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Cytology and colposcopy are well recognized methods in the early diagnosis of pre-malignant and early invasive changes of the uterine cervix. Since 1971 the University Department for Women in Leipzig has a cytology clinic. The results of repeat smears before biopsies and the follow-up examinations on 202 cone biopsies are reviewed. The incidence of negative findings decreases with increasing atypia of the squamous epithelium. The highest incidence of false negative smears was 73.3% in mild and moderate dysplasias. The more pronounced the atypia the smaller is the number of inadequate pap smears. In cases with negative cytology and colposcopic atypia the colposcopic findings must be clarified. Only the combination of colposcopy and cytology leads to optimal early diagnosis of cervical intra-epitheal neoplasia and invasive carcinoma of the cervix. The false positive cytosmears in the screening are discussed and a treatment with estrogens prior to repeat examination is recommended. Diagnostic problems arise from a discrepancy in the colposcopic and cytologic findings. Discrepancies depend on the colposcopic experience of the examiner. Improvement of the colposcopic diagnosis is obtained by directed colposcopic biopsy.