Office-based procedure for the treatment of specific
types of abnormal PAP smears
Mild forms of abnormalities found on cervical biopsy may be treated by freezing the cervix with a metal probe, a procedure called “cryotherapy”. ?If you are reading this, it is probably because you have had a PAP smear showing some abnormality, which when evaluated further, showed mild dysplasia. The following is a brief description of the procedure and is designed to answer questions you may have. It is my desire for you to understand why there is need for cryotherapy, and to make you feel more comfortable with the procedure. ??
WHAT IS “DYSPLASIA”?
From the Latin, it’s “Dys (abnormal) – plasia (growth). Abnormal growth of the cells of the surface (skin) of the cervix. This refers to benign cells that may, left unchecked, progress to malignant cells. Often times, when patients present with Low-grade dysplasia, the cellular changes that have occurred may spontaneous change back to normal with no therapy. High-grade dysplasia, however, is more likely to progress to cancer, and therefore is usually treated more aggressively.
MY PAP SHOWED LOW GRADE DYSPLASIA. WHAT DOES THAT MEAN?
This finding is usually associated with an HPV infection. Please see my discussion on this common infection in the section on HPV Vaccine. The virus attacks the cells and induces changes in the cells nucleus that makes them pre-cancerous. “Low-Grade” means that the changes occur in only few cells in the “skin” of the cervix. In a PAP showing Low Grade Dysplasia (LGSIL), colposcopic evaluation and biopsy is indicated to confirm the presence of precancerous cells. If LGSIL is confirmed, then options for therapy include freezing the cervix (Cryotherapy) to kill normal and pre-cancerous cells alike so that healthy cells grow back in their place. Alternatively, since a significant number of LGSIL cells revert back to normal spontaneously, follow-up serial PAP smears can be performed to track the resolution of dysplasia.
HOW IS CRYOTHERAPY PERFORMED?
Cryotherapy works by destroying tissue by causing cytolysis (rupturing of cells) that results in sloughing of the abnormal cells as well as healthy ones. This allows healthy cells to re-grow and replace the abnormal cells. This procedure is specifically targeted to destroy mildly precancerous cells. The procedure is started by placing a speculum into the vagina. A metal probe shaped to completely come in contact with the outside part of the cervix as well as part of the endocervical canal is then placed against the cervix. Nitrous Oxide gas then circulates through the probe and the metal tip freezes. The cold temperature spreads to the cervix and an “ice-ball” forms on the tip of the cervix. The probe is held against the cervix for 5 full minutes, and then is removed for 2 minutes. Then the probe is replaced for another 5 full minutes. At this point, the speculum is removed and the procedure is completed.
During the procedure, it is common to have well-tolerated cramping in response to the freezing of the cervix. This is usually short-lived and resolves when the procedure is completed.
Most women return immediately to their usual routine. There is no need for special care immediately after the procedure.
BENEFITS, RISKS AND ALTERNATIVES
The benefit of cryotherapy is destruction of the abnormal areas with a cure rate of 90 – 95%. The risk of the procedure is negligible. There are no significant fertility risks associated with cryotherapy. As mentioned previously, an alternative to cryotherapy is serial follow-up PAP smears. If this approach is desired, then it is imperative to perform Pap smears and colposcopy at a more frequent interval. If there is no resolution of low-grade dysplasia in a two-year period of time, then treatment is definitely indicated. For the most part, women tend to desire treatment that has significant success rate rather than “waiting and wondering” with follow-up PAPs.
It may take a few weeks for your cervix to heal. While your cervix heals, you may have:
Vaginal bleeding (less than a normal menstrual flow)
A brownish-black discharge initially
A watery discharge that will last up to several weeks.
The reason for the watery discharge is explained in this way: If you were to burn the skin on your forearm, the area would “weep” for a while until a scab forms. The scab stops the weeping until complete healing of the sore has occurred. After cryotherapy, the cervix also “weeps” but since it is so moist and does not come in contact with air, no scab can form. As a result, the cervix keeps weeping until it is completely healed.
For a few weeks after the procedure, you should not have sex or use tampons or douches. If you have any discomfort, we may prescribe pain relief medications. This is unusual, and most of the time Tylenol or Advil will work well for cramping.
We will absolutely want you to return in 3 months for a repeat PAP smear to see if the dysplasia has resolved.