What it is
Conization removes a cone-shaped wedge of the cervix. The point of the cone reaches up into the cervical canal, so it goes deeper than a LEEP.
It is done when abnormal cells sit higher in the canal than a loop can reach, or when the pathologist needs a clean, uncrushed edge to read.
It can be done with a scalpel, a laser or a loop. The scalpel version is called a cold knife cone and happens in an operating room.
Why it is done
- Abnormal cells that extend up into the cervical canal
- A LEEP that came back with abnormal cells at the edge of the specimen
- A biopsy suggesting the abnormality goes deeper than the surface
- A colposcopy that cannot see the top of the abnormal area
- A pap result that does not match what colposcopy found
- Suspected adenocarcinoma in situ, where the margins have to be read cleanly
What happens, step by step
- 1
You are asleep
Most cone biopsies are done under general or spinal anesthesia.
- 2
Marking the cervix
A stitch or dye marks the top of the specimen for the lab.
- 3
Removing the cone
The wedge is cut out around the canal in one piece.
- 4
Controlling bleeding
The base is cauterized, and sometimes stitched.
- 5
To the lab
The cone goes to pathology whole, with its margins readable.
- 6
Home the same day
You go home once the anesthetic wears off.
Questions people ask
- How is this different from a LEEP?
- A cone goes deeper and takes a wedge shape. LEEP is shallower and can be done in the office.
- Does it hurt?
- Not during it, because you are asleep. Afterwards expect period-like cramping for a day or two.
- Can I drive home?
- No. You have had anesthesia, so someone has to drive you.
- Will I still be able to get pregnant?
- Usually yes. A deeper cone can weaken the cervix, so tell your obstetrician you have had one.
- How long does the bleeding last?
- Light bleeding or discharge for two to three weeks. Call if it turns heavy or bright red.
- How much time off do I need?
- Two or three days for desk work. No sex, tampons or swimming for four weeks.