Background: A clinically unhealthy cervix may be associated with benign inflammatory conditions as well as cervical intraepithelial neoplasia (CIN) and invasive carcinoma. Colposcopy provides magnified assessment of cervical abnormalities and facilitates targeted biopsy, while histopathology remains the definitive diagnostic method. This study evaluated colposcopic findings and their correlation with histopathological diagnoses among women with a clinically unhealthy cervix. Methods: This prospective observational study was conducted in the Department of Obstetrics and Gynecology, Dhaka Medical College Hospital, Bangladesh, from January to June 2026. A total of 150 women with a clinically unhealthy cervix were enrolled. All participants underwent clinical examination, colposcopic evaluation, and colposcopy-directed cervical biopsy. Histopathological findings were considered the reference standard. The diagnostic performance of colposcopy for detecting CIN 2+ was assessed, and agreement between colposcopic impression and histopathological diagnosis was evaluated using Cohen’s kappa. Results: The mean age was 44.1±10.2 years, and 31.3% were aged 41–50 years. Abnormal vaginal discharge was the commonest complaint (60.7%), while acetowhite epithelium was the most frequent colposcopic finding (48.7%). Histopathology revealed chronic cervicitis/inflammatory lesions in 34.7%, CIN 1 in 19.3%, CIN 2 in 11.3%, CIN 3 in 9.3%, and invasive squamous cell carcinoma in 6.7%. Overall, CIN 2+ was identified in 27.3%. Colposcopy showed 85.4% sensitivity, 83.5% specificity, and 84.0% diagnostic accuracy for CIN 2+. Agreement with histopathology was fair (κ=0.37, p<0.001). Conclusion: Colposcopy is a useful diagnostic tool for evaluating clinically unhealthy cervices, but histopathological confirmation remains essential for definitive diagnosis.