Cone Biopsy Procedures and Risks

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A cone biopsy is a surgical procedure that is used to remove a cone-shaped piece of tissue from the cervix and cervical canal. Cone biopsy is useful when diagnosing or treating a cervical condition such as cervical intraepithelial neoplasia (CIN) or cervical cancer. It is also called conization.


A cone biopsy is most often useful if a Pap smear indicates there are abnormal cells in your cervix. This shouldn’t suggest that there is a problem, only that the abnormality requires further investigation.

From a broader perspective, a cone biopsy serves various purposes:

  • A diagnostic tool get a tissue sample (biopsy) to evaluate microscopically 
  • A form of treatment to remove abnormal tissue from the cervix
  • A means to evaluate the extent of cervical cancer that is already diagnosed

How the Procedure Is Performed

A cone biopsy is performed in a hospital on an outpatient basis. There are three different procedures that may be used:

  • Cryosurgery using a carbon dioxide laser to excise a portion of tissue
  • Loop electrosurgical excision procedure (LEEP) which employs a thin wire loop attached to a generator to electrically remove a piece of tissue
  • Cold knife conization (CKC) in which a surgical scalpel is used

Prior to the surgery, your doctor will discuss which anesthesia will be best for you. In most cases, people will choose to stay awake, either with the use of a regional anesthetic or spinal epidural. You will be advised to avoid eating or drinking for six to eight hours before the procedure. 

The lead up to the procedure is similar to that of a routine Pap smear. You will usually be placed your back with your legs in stirrups. Your doctor will then insert a lubricated tool called a speculum into your vagina to spread the vaginal walls. If a LEEP biopsy is performed, you may be injected with a medication to numb the cervix.

What to Expect Afterward

You will usually be monitored for three to four hours after the procedure and will be allowed to go home so long as someone can stay with you overnight.

After a cone biopsy, you can expect some bleeding for around one week but may have some spotting for another week or two after. You will probably feel cramping for the first day or two, as well. Your doctor can advise you about what you can take for pain relief.

It's important to avoid tampons, douches, and sexual intercourse for four to six weeks while you are healing. You should also avoid heavy lifting which can increase bleeding.

While your doctor will likely recommend that someone stay with you for 24 hours following the procedure, you should consider having a friend or family member stay with you for several days if you live alone.

Side Effects

The cone biopsy procedure is usually well tolerated. Excessive bleeding rarely occurs. Infection is sometimes possible and is usually characterized by a yellow or green discharge with a foul smell.

After any surgical procedure, there is always a small risk of blood clots in the legs. While this is uncommon with a cone biopsy, speak with your doctor if you have any pain, redness, or swelling in one or both of your legs.

Should you have persistent pelvic pain, abnormally heaving bleeding, foul-smelling discharge, or a fever greater than 101 Fahrenheit, call your doctor immediately. The same applies if any symptoms just don't seem right to you. Do not hesitate. None of these conditions can be considered normal.

Long-Term Risks

It is important to speak with your doctor about any long-term risks associated with a cone biopsy. However small, complications have been known to occur. Among them:

  • Recurrence of human papillomavirus (HPV) infection doesn’t happen all that often, but it is known to occur in women who have high-risk HPV strains (particularly types 16) as well as high HPV viral loads.
  • Recurrence of abnormal cervical cells (dysplasia) is also known to occur. The risk tends to be lowest for cold knife conization (less than two percent) when compared to LEEP and cryosurgery.
  • Preterm delivery is uncommon but can happen as a result of a cone biopsy. A 2016 study suggested that that risk following cold knife conization was higher compared to LEEP or cryosurgery.

These factors only reinforce the importance of consistent, routine follow-ups with your health provider as well as ensuring that any obstetric or gynecologic specialist if fully appraised of your medical history.

A Word From Verywell

Before undergoing a cone biopsy, be sure to sit with your doctor and ask all of the questions you need to ask. Don't hold back; there are no "silly" questions. If uncertain, don’t hesitate to seek a second opinion.

Sometimes it is helpful to speak with others who have undergone the procedure but be selective. As with other fields of medicine, cone biopsies are constantly improving. In the end, the chances that your procedure will be effective and without complications is higher than someone who may have had the procedure in the distant past.

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Article Sources
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  1. U.S. National Library of Medicine. MedlinePlus. Cone biopsy. Reviewed January 14, 2018.

  2. Memorial Sloan Kettering Cancer Center. Caring for yourself after your cone biopsy of the cervix. Updated August 5, 2019.

  3. Santesso N, Mustafa RA, Wiercioch W, et al. Systematic reviews and meta-analyses of benefits and harms of cryotherapy, LEEP, and cold knife conization to treat cervical intraepithelial neoplasia. Int J Gynaecol Obstet. 2016;132(3):266-71. doi:10.1016/j.ijgo.2015.07.026

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