Cervical conization, also called a cone biopsy, is a procedure where a surgeon removes a cone-shaped piece of tissue from the cervix. The cervix is the lower part of the uterus that opens into the vagina. This procedure serves two functions: it can be used to diagnose and to treat abnormal conditions of the cervix. By removing the irregular tissue, it allows for a detailed analysis to determine the nature of the cells while often resolving the issue simultaneously.
Reasons for the Procedure
A recommendation for cervical conization typically follows abnormal results from a routine Pap test or a colposcopy. These tests can detect the presence of abnormal cells on the surface of the cervix, which require further investigation. The primary purpose of conization is to diagnose and remove precancerous cells, a condition known as cervical intraepithelial neoplasia (CIN). CIN is graded on a scale from 1 to 3, with higher numbers indicating more advanced cellular abnormalities.
These cellular changes are frequently linked to persistent infection with high-risk strains of the human papillomavirus (HPV). While many HPV infections resolve on their own, some can lead to the development of CIN, which, if left untreated, can progress to cervical cancer. Conization is therefore performed to remove these precancerous lesions and, in cases where cancer is detected at a very early stage, it can also serve as a treatment.
The Conization Procedure
On the day of the procedure, anesthesia is administered to ensure comfort; this may be general anesthesia, where you are asleep, or a local anesthetic that numbs the cervix and surrounding area. The surgeon will position you on an examination table, similar to a Pap test, and use a speculum to view the cervix. The goal is the precise removal of a cone-shaped tissue sample from the cervix, which is wide at the outer part of the cervix and narrows as it goes up into the cervical canal.
The size of the removed tissue averages about 15 mm in height and 1 to 2 cm in width at its base. Two common methods are used for this procedure. The first is cold knife conization, which involves using a surgical scalpel to excise the tissue. The second method is the loop electrosurgical excision procedure (LEEP), which uses a thin, low-voltage electrified wire loop. After the tissue is removed, the surgeon may use various techniques to control bleeding at the site.
Recovery and Aftercare
Following the conization procedure, a period of recovery is necessary as the cervix heals. It is common to experience mild, menstrual-like cramping and some discomfort in the lower abdomen. Vaginal bleeding or spotting is also expected and can persist for a few weeks. You may also notice a dark-colored vaginal discharge as the surgical site heals.
To support proper healing and reduce the risk of complications, specific aftercare instructions must be followed. For a period lasting four to six weeks, it is advised to avoid sexual intercourse, using tampons, and douching. It is also recommended to avoid heavy lifting and strenuous physical activity for at least one week. Showering is preferred over bathing during the initial two-week recovery period.
Understanding the Results and Follow-Up
The cone-shaped tissue removed during the procedure is sent to a laboratory for microscopic analysis by a pathologist. This examination determines if the cells are normal, precancerous, or cancerous. A part of the pathology report is the status of the “surgical margins,” which refers to the outer edges of the removed tissue sample.
If the margins are described as “clear” or “negative,” it means that no abnormal cells were found at the edges of the sample, suggesting that all the affected tissue was successfully removed. Conversely, “positive” margins indicate that abnormal cells were found at the edge of the tissue, which may mean some irregular cells remain on the cervix. Regardless of the margin status, regular follow-up appointments are necessary, which will likely include more frequent Pap tests to monitor the cervix.
Impact on Future Health and Pregnancy
For most individuals, cervical conization does not affect the ability to become pregnant in the future. However, the procedure is associated with a slightly increased risk of certain complications in subsequent pregnancies. One concern is a potential weakening of the cervix, known as cervical insufficiency, which can increase the risk of preterm delivery. The removal of cervical tissue can sometimes shorten the cervix, a factor linked to premature birth.
Another rare, long-term effect is cervical stenosis, which is a narrowing of the cervical opening. This narrowing could interfere with menstrual flow or, in some cases, make it more difficult for the cervix to dilate during childbirth. You should inform your healthcare provider about a past conization procedure if you become pregnant, as they can monitor your cervical length and take appropriate measures.
The time between the conization and a future pregnancy may also play a role, with some evidence suggesting a longer healing interval could reduce risks.