obstetrician-gynaecologist with more than 25 years of experience and Associate Professor at the University of Medicine, Tirana.
• Dr. Gjata trained specifically in colposcopy at Hôpital Édouard Herriot in Lyon (2000), at the colposcopy school in Ascoli Piceno, Italy (2003), and in colposcopy and hysteroscopy at Hôpital Tenon and Clinique d’Alma in Paris (2006).
• She is a co-author of research on cervical cancer awareness and prevention and on HPV vaccine uptake in Albania (2024–2025).
• Pap test, HPV test, colposcopy and biopsy are available in one place, and you discuss the results with the same doctor.
• The clinic has been working in Tirana since 2009, with a calm and discreet approach.

What affects the cost of a colposcopy? The cost varies depending on what your case requires:

• whether it is colposcopy only or colposcopy with biopsy;
• the number of biopsies and the laboratory histopathology analysis;
• whether a Pap test or HPV test is done at the same visit;
• later follow-up visits;
• treatment, if needed, which is planned separately.

For accurate information about your case and to book an appointment, call Klinika Gjata on +355 4 234 0059. The clinic is on Rruga Hasan Sufa, Tirana.