Conization of the cervix is an operation to prevent cervical cancer. It consists of removing a small part of the cervix to confirm the exact type of lesion and its extent.
Conization of the cervix is a surgical procedure that involves removing a small part of the cervix. It is performed in case of severe intraepithelial lesion (due to a papillomavirus-HPV for example) or of carcinoma in situ. It makes it possible to confirm the exact type of lesion and its extent, but also to completely remove the lesions, so that they do not evolve into cancer of the cervix.
What is a conization of the cervix?
The surgical procedure called conization consists of remove a small area of the cervix which has the shape of a cone, hence the name “conization”. The removal is done with a scalpel or laser.
Why is a conization of the cervix done?
When women present a smear with severe lesions (called high grade), best to remove them before they become too aggressive. Conization makes it possible to specify the nature of the atypical cells and the extent of these lesions but also toprevent their progression to cervical cancer.
Conization is performed by natural means. The presence of an IUD is not an obstacle to the examination. The choice of the conization technique depends in particular on the extent of the lesion and the anapathological results of the cells. Conization can be performed usingan electric scalpel (electroconization),a “classic” scalpel or a laser. The procedure can be performed under local, locoregional (epidural) or general anesthesia, depending on the choice of the patient and the decisions of the surgeon and the anesthesiologist. The removed area measures 1 to 2 cm wide and 15 mm in height on average.
It takes place under loco-regional anesthesia, epidural, spinal anesthesia, or under general anesthesia. It therefore does not hurt and conization causes practically no postoperative pain. It is most often performed on an outpatient basis, so the patient can go home a few hours after the end of the procedure. Bleeding may appear in the first few hours following the operation and continue for approximately 2 weeks. During the 4 weeks following a conization, sexual intercourse with penetration is prohibited. Similarly, baths and the use of tampons are to be banned for a month.
What are the risks of conization of the cervix?
This remains rare, but this procedure carries a risk of cervical stenosis (narrowing of the cervix) with possible consequences:
- Hematometry (retention of blood in the uterus)
- infertility
- A risk of premature delivery
- Monitoring difficulties due to difficult access to the uterus
- Obstetric risks of miscarriage and premature delivery.
Can the papillomavirus come back after conization?
After conization, 95% of lesions are permanently eradicated. But long-term monitoring remains essential. Since October 15, 2019 and by decision of the National Cancer Institute (INCa) supported by the French Society of Colposcopy and Cervicovaginal Pathology, the smear is no longer indicated for the follow-up of women treated by conization for lesions high grade. It is replaced by carrying out an HPV test by cervico-vaginal sampling 6 months after stopping treatment. This monitoring test must be carried out every 3 years.
- A negative HPV test following the treatment of a high-grade intraepithelial lesion of the cervix guarantees the success of the treatment.
- A positive HPV test had a colposcopy performed to look for a recurrence.
Can you get pregnant after conization of the cervix?
A pregnancy can be considered following a conization but a risk of premature delivery may exist during a subsequent pregnancy. On the other hand, Doctor Even specifies that “conization cannot be performed during pregnancy because of a risk of premature delivery, cervical dystocia and secondary cervical stenosis”.
How much does a conization of the cervix cost?
Conization is a surgical procedure whose cost varies depending on the practitioner who will perform the procedure. But on average, you have to count a hundred euros. This act is covered by Social Security and by certain complementary health insurance companies (mutuelles).
Thanks to Doctor Marc Even, obstetrician-gynecologist.