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  Thomas Ind, Gynaecological Surgeon.   thomas ind
    Gynaecological Surgeon Royal Marsden and
St George’s Hospitals
   
51 Sloane Street, London SW1X 9SW
Tel: 020 7201 2666; Fax 020 7823 1499
   
 
   
 
Treatment for CIN
Many people think that treatment for CIN involves LASER. In fact, LASER is used little nowadays and has been superseded by more modern techniques such as diathermy excision. This is sometimes called LLETZ (Large Loop Excision of the Transformation Zone) or LEEP (Loop Electrical Excision Procedure). Other methods also exist such as something called Cold Coagulation, however, this leaflet concentrates on LLETZ which is the most common method of treatment.


Why do I need treatment?

The main reason for performing treatment is to remove an area of cells with an abnormality called CIN. CIN stands for
Cervical Intraepithelial Neoplasia which in layman’s terms might translate as Cervix In-the-skin New-cells. These are abnormal cells that exist in the cervix due to changes caused by the wart virus. If left untreated, the CIN cells might turn into cancer.

Not all CIN cells need treatment but only those that are not mild or which have persisted. The CIN cells might have been detected firstly by the smear test and then confirmed during a colposcopy examination and possibly a biopsy.


Where does treatment occur?

Treatment usually occurs as an outpatient (in the clinic). Occasionally, women who find the colposcopy examination particularly uncomfortable and other women with pre-existing conditions need treatment under general anaesthetic.


What happens during treatment?


A colposcopy examination is performed in the same manner it was previously (see leaflet on colposcopy). Once the gynaecologist has decided which area of the cervix should be removed, local anaesthetic is injected. This is very fast acting and sometimes makes you feel a little light headed. If LLETZ is used, a suction device is then turned on and treatment is performed. The whole procedure usually takes less that 15 minutes.


What are the complications?

Treatment for CIN is generally very safe. Very few complications exist but some important problems can occur. Some women bleed excessively following treatment. In very rare circumstances this can be so severe that a woman requires admission to hospital and administration of a blood transfusion. However, this is very rare. Bleeding can occur late after treatment as bacteria that live naturally in the vagina cause vessels to open up. If this occurs, women sometimes need additional measures to stop the bleeding.

Older methods of treatment were sometimes complicated by conditions known as ‘cevical stenosis’ and ‘cervical incompetence’. It is controversial as to whether these complications exist or not with newer forms of treatment. It is probable that they can exist, but only extremely rarely. Cervical incompetence is a condition associated with repeated miscarriage in pregnancy. Cervical stenosis is when the neck of the womb blocks off preventing women from having periods. Cervical stenosis can also cause infertility and pain. These complications are so rare that they are always outweighed by the risks of not having treatment for CIN.


What is the success rate?

Ninety five percent of women are cured following their first treatment. Some women need continued surveillance for minor abnormalities following treatment and others need repeated treatment. It is important you have the follow-up smear tests that you are recommended.


What should I do after treatment?


It is recommended that women do not return to work on the day of treatment but most women can return to work the next day. If you have bleeding which is worse than the worse day of your worse ever period then you need to see a doctor as an emergency. You should contact your gynaecologist or present to a hospital casualty. You should refrain from sex for four weeks following treatment because of the risks of bleeding complications.


Follow-up appointments?

The frequency of follow-up appointments depends on the abnormality.

After treatment for CIN it is normal to require at least one follow-up appointment after treatment. If you have been discharged from the colposcopy clinic, you may require smears more frequently than you had them before. You should always ensure that you know when your next smear test should be afterwards.
 
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