Background: Evidence for using colposcopy in the absence of a squamous intraepithelial lesion on conventional cytology has important position in cervical cancer screening. Aim of this study to evaluate sensitivity, specificity and diagnostic accuracy of colposcopy and cytology in unhealthy cervix to know role of colposcopy in concurrent use with cytology or replacing to cytology at tertiary centre experience. Methods: Prospective study was carried out over a period of one year, in patients attending Gynaecology OPD, King George’s Medical University, Lucknow, Uttar Pradesh. After informed consent and ethical clearance from institutional ethics committee, total 664 diagnostic colposcopy were performed in women presenting with gynaecological complaint. These women were called for concurrent colposcopy and pap smear. 41 women were lost to follow up, only 623 women were subjected for concurrent colposcopy and cytology. 99 women who had high grade colposcopy with Swede score ≥5 underwent colposcopic guided biopsy and tissue were sent for histopathological examination and cytology of same patients were compared for analysis. Results: Mean age of women was 42.68±11.69 years and mean age of consummation of marriage 20.94±3.21years. Cervical erosion was most common finding (41.4%) followed by hypertrophy of cervix (33.3%) and cervix bleeds on touch (17.2%). 24.14% (n=7) women with ASCUS cytology had high grade HPE (CIN2+) while 42.3% (n=11) women with LSIL had high grade HPE (CIN2+). Taking ASCUS and above as cut-off, the sensitivity, specificity, of Pap smear was 97.8%, 14.6% and diagnostic accuracy was 55.3%. For overall analysis of Colposcopy Swede Score at ≥5, colposcopy was 100% sensitive and 41.2% specific and diagnostic accuracy was 69.7%. At swede score ≥7, colposcopy was 64.6% sensitive and 100% specific and diagnostic accuracy was 82.8%. Conclusion: Colposcopy has good sensitivity and specificity as compared to cytology and can be used in evaluation of abnormal or controversial cytology to obtain better outcome.