Cervical Cryosurgery: Everything You Need to Know

What to Expect When Getting This Procedure

Cervical cryosurgery, also referred to as cervical cryotherapy, is the freezing of small areas of abnormal tissue in the cervix to destroy cells and prevent them from becoming cancerous. Cervical cryotherapy is most often used for the treatment of cervical dysplasia, a change in the cervix that is considered precancerous. The procedure may also be used to treat certain other gynecological conditions that result from superficial cellular changes.

A gynecologist performing procedure on woman in stirrups
Nikola Ilic / Getty Images

What Is Cervical Cryosurgery?

In cervical cryotherapy, a cryoprobe—a long, slim surgical device with a pointed tip that produces a very cold temperature—is applied to a limited area of inner cervical lining. In response, the targeted tissue freezes and decomposes.

This does not require an incision. Rather, the probe is inserted into the vagina until it reaches the cervix (a.k.a., the birth canal, which is located just before the uterus). The cold is generated by either liquid nitrogen or compressed argon gas, which gets pumped through the probe once it is in position.

This ambulatory (outpatient) procedure is done while you are awake; anesthesia is not needed.

Contraindications

Cryosurgery could be an option for you if your doctor is certain that your cervical dysplasia is very localized and has been definitively identified. If you have a pelvic infection, however, the procedure must be postponed until the infection has fully resolved.

But because cryosurgery only freezes the superficial cells of the cervix, the procedure is not recommended in cases when a doctor is aware of or even suspects the possibility of changes in deeper tissue.

As such, this procedure is not appropriate if:

  • Your doctor needs to obtain a biopsy sample of your cervix to be examined with a microscope in order to be confident about your case
  • Your cervical changes are located in the upper section of the cervix:cone biopsy is recommended instead.
  • You have a large area of advanced dysplasia: This would usually be treated with an excisional procedure, in which the altered tissue is removed with a surgical incision.
  • You have cervical cancer: Tissue is generally resected and followed by an examination of the surgical margins to ensure that all the cancer cells have been removed.

Potential Risks

Generally, cervical cryosurgery is considered safe, although it may result in some complications such as:

  • Excessive bleeding
  • Infection
  • Discharge
  • Pain

Your risk of complications can be greatly reduced if you avoid inserting anything into your vagina for two weeks after the procedure.

If issues do arise, they need to be addressed promptly to avoid lasting complications, such as cervical scarring, constant pelvic pain, or pelvic pain during or after sex.

Cervical cryotherapy can cause uterine contractions for several days after the procedure and may increase your risk of miscarriage if you are already pregnant. Because cervical dysplasia should be treated without delay, your doctor will discuss the risk of pregnancy complications with you and provide guidance regarding prevention.

If you have been exposed to diethylstilbestrol (DES), a medication that was used to prevent miscarriage before 1971, you may be prone to permanent cervical stenosis due to scarring after cryotherapy. This adverse effect can cause persistent cramping during menstruation, decreased fertility, predisposition to miscarriage, and may interfere with vaginal delivery.

Because the procedure doesn't involve a way of confirming that all of pre-cancerous cervical tissue has been removed, there is a chance that an area of pre-cancerous dysplasia could be missed or left behind with cervical cryotherapy. This is a known risk (and why the procedure is contraindicated in some cases); surveillance follow-up is a part of the typical plan after this procedure.

Purpose of Cervical Cryosurgery

Cervical cryosurgery is done as a way to treat and prevent disease of the lower part of the cervix by directly removing the diseased tissue. It is minimally invasive, and this approach is selected when the condition being addressed only affects the superficial layers of the inner cervical lining.

Because it is minimally invasive and involves relatively fast healing and a low complication risk, cryotherapy is considered advantageous when effective treatment can be achieved without extensive surgery.

Cervical dysplasia, which is identified with a routine Pap smear or a colposcopy, is the most common indication for cervical cryosurgery.

  • During a Pap smear, your doctor would take a small scraping of cervical cells so they can be examined in a lab.
  • During a colposcopy, your doctor would look at your cervix with a light and magnifier to see if there are any visible abnormalities. Sometimes, color-producing solutions are applied to the cervix to help visualize abnormalities. A biopsy can be obtained during a colposcopy as well.

Dysplasia means that the cells appear abnormal when they are examined with a microscope. This occurs due to mutations in the genes, which can happen without a known cause, or as a result of sexually transmitted infections such as human papillomavirus (HPV).

Cells that have become dysplastic are predisposed to becoming cancerous. Cervical cryosurgery destroys small areas of abnormal tissue so that the cells cannot become malignant. The procedure eliminates all abnormal cervical tissue 74% of the time.

Cervical cryosurgery is also sometimes used to treat cervical warts or cervicitis (inflammation of the cervix). These conditions aren't as dangerous as cervical cancer, but they cause discomfort and may lead to issues like bleeding or infections.

How to Prepare

If your Pap smear or colposcopy shows that you have one or more small areas of cervical dysplasia, you will likely be scheduled for cervical cryotherapy within a few weeks. You might even have the procedure within a few days.

You will have pre-procedure testing, including a urine test and complete blood count (CBC). If either of these shows evidence of an infection, you will need treatment before you can proceed with your procedure.

If your preliminary tests raise concern that you could have cancer, you may have some additional testing to determine whether you have advanced dysplasia or cervical cancer. Your evaluation can include a biopsy or imaging tests. If you have advanced disease, you will need treatment with a more invasive type of surgery, not with cervical cryotherapy.

Location

Generally, cryosurgery is done in your doctor's office. It can also be done in a dedicated procedure suite in a hospital or surgical center.

What to Wear

You can wear whatever is comfortable to your cryotherapy appointment. You will be asked to undress from the waist down for your procedure.

Food and Drink

You do not need to fast or abstain from food or drink prior to your procedure.

Medications

Your doctor may ask you to reduce or stop taking blood thinners for a few days prior to cervical cryosurgery.

Avoid using vaginal creams or lubricants unless directed to do so by your doctor. If you are using a medicated cream, such as estrogen cream for the management of menopausal symptoms, be sure to discuss specific instructions with your doctor so you will know when and how to use it before and after your procedure.

What to Bring

Be sure to bring your health insurance card, a form of identification, and a method of payment in case you are responsible for a co-pay for your procedure. You can drive yourself home after your surgery.

Pre-Op Lifestyle Changes

Your doctor will instruct you to abstain from sexual intercourse for 24 hours prior to your procedure. Similarly, you should not place anything in your vagina, including tampons.

Avoid douching or inserting and any cleansing solutions into your vagina before your procedure; your doctor may specify that you abstain from this for longer than 24 hours.

Due to possible pregnancy-related complications, your doctor may advise you to pause efforts to conceive until after your cervical cryosurgery is done. And if you are already pregnant, your doctor may recommend bed rest and/or close monitoring for several days after the procedure.

What to Expect on the Day of Surgery

When you go in for your cryosurgery appointment, you will register and sign a consent form.

Cryosurgery itself should take about 10 to 20 minutes, but there will be some time spent before that preparing you and collecting important information.

Before the Surgery

Your doctor or nurse will ask you if you have been having irregular periods, pelvic discomfort, vaginal bleeding, or discharge.

You will have your temperature, blood pressure, pulse, and breathing rate checked. You will have the chance to use the toilet if you need to before the procedure.

Then, you will be asked to undress from the waist down, put on a medical gown, and lie down on the procedure table. A medical sheet will be placed to cover your waist and legs.

During the Surgery

When it is time for your cryotherapy procedure, you will be asked to place your feet in stirrups attached to the exam table.

Your doctor or nurse should talk you through the entire procedure so you are aware of what is happening when. Feel free to ask questions as things proceed.

Steps to the procedure:

  • Your doctor inserts a speculum into your vagina to visualize your cervix.
  • The cryoprobe is gently inserted into your vagina until it firmly covers the abnormal areas of cervical tissue.
  • Liquid nitrogen or compressed argon gas at a temperature of about -58 degrees F begins to flow through the cryoprobe to cool it.
  • The cold is applied to the inner surface of the cervix for three minutes. The cervical tissue in contact with the probe cools to about -4 degrees F.
  • The cryoprobe is removed from the vagina for approximately five minutes.
  • The treatment is repeated for three more minutes and removed one last time.

You may experience a sensation of cold (even heat) and/or slight cramping, and the temperature sensation should resolve right after the procedure is done.

After the Surgery

After your procedure, you will be able to sit up or lie down and rest. You shouldn't feel any residual pain, but you may have mild cramping. You can use the toilet if needed (wipe gently).

You may see a small amount of blood, but you might not have any bleeding at all. You will be given a sanitary pad to wear in case any bleeding does occur once you leave the office. (You may also be given extras for the days ahead).

Once you are dressed and you feel ready, you will be able to leave.

Recovery

You can resume driving, walking, and exercise right away without concern. You shouldn't need pain medication or a procedure follow-up appointment unless you develop complications.

Healing

As you are healing after your cervical cryosurgery, you should not insert anything into your vagina for at least two to three weeks.

It is normal to experience slight cramping for a few days and watery or blood-tinged discharge for up to two weeks. This is caused by the sloughing of dead cervical tissue. You may soak several sanitary pads over the first two to three days after your procedure. The amount can vary based on how many areas were treated and how large they were.

Your medical team will let you know how much bleeding you should expect in the days after your procedure.

While it is rare, you may experience excessive bleeding, an infection, or persistent pain. More serious complications include the development of scars or ulcerations.

If you experience any of the following symptoms, call your doctor:

  • Fever over 99 degrees F
  • Bleeding that is heavier than what you were told to expect
  • Severe or increasing pelvic pain
  • A foul smell or yellowish vaginal discharge
  • Blisters, bumps, or ulcers

Coping With Recovery

Once you have healed after your procedure, you should not have any residual effects from the surgery.

After two or three weeks (be sure to follow your doctor's specific instructions), you can start tampon use during your periods if you normally use them, resume sexual intercourse, and try to become pregnant if you wish.

Long-Term Care

Because the success rate of this procedure is not 100%, and because even successful treatment of some areas does not preclude cancer from developing elsewhere in the cervix, you need to maintain proper surveillance.

Resume your routine gynecological examinations on the schedule recommended by your doctor. This will involve more frequent Pap smears than usual for approximately one year (every four to six months, or as recommended by your doctor). If your tests are normal after that, you can resume the normal schedule that is recommended for women your age.

If your Pap smears raise any concern, your evaluation and treatment may include steps such as biopsy, imaging tests, and surgical or medical intervention.

Possible Future Surgeries

If you don't have any complications from cervical cryotherapy, you shouldn't need additional surgery unless cervical dysplasia or cervical cancer is detected with future screening tests.

If there is evidence that you have pre-cancerous cells or cervical dysplasia after you have already had cryosurgery, you may need a more extensive or invasive procedure. You are also likely to have a biopsy and imaging studies to determine whether there is any spread of cancerous tissue.

A Word From Verywell

Cryosurgery can be an important part of cervical cancer prevention. It is relatively low risk, with rare complications. Once you have had several normal Pap smears in a row after having had cryosurgery, your doctor will give you recommendations for how often you need to have a Pap smear or other screening for cervical cancer.

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