Objective Women are at risk for prolonged psychological distress following attendance at colposcopy for cervical abnormalities, with potentially negative consequences. Little is presently known about the correlates of post-colposcopy distress. The present study aimed to extend knowledge of correlates of post-colposcopy anxiety and negative affect, and identify women at risk for elevated psychological distress. Methods Psychosocial data (demographic variables, anxiety, negative affect, and pain) were collected using validated questionnaires from 164 women attending colposcopy for the first time immediately prior to their colposcopy examination and immediately following it. Two separate logistic regressions were conducted to identify key factors that may be useful targets for preventing post-colposcopy distress and to determine which factors exert the biggest influence and therefore may be targeted in future intervention studies. Results Pre-colposcopy state anxiety, pain experienced during colposcopy, and trait anxiety emerged as independent predictors of post-colposcopy state anxiety, accounting for 36% of the variance. Pre-colposcopy negative affect, pain experienced during colposcopy, trait anxiety, and referral smear grade were independent predictors of post-colposcopy negative affect, explaining 32% of variance. Conclusions Whether or not women underwent punch biopsy or treatment did not influence post-colposcopy distress levels; however, pain experienced during colposcopy remains a risk for continued psychological distress. Trait anxiety may be an important variable to consider in future studies, as women high in trait anxiety may represent a particularly vulnerable subgroup of women referred for colposcopy, at greater risk for negative psychosocial consequences associated with colposcopy, and to be targeted for interventions to reduce psychological distress.