The cervical conization is done to women who have been diagnosed with a precancerous or premalignant lesion in the neck of the uterus . These lesions appear as a consequence of a persistent infection by the human papilloma virus (HPV), which is acquired by having sexual intercourse.
Summary
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- 1 Objective
- 2 Tips for the patient
- 3 Healing and risk of new injuries after cervical conization
- 4 Recommendations to reduce the risk of new injuries after cervical conization
- 5 Reasons to get vaccinated
- 6 Source
objective
The goal of cervical conization is twofold: Treatment of premalignant lesions of the cervix, the spontaneous evolution of which, in some cases, may pose a risk of developing cervical cancer. Therefore, it is a preventive treatment for this type of cancer.
Definitive diagnosis of the lesion and, in exceptional cases, allows us to rule out the existence of very early cervical cancer.
In the short term, during the days after conization.
- Hemorrhage (superior to a menstruation) that does not ease following the indications of your doctor and requires an emergency room visit. It occurs in about 2% of cases and is easily resolved by clotting bleeding points.
- Wound infection. Still less frequent. It is manifested by discomfort in the pelvis, abundant smelly and purulent-looking discharge and occasionally fever. It is treated with antibiotics .
Long term, months or years after treatment. Consequences on reproduction.
- Narrowing of the cervical canal . Exceptionally, the wound, when it heals, narrows the cervical canal excessively, causing difficulty for menstruation or getting pregnant.
- Abortions or premature deliveries. The effect of conization is controversial in this type of complications, which are already frequent in the general population of pregnant women who have not undergone conization.
The weakening of the cervix after wide conizations or several conizations due to recurrence of the lesion would explain why in some cases there are abortions in the second trimester or premature deliveries.
- No effect on sexual life has been demonstrated.
Tips for the patient
Before conization :
- Carry out a basic preoperative study.
- Inform the doctor if you have inflammatory signs that indicate vulvo-vaginal infection.
- Go accompanied.
- It is not necessary to go on an empty stomach if the conization is performed under local anesthesia.
- Fast in the 8 hours prior to conization if performed with regional or general anesthesia.
Rest, especially the first 3-4 days. Subsequently limit vigorous physical activity for the next 10 days.
- Avoid soaking in water or douches or using tampons for the first 3-4 weeks.
- Avoid having sex for the first 4 weeks after treatment.
- Little or moderate vaginal bleeding (less than menstruation) or loss of pink or dark discharge in variable amounts during the days after treatment is normal.
- You should consult your doctor if you have heavy bleeding (higher than menstruation) that does not stop with rest, or a smelly and very heavy flow.
Other reasons for consultation should be persistent abdominal pain or fever.
Healing and risk of new injuries after cervical conization
After treatment, the injury may be completely healed, which generally occurs in more than 90% of cases, or the injury may reappear after a time. In general, women treated for a premalignant cervical injury are more likely to have new injuries or cancer, so it is advisable to perform more stringent checks and controls.
The reasons for the appearance of new injuries after a conization are:
Persistence of a residual lesion, generally associated with incomplete removal.
New infection with the same type of HPV that caused the injury or with a different type of HPV (there are up to 15 types of HPV with the capacity to produce cancer and precancerous lesions), leading to the development of a new injury.
Recommendations to reduce the risk of new injuries after cervical conization
In order to reduce the risk of developing a second injury it is recommended:
- Use of condoms. Its use is recommended during the first 6 months after conization .
A test is usually done at this time to see if you have HPV. From here the doctor will advise you if it is convenient to continue using it.
- Give up the birth control pill . An increased risk of HPV persistence has been demonstrated among long-term users of this method.
This recommendation makes more sense if the condom is used until the disappearance of HPV.
- If you are a smoker you should stop smoking. Tobacco use has been shown to interfere with the immune system’s ability to defend itself against HPV, predisposing it to persistent infection and therefore the appearance of new lesions.
- Taking the cervical cancer vaccine (full three-dose regimen) can reduce the risk of new lesions by 60-80% in women previously treated with cervical conization.
Reasons to get vaccinated
Women who have been treated for a previous injury can benefit from the preventive capacity of this vaccine as it has been shown that:
The risk of cervical cancer among women treated for a precancerous lesion is greater than that of the general population over the next 10-20 years.
They are more likely to get a new HPV infection and to develop new lesions on the cervix or other areas of the genital tract.
At an older age, women have a lower ability to eliminate HPV infection, which means that the virus is more likely to persist and, consequently, a greater risk of developing premalignant lesions or cancer over time.
Previous infection with one type of HPV does not always provide protection against new infections with this same type of HPV, which poses a potential risk of developing a new injury.
The vaccine will not heal your current injury. The goal of vaccination is therefore to reduce the risk of new HPV infections and injuries. Recent data confirms the reduced risk of new post-treatment injuries among previously vaccinated women, which is an additional benefit to conization.
The vaccine can prevent infections by the types of HPV included in its composition (16 and 18) and which cause more than 70% of cases of cervical cancer. But, in addition, it also partially protects against other types of HPV not included in the vaccine and that cause approximately another 13% of cases of cervical cancer.
Your doctor will advise you on the best time to administer the vaccine, but it seems advisable to administer it as soon as possible.
