Well-being after conization of the cervix. Normal and pathological discharge after conization of the cervix

Conization of the cervix is carried out for two purposes - diagnostic and therapeutic. This surgical technique involves resection of part of the vagina in a cone-shaped shape, the apex of which is directed towards the cervical canal. Conization of the cervix is performed in cases where various diseases and pathological processes led to changes in the structure of soft tissues. Reviews about whether it is painful to perform cervical conization (CC) indicate that patients may experience unpleasant discomfort both during and after the procedure. Intensity level discomfort depends on the method by which conization is done.

Indications for use

Conization is carried out in a hospital setting. This is a complex type of surgical intervention that has certain risks of complications, so you need to properly prepare for conization. In what cases is it carried out? surgical intervention, the doctor determines. Usually this:

the presence of altered epithelium, which was diagnosed during colposcopy;
dysplasia 2 and 3 degrees of development;
atypical cells in the vaginal smear;
cervical erosion;
polypous formations;
scarring of tissue after surgery.

Electroconization of the cervix for dysplasia is used in cases where a previous operation gave only short-term results. positive result, and a relapse occurred.

Features of preparation

Before conization the following are surrendered:

laboratory blood tests to determine HIV;

V mandatory a blood test is performed to check glucose levels;

bacteriological culture of a vaginal smear.

Preparatory research includes colposcopy to make an accurate diagnosis. It is imperative to prepare for conization, since if a woman has contraindications to the procedure, serious complications may arise.

Contraindications

Conization is not carried out if the following are present: pathological conditions and diseases:

inflammation in the vagina and on the cervix;

infectious and viral diseases occurring in the acute stage;

heart failure;

diabetes;

diseases in which the blood clotting process is disrupted.

CMM conization is not performed on women during pregnancy and lactation.

Types of surgery

Conization of the uterine cervix can be carried out in the following ways:

radio wave method using an electric knife;
laser;
cauterization liquid nitrogen– cryoconization method;
operation with an ordinary surgical scalpel.

What way surgery The attending physician decides what to choose. The method is selected depending on the stage of dysplasia and whether the patient has concomitant pathologies that must be simultaneously removed. An important role is played by the patient’s age and the number of births, since some techniques are more or less traumatic.

Knife method

The method, when the cervix is partially excised with a simple surgical scalpel, is performed extremely rarely today. Reason – high risks complications:

formation of scars on soft tissues;
long period of tissue healing after surgery.

It is also possible that a woman will develop infertility due to injury to the soft structures of the cervix. But there is this method and an undeniable advantage, unlike many other methods. During surgical conization, high-quality biological material can be obtained, which after the operation is sent to the laboratory for research.

If a woman has a history of childbirth, she no longer wants to have children, and dysplasia develops rapidly, surgical conization can be performed.

Laser method

Laser dysplasia is treated by burning out pathological tissues of the cervix by directing a laser beam at them. The advantage of this method is that it is bloodless, painful and uncomfortable sensations are reduced to a minimum. After the operation, the patient recovers faster and easier.

Disadvantages of the procedure: the likelihood of severe burns to adjacent soft tissues; the operation is performed using general anesthesia, since it is necessary to completely immobilize the woman so as not to knock her down laser ray. Another disadvantage of the procedure is its high price.

Radio wave technology

Radio wave conization of the cervix involves burning out pathological tissues using the influence of current on them high frequency. The radiosurgical conization method is carried out using a special instrument, which is a loop of an electrode.

The advantage of the method is the ability to use local anesthesia; the patient will experience a slight feeling of discomfort. There is no risk of burns to adjacent soft tissues. The risks of complications are reduced to a minimum.

Nitrogen use

This technique involves freezing tissue with liquid nitrogen, which leads to natural destruction. The method is absolutely safe, there are no risks of complications, as with other methods.

Despite the low cost, this technique rarely used. The reason is that it is not possible to take samples of biological material for further laboratory study, which is extremely important in cases where dysplasia is rapidly developing and there is a likelihood of serious complications developing.

Progress of the operation

In most cases, local anesthesia is used for conization. If a woman has a hard time bearing any medical manipulations, before the procedure she is given sedatives. The patient is located in a gynecological chair.

To obtain an accurate picture of the condition of the tissues to be removed, the cervix is treated with 3% Lugol's solution. Why do this? When this substance comes into contact with healthy tissue, it acquires yellow tint, while pathological areas are not stained at all. For this manipulation, diluted with water can be used. acetic acid. When it is used, healthy tissue becomes whitish.

To prevent the woman from feeling pain, the cervix is treated with anesthetic solutions - Novocaine or Lidocaine. After all these preparations, conization is carried out directly according to the method chosen by the doctor.

After conization of the cervix, a piece of soft tissue obtained during the procedure is sent to the laboratory for examination. Conization lasts up to 20-30 minutes.

Postoperative period

Most patients are concerned about whether it is possible to be discharged from the hospital on the day of the operation, and how many days the hospitalization lasts before conization. Doctors believe that, despite the fact that the procedure is performed in a hospital setting, long-term hospitalization is not required.

The woman comes to the hospital on the day of the operation, and after the operation remains under the supervision of doctors for several hours. After this, she can go home the same day, provided there are no complications.

After the operation, the woman will have minor abdominal pain of a pulling nature. The postoperative period is always accompanied by the presence of discharge; it should not be copious, but rather similar to ichor. The normal nature of the discharge is watery, white or brownish, with small bloody impurities. The presence of an unpleasant odor is normal. Clinic that should alert you after surgery:

severe pain in the lower abdomen;
deterioration of general condition;
high body temperature, from 37.5 and above;
copious discharge;
the color of the discharge is dark, with a lot of blood;
deterioration of general condition.

These signs indicate the development of complications - discovery uterine bleeding or infection.

Main restrictions after conization

In order for the cervix to heal quickly, without negative consequences and complications, a woman must follow the following medical recommendations:

sex is prohibited for a month. This is due to the fact that vaginal sex will damage the tissue of the cervix and cause bleeding;
taking a bath, visiting saunas and steam baths, solariums, and performing any procedures that involve exposure to heat on the body are excluded;
It is prohibited to engage in sports and other active physical activity, lift heavy objects;
reception is excluded medicines from the group of anticoagulants that thin the blood, for example, Aspirin, so as not to provoke bleeding;
Vaginal douching and the use of tampons are strictly prohibited.

If there is bleeding after surgery, you can only use pads that need to be changed regularly. It is prohibited to visit public pools and swim in natural bodies of water. Only a doctor can tell you when sex will be allowed, after a routine examination a month after the conization.

The normal duration of discharge after conization is 2 to 3 weeks. After a week and a half, the volume of blood released may increase significantly; this is normal. This is explained by the fact that a scab comes off from the cervix. Increased discharge should not have an unpleasant odor. When you start menstruating again after conization depends on the presence of complications. If there are no complications, menstruation will occur as usual, at the woman’s usual time. A slight deviation in the cycle for a few days is allowed.

Possible complications

Conization, if the procedure was performed by an experienced doctor, rarely causes any complications. In most cases, the woman herself becomes guilty of having problems after the operation. Negative consequences. This could be early sex, using tampons, or playing sports.

After conization of cervix, the following may occur:

narrowing of the cervical canal;
stenosis;
addition of infection;
opening of uterine bleeding;
scarring of soft tissues.

When an infection occurs, affecting organs genitourinary system, antibiotics are prescribed. The drugs are selected individually, depending on the type of pathogenic microflora. If stenosis occurs or is damaged postoperative scar, surgery is performed again.

Pain during and after surgery

The conization of the uterine cervix itself is painless procedure. But as soon as it stops working local anesthesia after the intervention, the patient will return to her previous sensitivity, and she may experience minor pain in the lower abdomen, which is of a pulling nature.

After 1-2 weeks, as the soft tissues heal, the uterus will begin to contract intensively, which will be accompanied by cramping pain. The pain is of medium intensity and is easily tolerated by most women. As a rule, patients do not need to take painkillers. If the pain is intense, the doctor prescribes painkillers and antispasmodics.

Pregnancy after conization

Surgical intervention performed using minimally traumatic methods does not negatively affect the ability to conceive a child. Conception is possible after the soft tissue of the cervix has completely healed. This happens after 3-4 months.

Pregnancy in a woman who has undergone conization proceeds without complications, but natural childbirth is not recommended. This is explained by the fact that a scar forms on the healed tissue of the cervix, due to which the degree of stretching of the walls of the organ is slightly reduced. During natural birth the scar may rupture. To avoid this complication, women with a history of previous conization undergo cesarean section.

Relapse

Conization is not a panacea for a complete cure. If a woman has accompanying illnesses, especially human papillomavirus, dysplasia can develop again.

According to medical statistics, 70% of patients diagnosed with human papillomavirus experience a relapse after some time. As a rule, when it occurs again, it is more difficult and develops more rapidly.

The most unfavorable outcome is the presence cancer cells in the studied soft tissue sample taken from the cervix during conization. IN in this case held drug therapy aimed at stopping further development pathological process. If this process is started and left without treatment, complications will begin. Subsequently, it will be necessary to resort to extensive surgery, during which the woman’s reproductive organs affected by cancer cells are removed.

Conization of the cervix is an operation performed in day hospital. It takes 15 – 20 minutes. The woman is under the supervision of a doctor for some time. Next, you need to go to the hospital for a week to treat the wound. After surgery you cannot do:

physical labor;
lead sex life within 2 months;
visit the sauna;
swim in outdoor ponds;
use suppositories, tampons or douches.

The operation is performed under general or local anesthesia– an injection is given into a vein or cervix. Pain relief is not always carried out; according to patients, the pain is not so severe that it cannot be tolerated - it is not so much painful as unpleasant. After the procedure the following are noted:

aching pain in the lower abdomen;
dizziness, which is more associated with the use of anesthetics;
blood discharge;
weakness - not all women, young unpleasant symptoms may not exist at all.

IN postoperative period Usually, release from work is not required, but this depends on the characteristics of the body - how the wound heals, how the woman feels, what method was used to perform the operation. It is better if someone helps with the housework in the first days.

Sometimes you need to take medication restorative action to speed up tissue regeneration and help the body cope with the consequences. Antibiotics are recommended to rule out infection and avoid complications.

Indications for surgery

Conization surgery is performed for therapeutic purposes in the following cases:

Diagnostic conization is carried out to establish or clarify an oncological diagnosis.

It is dangerous for young women planning pregnancy to undergo conization, as it is more difficult after it. Although there are most modern methods surgical treatment, surgery is a traumatic intervention in the body.

Exists official statistics, according to which, in 98% of cases, conization of the cervical tumor can not be done, because it does not guarantee the absence of relapses, especially in cases of low immunity and the presence of cancer that cannot be treated. Severe dysplasia is treated in a maximum of half of women, which means that every second case will be unsuccessful. After surgery, the infection becomes more resistant to drugs, so the course of the disease worsens after 1 to 2 years.

If conization of the cervix was performed the first time, not everyone will be able to perform it a second time due to the characteristics of the body and the stage of the disease.

Contraindications to surgical treatment

Conization of the cervix is not done if genital tract infections are detected - chlamydia, trichomoniasis, gonorrhea and others.

At inflammatory processes V bladder or kidney surgery is not performed. Acute processes in the body, regardless of location.

A confirmed diagnosis of cervical cancer is also an obstacle to conization. In this case, cancer cells become more aggressive and begin to multiply rapidly.

Preparation for conization of CMM

If you still decide to carry out conization, then before that you need to take tests for different kinds infections. If pathogenic viruses or bacteria are detected, treatment must be carried out and only then proceed with surgery. These can be both HPV and herpetic infections of the genital organs. An obstacle to surgery is various pustular skin rashes. If available varicose veins veins, additional examination is carried out lower limbs in order to prevent the formation of blood clots.

Severe viral and bacterial infections- such as hepatitis C, HIV or syphilis - require a special approach, so tests are required.

A general blood test is also necessary. He will give information to the doctor about general state body, which is important in the postoperative period. Shouldn't be viral respiratory diseases, or after their completion, at least 2 weeks must pass for the body to regain strength.

Biochemical blood test shows the condition internal organs– liver, kidneys. It is necessary to do fluorography to exclude hidden diseases lungs.

A good specialized clinic may recommend an MRI of the pelvic organs to determine the extent of damage to the mucosa - how deep the process has gone into the tissue. MRI is the most informative method, which allows you to accurately calculate the depth of tissue removal.

You need to take tests medical center or a clinic where it is planned to undergo conization.

Important! Maximum information about a woman’s body will help avoid dangerous consequences in the postoperative period, therefore a minimum number of tests is not recommended.

On what day of the cycle is conization performed?

They try to carry out conization of the cervix on the 7th day of the cycle, starting from the first day of menstruation, or immediately after the end of menstruation. This allows you to exclude pregnancy and give the wound time to heal before the next day. menstrual cycle.

Usually they operate by appointment - the time of the operation is determined in advance, when all the tests have been completed and a physician’s opinion on the possibility of surgical intervention has been received.

fermented milk products;
fruits and vegetables;
croup

Why is this necessary? To reduce the toxic load and alleviate the condition of the body. It is better not to consume baked goods, as yeast affects the condition of the intestines.

Before the operation in the evening, you can indulge in yogurt and cottage cheese. In the evening, do a cleansing enema. If the woman is in the hospital at this moment, the procedure is carried out in the morning before the operation. It is not recommended to drink 8 hours before, although with conization, which lasts 15 minutes, this is not significant.

There is no need to shave the pubic area so as not to provoke inflammation. hair follicles, otherwise you may end up in the infectious diseases department. Hair cutting in the perineum should be done so that the length does not exceed 0.5 cm - this will help the doctor who will carry out the conization.

Gentle methods of conization of CMM

On this moment Conization surgery using a scalpel is practically not performed. The method is considered traumatic and outdated. The cone-shaped fragment of the neck is removed using:

The most gentle are radio wave method and loop excision.

Radio waves allow you to accurately calculate the depth of exposure so as not to damage healthy tissue. Used in women who are planning to have children. Bleeding when this method absent. Infection is also unlikely. The wound heals quickly and painful sensations practically absent. The rehabilitation period lasts about 3 weeks. The procedure is performed immediately after the end of menstruation. Used for the treatment of dysplasia II – III degrees.

Loop laser or radio wave excision is performed with an electrode, under the influence of which cells are heated and evaporated. Helps avoid wounds and scars. Method shown:

for benign and malignant tumors of the cervix;
ectopia;
erosion;
scars;
dysplasia.

The method leaves no chance of infection and eliminates the risk of adhesions.

Electroconization is a more traumatic type surgical intervention. Young women reproductive age It is better not to use it. The procedure is cheaper than the methods described above.

For information! You can reduce the cost of treatment by taking out compulsory health insurance (CHI).

The type of anesthesia is selected by the doctor. This could be as light an intravenous general anesthesia, so local medicines. The procedure can be anesthetized with novocaine, lidocaine and adrenaline to reduce blood loss. After surgery, if any painful sensations take Nurofen, Ketanov.

Long-term consequences of conization

The operation has an impact on pregnancy.

Due to a decrease in tissue elasticity and changes in the length of the cervix, a woman may not carry the child to full term. Sometimes premature disclosure occurs.
If, as a result of conization, a narrowing of the cervical canal occurs, then there may be problems with conception.
After conization, doctors recommend delivery by cesarean section, as they are not confident in the full dilatation of the cervix due to loss of elasticity.
There is a risk of spontaneous abortion if pregnancy occurs soon. The recommended period after surgery is 1 year.
Development is possible. According to statistics, 1 - 2% of all cases.

After the operation, it is necessary to see a gynecologist first every month, then every three months to take a smear for cells. After 3 years, if there are no complications or relapses, you should visit the doctor every six months.

conclusions

Conization of the cervix, carried out in a qualified manner, taking into account all indications and contraindications, is safe method treatment. The patient's age and plans for having children should be taken into account. In this case, it is better to choose a more expensive method, but reduce the risk of infertility or problems with bearing a child in the future.

If you are reading this material, you are probably about to undergo cervical conization surgery. You've probably already visited the forums asking where and who is the best place to do it - at Herzen, at Blokhin or at Kashirka.

Despite all the doctors’ assurances of the absolute safety of the procedure, conization is a full-fledged surgical intervention that has very definite consequences for your health.

Unlike the kidneys, ovaries and lungs, the uterus is an unpaired organ. Like the heart, it cannot be replaced, and disruption of the uterus has irreversible consequences.

Therefore, when deciding whether to undergo conization, it makes sense to form an objective opinion about the procedure, learn about alternative effective treatment methods and make an informed decision.

I consciously and responsibly, based on my own practical experience and the clinical data of my patients, I declare: even if there are direct indications, in 98% of cases conization MAY NOT BE DONE.

Unfortunately, when offering conization, doctors hide the long-term consequences of this procedure from their patients. This has been customary in Russian medicine since Soviet times, when even the diagnosis is communicated only to the relatives of the sick person.

2. Relapse. Conization does not protect against recurrence of the underlying disease.

3. Progression of the disease. In 50-70% of cases, within 6-24 months the course of the disease follows a pessimistic scenario and enters a more severe stage.

Often re-conization is not possible. Each woman has an individual anatomy of the cervix, and not everyone can undergo a second conization after the first conization, even if there are indications. In this case, classical medicine can only offer amputation of the cervix or the entire uterus.

Young women come to see me every day, often having not even partially fulfilled their reproductive function, “wound up” about the outcome of the disease, with a strong recommendation from their attending physicians immediately remove the uterus.

Here is one example - the first letter from my patient from Yekaterinburg, now healthy:

“Please tell me, is PDT used in the treatment of CIN 2-3 of the cervical canal? In June 2017, conization was performed at the Yekaterinburg Oncology Center, but dysplasia remained alive in the cervical canal, and in its upper part. My attending physician says that they also use PDT, but this is not my case, the uterus must be removed... We also treat the HPV virus, but to no avail...”

My dears, dysplasia and other precancerous conditions of the cervix and uterus are successfully treated using photodynamic therapy. Unfortunately, not all specialists are competent enough and strictly adhere to work regulations in the process of preparing and performing PDT.

Therefore, before planning treatment, I have to engage in psychotherapy and restore a method discredited by colleagues.

The conization procedure occupies a special place in the lives of nulliparous women.

Unlike conization, PDT is a non-traumatic therapeutic method. It targets neoplasia in two directions at once:

destroys tumor and virus-infected cells,

destroys the papilloma virus in the mucous membranes of the cervix and cervical canal.

By using PDT for treatment, we preserve the integrity of the cervix and uterus and restore immunity at the organ level. A healthy cervix reliably protects itself and the uterus from infections, it is ready for conception, for full independent pregnancy and childbirth.

The method received this name because during the operation a small cone-shaped section of mucous is removed from the cervical epithelium of the uterus.
Today, conization is a common treatment and examination option. It is used in large centers and small gynecological hospitals. The popularity is explained by the ability to remove the pathological area and examine it. Healing after conization proceeds quickly. It is extremely rarely complicated. The intervention is little or painless. Some of the pathologies can be cured with medication. But it takes a long time and is not always effective. Histological examination of a piece of tissue removed during conization is the most informative in diagnosing oncological changes.

Indications for surgery

Conization of the cervix is used in the diagnosis of oncological pathologies and for therapeutic purposes. She also helps to choose optimal treatment, if required. Conization is recommended for:

presence in cytological analysis atypical cells;
pathological changes in the cervical epithelium (pseudo-erosions, erosions, cysts, polyps);
ectropionic cervix;
cervical deformities formed in the postpartum period after severe traumatic childbirth;
with diagnosed dysplasia of the cervical epithelium of II-III degree with histological confirmation.

Conization of the cervix for grade 3 dysplasia is the method of choice. It will allow you to remove the pathological area and give the most reliable answer about the presence or absence of a tumor.

Conization of the cervix is effective method. After a single operation, atypical cells are rarely detected again. However, repeated conization of the cervix does occur.

Contraindications

Conization is not performed in cases of diagnosed invasive cervical cancer. It is also contraindicated in the presence of sexually transmitted diseases and various infectious pathologies of the genital organs. Surgical intervention is postponed both during execution and during exacerbation chronic pathologies body. In the presence of infectious or inflammatory gynecological pathologies the operation must be postponed. Then carry out a course of treatment infectious pathology or inflammation of the female reproductive organs.

As a rule, the course of treatment consists of sensitivity-appropriate antibiotics and anti-inflammatory therapy.
We recommend watching a video of how conization is done with a scalpel and laser:

Preparing for surgery

The preliminary examination consists of a complex of laboratory and instrumental studies:

general blood test and biochemical;
analysis on viral hepatitis, HIV;
smear on the state of microflora;
colposcopy

What is conization

If conization of the cervix is planned, how is the operation performed?

The procedure involves removing a pathologically changed area of the inner epithelial layer of the cervix. The wide side of the cone faces the vagina. It should capture the entire pathological epithelium. Narrow part it faces the cervical canal.

Conization is carried out in the first few days after the end of menstruation. Thus, by the beginning of the next menstruation, the operation site will have already healed.

The operation is usually performed in a small operating room, in a regular gynecological chair. Conization is not a complicated operation. Typically carried out under local anesthesia. Sometimes it is supplemented with drug sedation. But this is quite rare. The uterus has no painful endings, and the tissue of the cervix is numbed locally by the doctor. After the operation, there is practically no hospitalization. According to the doctor's decision, the patient after the operation can remain under observation for several hours or days.

Conization techniques

There are several conization techniques.

Previously, loop electroconization and knife methods were popular. A simple method using a scalpel or a “knife” is fraught with bleeding and perforation of the neck, which is more traumatic. Not applicable today.

Radio wave conization

Radioconization is an effective method. The dissected tissues are simultaneously coagulated. This prevents bleeding. The technique ensures the accuracy of the impact. It is not painful.
In the postoperative period after radiowave conization, infection is rare. Healing is fast. Pain is minimal.

Laser conization

This method is relatively expensive. The high price is explained by the necessary expensive equipment. In addition, staff must undergo additional training. As a result, the technique can only be used in large centers.

A section of tissue is removed using a laser. The procedure is practically painless. Its low-invasiveness allows you to accurately examine and describe the remote area due to its minimal damage.

Loop electroexcision is the most recent of modern techniques. The cone-shaped area is excised using a wire loop. In this option, tissue damage is minimal. There is little damage to the area being removed. Which is very valuable for subsequent histological examination.
The postoperative period is progressing well. Bleeding practically does not occur. The pain is either of low intensity and short-lived, or absent.

Postoperative period

Conization of the cervix, how does healing proceed?
This question worries no less than the question about the operation itself. After conization of the cervix is performed, the postoperative period may differ slightly in different patients. This depends on the condition of the neck, the size of the removed element, and the characteristics of the operation. As a rule, postoperative pain is similar to that accompanying menstruation. Just as compelling. But longer.

The discharge will be bloody or watery in any case. Their volume can be significant. If it exceeds the volume typical for normal menstruation, then you should consult your doctor. Many people report cessation after 2 weeks, on average. However, up to 4 weeks is possible. Complete healing occurs after 4 months. But all postoperative manifestations disappear within a month. Darkish, even somewhat brownish, or watery pink discharge after conization of the cervix is normal.

After about a week, the scab comes off from the wound. The volume of discharge may increase slightly. Some patients note that they definitely felt the scab coming off after conization of the cervix. An increase in discharge and its darkening, characteristic of the discharge of a scab, may not be pronounced.

Menstruation after conization of the cervix usually occurs on time. However, they are more abundant. Next time their volume will be normalized.

Anti-inflammatory non-steroidal drugs are quite sufficient for pain relief.

The recommendation about how long you should not sit after conization of the cervix remains ambiguous. It is sometimes recommended to refrain from sitting position in a week. Or they don’t make such a restriction. It depends on the scope of the operation itself, and on the opinion of a particular doctor.

Taking a hot shower, visiting saunas, baths, and sex is excluded for a month. Sports activities must be cancelled. You cannot lift weights exceeding 3 kg.

Pregnancy in those who have undergone conization

There are different opinions on whether it is possible to get pregnant after conization of the cervix. The idea that it is impossible to get pregnant is completely wrong. It is only advisable to postpone pregnancy after conization of the cervix for a year, or better yet, for a couple of years. Conization has absolutely no effect on the process of conception. The possibility of conception is reduced due to the narrowness of the cervical canal. But pathologically altered tissue that was not removed could narrow the canal more.

Information about conization in the anamnesis must be indicated in the medical documents women in labor. Risk remains premature birth due to the danger that the cervix will not withstand the load of the pregnant uterus. If the gynecologist suspects such a risk, he may stitch the cervix. It is removed before giving birth. Sometimes delivery by caesarean section is recommended. This avoids disruption of cervical dilatation due to decreased elasticity.
Such women are under constant supervision of gynecologists during pregnancy.

Complications

Bleeding occurs in no more than 2% of conizations.
In rare cases, but infection of the postoperative wound cannot be ruled out.
Possible cicatricial narrowing of the cervical canal, stenosis.
Cases of ismic-cervical insufficiency have been described. When miscarriage occurs due to insufficiency of the obturator function of the cervix.

Why is there a delay after cauterization of cervical erosion?

Conization is surgical removal parts of the cervix and cervical canal in the form of a cone.

It is used for treatment (see “indications”) and diagnostics, that is, with therapeutic diagnostic purpose.

For diagnostic purposes, the removed cone is sent to the pathology laboratory for histological analysis to identify cancer cells and the degree of the tumor process.

In what phase of the cycle is cauterization performed?

The purpose of cauterization depends on the phase of the cycle and the urgency of the procedure. There are 3 types of procedures:

diathermocoagulation;
cryodestruction;
laser radio wave therapy.

Diathermocoagulation is carried out urgently when there is a high probability of rapid growth of polyps and their degeneration into malignant tumor A biopsy of the cervix is also often taken to rule out cancer.

Laser radio wave therapy as a low-traumatic method for fast healing The wound is performed on days 5-7 of the menstrual cycle, so that the cervix will heal before the next menstruation arrives.

It is better when moxibustion is performed between days 3 and 9 of the cycle. This is the time when the muscle tissue of the uterus is in a softer, relaxed state, and its cervix is slightly open.

It is easier for the gynecologist to view the entire cavity and carry out the conization procedure in order to complete removal modified affected epithelial tissue without leaving any particles behind. In addition, the doctor will not affect healthy nearby areas during the operation, which means that the healing process will be faster in the future.

Conization is performed at the beginning of the cycle, on days 5-10, in order to ensure healing of the cervix in the next cycle.

The process of conization and its types

There are several types of conization, the most common are the following:

loop electroconization;
radio wave type of conization;
laser type of biopsy;
knife type of surgery.

The knife type of surgical intervention is used very rarely due to the high likelihood of complications after its use.

The laser type of intervention is high-tech and the most expensive. Loop conization is a method that has a small percentage of complications and a relatively low cost of the intervention.

The optimal time for the operation is the period immediately after the end of menstruation. This period is preferable due to the fact that it completely eliminates the possibility of pregnancy and leaves a sufficiently long period for the cervix to heal at the site of formation. surgical field.

Carrying out loop conization consists of several stages. The main stages are the following:

Inserting a plastic speculum into the vagina of a woman lying in a gynecological chair.
Removing vaginal discharge.
Treatment of the surgical field using Lugol's solution.
Anesthesia with injections of an anesthetic composition consisting of 1% lidocaine solution with adrenaline. Adrenaline is necessary to reduce bleeding.
The electrode loop is installed at a distance of 3-5 mm from the boundary of the transformation zone. By passing high-frequency alternating current, the transformation zone is cut out to a depth of 5 mm.
The cut section of tissue is removed using tweezers and sent for examination.
On last stage Coagulation of bleeding points on the surgical field is carried out.

The procedure takes about 15 minutes.

after conization it is more difficult to get pregnant;

is decreasing barrier function uterus on the way inflammatory diseases, which in themselves negatively affect the possibility of pregnancy and healthy childbirth;

high risk of miscarriage and premature birth after 16 weeks of pregnancy;

birth by cesarean section;

Reproductologists often refuse IVF to women with conization of the cervix due to a history of dysplasia.

Unlike conization, PDT is a non-traumatic therapeutic method. It targets neoplasia in two directions at once:

destroys tumor and virus-infected cells,

destroys the papilloma virus in the mucous membranes of the cervix and cervical canal.

The human papillomavirus in the mucous membrane is completely destroyed, which serves as a reliable lifelong prevention of precancerous diseases of the cervix.

Prognosis after PDT treatment

What to do after conization to reduce the likelihood of relapse to zero?

If you do choose conization, in order to prevent relapse, I recommend performing one photodynamic therapy procedure to get rid of HPV and reliably protect yourself.

For full recovery Usually one session is enough.

After treatment with PDT over a seven-year period, no relapse is observed in 95% of cases. All patients stay in touch with me - modern technologies allow it to be maintained

The effectiveness of PDT treatment is assessed according to the international algorithm:

colposcopy (vidocolposcopy)

cytological screening (scraping from the cervix for cytology).

Screening after PDT is carried out 1, 4 and 7 months after the procedure, then once a year.

Postoperative period

After surgery, a woman may feel slight discomfort and nagging pain in the lower abdomen. A woman’s menstruation after the procedure can significantly intensify and become longer than before the surgical procedure.

In addition, after conization of the cervix, formation is observed brown discharge, which are the norm in this condition female body. If this type of discharge occurs, there is no need to worry.

Regardless of the type of operation chosen, a wound surface is formed on the cervix. In the process of conization upper layer destroyed by laser, electricity or radio waves. On the spot damaged cells A scab forms and comes off over time.

Women who are faced with the need to undergo conization of the cervix are worried. They are interested in how the operation itself is performed and how the postoperative period goes. Doctors warn that you should not rely on the experience of other women. The sensations will depend on the following factors:

pain threshold;
cervical conditions;
size of the remote area;
individual reaction to anesthesia;
features of the operation;
the amount of scab formed and the intensity of its discharge.

Patients who underwent conventional knife conization often complained of intense bleeding, severe pain after operation. The removal of the scab was often accompanied by bleeding.

After the knife method, an inelastic scar may remain on the cervix. It does not bother a woman, but can cause problems during pregnancy and childbirth. Sometimes scars remain after electroloop conization. And laser and radio wave procedures As a rule, they leave no traces.

For many, healing occurs in 4-6 weeks. But in some cases, the process lasts up to 4 months - the duration depends on the individual ability of the body to regenerate tissue.

If there were no problems during conization, and the woman adheres to the doctor’s recommendations, then the likelihood of complications occurring is minimal. Many patients do not even have blood in the first month, they only have copious watery discharge. Blood or spotting may appear only when the scab is removed.

In the postoperative period, women face the following problems:

bleeding within 2-3 weeks after surgery;
pain in the lower abdomen, similar in intensity to pain during menstruation;
increase in volume bloody discharge when the scab leaves;
unpleasant vaginal discharge.

Pain and increased volume of discharge may indicate damage to the tissue of the cervix and the onset of bleeding. Unpleasant smell appears when the damaged area is affected by pathogenic microorganisms.

Within a week after surgery, most patients begin to lose the scab. This may significantly increase the volume of discharge. For many, they become not only more abundant, but also darker.

The conization procedure occupies a special place in the lives of nulliparous women.

This is a procedure in which a cone-shaped fragment is removed from the cervix. After this, it is sent for histological examination.

There are contraindications for cervical conization:

diseases of the female reproductive system that are inflammatory or infectious in nature,
invasive cervical cancer, which is confirmed by the results of histological examination.

Indications for conization of the cervix

Conization is a widely used procedure in gynecology. The purpose of the operation is to remove the following elements:

neoplasms in the uterine cavity;
erosive areas;
malignant tumors;
tumor-like fragments of unknown etiology.

Conization is often performed to reduce the risk of developing cancer. During the procedure, a biopsy of the cervix is often taken to examine the tissue for histology.

Conization of the cervix is prescribed in the following cases:

detection of pathological areas in the cervical canal of the cervix;
dysplasia 2-3 degrees;
according to the results of histological examination;
if the development of cancer is suspected, when a cervical biopsy is necessary.

A similar operation is carried out using a loop, laser or radio wave. Almost any of the methods used to cauterize erosion leads to a delay in menstruation. The procedure is contraindicated in the following cases:

in inflammatory processes;
for infectious diseases in the genital tract;
for invasive cervical cancer.

In general, conization takes no more than 20 minutes and does not cause pain due to the absence of nerve endings in the cervix. No anesthesia is required.

Removal of pathological tissue is carried out by applying alternating current to the loop and cauterizing the erosion. To prevent complications and infection of the uterine cavity in the future, the doctor will prescribe a course of treatment for women. antibacterial drugs and vitamins to support immunity.

During the surgical procedure, the specialist removes a small cone-shaped area of the surface of the cervical canal and part of the cervix. Very often, conization of the cervix is carried out not so much for the purpose of treatment, but in order to conduct a histological examination of the tissue fragment obtained as a result of the operation.

As a result of histological analysis, the presence or absence of cells capable of degenerating into cancer in the tissue sample being studied is determined. Tissue showing signs pathological nature, is removed through one surgical intervention, which is an advantage.

After surgery and the end of the healing period of the surgical field on the surface of the cervix, you need to visit a doctor and undergo a cytological examination. Very rarely, but a repeat biopsy may still be required if suspicious cells appear.

There are a number of indications and contraindications for cervical conization. The main indications for surgical intervention are the following:

identification of pathological tissue areas on the mucous membrane of the cervical canal;
development of grade 2-3 dysplasia if the diagnosis is confirmed by histological analysis;
upon receiving negative results from a Pap test, which is a test of a smear from the cervix.

A contraindication to conization is the presence of invasive cervical cancer in a woman’s body; in addition, conization cannot be used if infectious diseases of the pelvic organs develop in the body.

cervical dysplasia grades 2 and 3,

multiple polyps and cysts of the cervical canal,

severe scar deformities,

initial forms of cancer - superficial cancer in situ and stage 1A cancer. Conization for the treatment of cervical cancer more severe stages does not apply.

The decision as to whether conization is indicated in a particular case is made on the basis of the unsatisfactory condition of the cervix according to extended colposcopy and the presence of atypical cells in cytological analysis.

After the procedure, I closely monitor the patient for 7 months and regularly - 1, 4 and 7 months after PDT - I perform colposcopy and a cytogram of scrapings from the cervix.

This observation tactic allows, at the slightest shift in the analysis, to make a decision both in favor of a repeat PDT procedure and in favor of loop conization to clarify the diagnosis (I perform loop conization of the cervical tumor only for diagnostic purposes).

Dangerous complications

In most cases, after conization of the cervix, the scab comes off painlessly. But some women say that this period is accompanied by the following:

pain appears in the lower abdomen;
there is discomfort in the cervical area;
the amount of bleeding increases.

Patients claim that the pain is similar in nature to menstrual pain. They can be pulling and aching. If necessary, you can take Ibuprofen or Ketonal to alleviate the condition. If a cutting appears, sharp pain, you should consult your doctor.

An examination by a gynecologist is necessary if a woman’s scab comes off and the following is recorded:

temperature rises;
intense discharge began, reminiscent of bleeding;
severe itching bothers me.

Dead tissue does not always begin to come off painlessly. Cutting pains accompanied by the appearance of heavy bleeding may indicate damage to the tissue of the cervix. In this case, the gynecologist must treat the damaged area to stop the bleeding. This way the scab should not come off. Women are also prescribed antibiotic therapy to prevent complications.

Some feel severe discomfort when the scab comes off. Patients complain of weakness, drowsiness, chills, and slight dizziness.

Many people are interested in how exactly the scab comes off after conization of the cervix. You can understand that the process of its rejection has begun if you look at the discharge. In them, women may notice dried blood in the form of crusts.

For most women, the postoperative period passes without complications. But sometimes special hemostatic drugs are required. If indicated, the doctor may prescribe:

water pepper tincture;
"Dicynon";
"Tranexam."

You cannot start taking hemostatic drugs on your own without a doctor’s examination. Perhaps while the scab was coming off, the vessel was damaged. Only coagulation can cope with bleeding.

In the standard time frame after conization, women begin menstruation. In the first and second cycles after surgery, periods are more abundant and may last longer than usual. But as a rule, by the 3rd cycle the situation returns to normal.

Some women cannot understand the nature of the discharge: it can be difficult to understand whether the scab is coming off or menstruation has begun. If conization was done on days 5-7, then the crust comes off on days 10-17 of the cycle. It's too early for your period to start.

Judging by the reviews of patients, it is possible to understand that dead cells are rejected by the nature of the bleeding. Usually in the morning the intensity of discharge is greater, and by the evening it practically stops.

It is considered normal if serous-bloody discharge occurs within 10-20 days after conization. From time to time they may intensify, resembling menstrual ones in character and intensity.

You should immediately consult a doctor in the following cases:

bleeding is heavier than normal menstruation,
copious discharge or a lot of clots,
severe pain in the lower abdomen,
increased body temperature,
discharge with an unpleasant odor continues for more than three weeks after the procedure.

Low efficiency of the method. Conization as a treatment method severe cervical dysplasia and cancer prevention is effective only in 30-50% of cases. These are official statistics.

Relapse. Conization does not protect against recurrence of the underlying disease.

Disease progression. In 50-70% of cases, within 6-24 months the course of the disease follows a pessimistic scenario and enters a more severe stage.

Second-degree dysplasia turns into third, third-degree dysplasia and leukoplakia into non-invasive cervical cancer.

Conization does not cure HPV. Human papillomavirus(HPV) remains in the epithelium of the cervix, remains active and in 50-70% of cases after treatment causes relapse.

Standard immunocorrection programs strengthen the immune system, but do not get rid of HPV, the cause of precancerous diseases of the uterus.

Any surgical intervention is a provoking factor.

Firstly, it provokes infection - it becomes more resistant (resistant) to any treatment methods. Secondly, in the presence of tumor cells, any surgical intervention makes the tumor cells more aggressive - it activates tumor growth and the process of metastasis.

Video of loop conization of the cervix

Often re-conization is not possible. Each woman has an individual anatomy of the cervix, and not everyone can undergo a second conization after the first conization, even if there are indications. In this case, classical medicine can only offer amputation of the cervix or the entire uterus.

Young women come to see me every day, often having not even partially fulfilled their reproductive function, “wrung up” about the outcome of the disease, with a strong recommendation from their attending physicians to immediately remove the uterus.

Therefore, before planning treatment, I have to engage in psychotherapy and restore a method discredited by colleagues.

The only immediate complication can be considered heavy bleeding after conization, inflammation (temperatures above 37.5° C require consultation with a doctor) and narrowing of the cervical canal (stenosis) during the healing process, which can be completely resolved in outpatient setting. But long-term complications are much more serious.

The epithelium, cervical size and cervical plug are a powerful part local immunity, laid down by nature.

After conization, the anatomy of the organ and vagina changes, and the cervix shortens. A short cervix and changes in the composition of the secretion of the plug in the cervical canal cannot fully serve as a barrier between the external environment and the uterus. Increased risk of developing infectious diseases uterus and appendages. And the higher the operation is performed, the higher the risks.