CRYOTHERAPY OF THE CERVIX AND GENITAL WARTS
Cryotherapy is a minimally invasive way to freeze abnormal tissue by placing a small frozen metal probe against the target area. In gynecology, it can be used to treat cervical dysplasia (pre-cancer) and genital warts. It is an outpatient procedure that is completed in a few minutes and requires no anesthesia and no down time. The success rate for treating both cervical dysplasia and genital warts with cryotherapy is greater than 90%.
What happens during cervical cryotherapy to treat cervical dysplasia?
Cervical cryotherapy, or freezing, usually lasts about 5-10 minutes and causes slight discomfort. The steps include:
1. We will check a urine pregancy test to make sure you are not pregnant and then a pelvic exam is performed. The speculum will be inserted and a brief repeat colposcopy will be performed to visualize the areas of dysplasia.
2. A metal probe is selected based on the size and location of the abnormal area. A small amount of lubricant is placed on the probe which is then attached to the cryo machine.
3. The entire device is placed against the cervix and, using liquid nitrogen in a gas form, cools the cervix to sub-zero temperatures. This is done in a freeze-thaw-freeze type manner to make sure the cells are adequately treated. The destroyed cells are shed afterwards in a heavy watery discharge over the next few weeks.
What happens after the procedure?
Cervical cryotherapy is often followed by a heavy and sometimes foul-smelling discharge for about a month after the procedure. The discharge is due to the abnormal cells leaving the treatment site. The patient should abstain from sexual intercourse and not use tampons for three weeks after the procedure. Excessive exercise should be avoided for 3 weeks as well, to lessen the occurrence of post-therapy bleeding. Patients should avoid bathing but showering is just fine. No douching or feminine products should be used.
Following the cryo procedure, it is also considered normal to experience the following:
- slight cramping for two to three days
- watery discharge requiring several pad changes daily
- bloody discharge, especially 12–16 days after the procedure
A follow-up pap smear will be performed within six months of the procedure. A normal result means all the abnormal cervical cells have been treated and not reoccured. If normal, pap smears are repeated every six months for 1-2 years. If the follow-up pap smear is abnormal, a colposcopy with biopsy will be performed. Other treatment methods, usually the loop electrocautery excision procedure (LEEP), are then used if persistent disease is discovered.
What risks are associated with cryo?
- Mild to moderate uterine cramping occurs during the cryotherapy but rapidly subsides after treatment. We recommend that you take 400 mg of Ibuprofen before your procedure to help minimize your discomfort.
- Bleeding and infection of the cervix are rare, but incidences have been reported.
- Future Pap smears and colposcopy may be more difficult after cryotherapy. This is due to slight scarring at the cervical opening called the “os”; however this is not likely to occur especially if you are compliant in returning for the prescribed frequent pap smears which are required after your cryo procedure.
- Cervical factor infertility: Because the cervix cells are frozen and scarring can occur, it can sometimes affect the production of cervical mucus and cause problems with fertility due to the decrease in cervical mucus. This is not common.
What are alternatives to cryotherapy?
- Laser treatment.: A carbon dioxide laser focuses a beam of light to vaporize the abnormal cells.
- Loop electrocautery excision procedure (LEEP): This procedure uses a fine wire loop with an electric current flowing through it to remove the desired area of the cervix. Loop excision is usually done under local anesthesia and causes very little discomfort.
- Expectant management with serial pap smears if you are a candidate.
What’s involved with cryo treatment for genital warts?
Cryotherapy for the treatment of genital warts is an alternative to TCA (trichloracetic acid) application, LASER, and aldara cream treatment. It involves a simple 5-10 minute procedure which uses the cryo machine and a special, directed probe designed to apply liquid nitrogen under pressure specifically to the affected areas. This causes the warts to slough off over the next several days. The procedure causes slight discomfort which is generally alleviated by using Advil or Aleve and cold compresses as needed. After the procedure you may choose to return to work or relax. Sometimes one treatment is all that is needed, but in other cases a repeat treatment may be required. A follow up appointment is suggested in 3 weeks to evaluate. There may be residual scarring from the treatment of warts no matter what treatment method is chosen.
Cryotherapy is another minimally invasive treatement alternative we offer at Peachtree Gynecology, but it is not appropriate for everyone. Give us a call at 678-539-5980 to see if this may be an option for you.