Objective: The efforts of the authors are to evaluate the role of performing a Papanicolaou (Pap) smear at the time of colposcopy. Materials and Methods: This retrospective chart review included patients from 2004 to 2009 who underwent cold knife cone (CKC) biopsy or loop electrosurgical excision procedure (LEEP) for cervical intraepithelial neoplasia types 2 and 3 (CIN 2 and 3) or patients with discrepancy between Pap and colposcopic results. All patients presented to the gynecology clinics in a tertiary care hospital. Results were compared which included: the abnormal Pap smear which led to referral for colposcopy, the Pap smear performed atthe time of colposcopy, the colposcopic biopsy, and the excisional biopsy. Interpretation of results was calculated with Cohen’s Statistics. Results: One hundred forty-seven patients qualified for the study. One hundred five patients had excisional biopsy proven high-grade squamous intraepithelial lesion (HSIL). Eighty-two of these high-grade excisional pathology results were preceded by high-grade Pap cytology at the time of colposcopy; however 23 Pap cytology results indicated either low-grade squamous intraepithelial lesion (LSIL) or negative (20 and 3 respectively), but were followed by an excisional procedure revealing high-grade pathology.Eighty-one colposcopic biopsies confirmed high-grade excisional biopsy pathology. However, 24 colposcopic biopsies were low-grade or negative (13 and 11 respectively), but followed by a high-grade excisional biopsy. Conclusion: The addition of a Pap smear at the time of colposcopy has the potential role of recognizing high-grade cervical dysplasia.