The natural history of cervical cryosurgical healing - The minimal effect of debridement of the cervical eschar

BACKGROUND Cryosurgery is a favored treatment method for cervical intraepit helial neoplasia (CIN) among family physicians, in part because it is inexp ensive and requires the least technical training and skill. Although cervic al cryosurgery has been used for more than 30 years. the natural history of the postprocedure process has never been described. The primary purpose of our study was to describe the natural history of the healing process after cervical cryosurgery. A secondary purpose was to determine the effect of m echanical debridement of the cervical eschar on the symptoms of healing. METHODS We conducted a prospective multicentered trial in which women who h ad a histologically documented CIN lesion underwent cervical cryosurgery. F orty-six women were randomized to undergo eschar debridement at 48 hours af ter cryosurgery, and 38 women received standard care. women were followed u p and given preweighed sanitary pads for hydrorrhea (watery discharge) coll ection and a diary to record the severity and number of days of odor, pain, tramping. and hydrorrhea that were experienced. RESULTS The average total amount of hydrorrhea or discharge was 288 g, whic h required using an average of 41 sanitary pads during a period of 12.4 day s, The duration of odor was 8.9 days, and the pain and cramping experienced after cryosurgery lasted 4.7 days. Women who were obese had greater hydror rhea and pad usage than nonobese women. Debridement of the cervical eschar did not significantly change the signs and symptoms of healing after cryosu rgery. CONCLUSIONS There are significant symptoms patients experience after cryosu rgery that are not ameliorated by debridement. The expectations of the cryo surgical healing process should be disclosed to women before the procedure.