Cervical surgery encompasses any procedure performed on the cervix, the lower, narrow part of the uterus that connects to the vagina. This cylindrical organ is often referred to as the “neck of the uterus.” Its primary function is to act as a barrier, protecting the uterine cavity and regulating the passage of substances, including menstrual flow. The cervix must also widen significantly during childbirth. Cervical surgery is a focused medical intervention designed to treat or remove abnormal tissue or correct a structural weakness in this organ.
Conditions Requiring Cervical Surgery
The need for cervical surgery most often arises from the detection of abnormal cell changes found during a routine Pap test. These cellular irregularities, known as cervical dysplasia or Cervical Intraepithelial Neoplasia (CIN), are frequently caused by a persistent Human Papillomavirus (HPV) infection. While low-grade dysplasia (CIN 1) often resolves naturally, moderate to high-grade changes (CIN 2 or CIN 3) require surgical intervention to prevent progression into invasive cervical cancer.
Cervical cancer, particularly in its early stages, is another primary reason for surgical management. The type of surgery depends heavily on the cancer’s stage, the size of the tumor, and the patient’s desire to preserve fertility. A third indication for surgery is cervical incompetence, a condition where the cervix prematurely shortens or dilates during the second trimester of pregnancy. This structural weakness can lead to preterm birth or pregnancy loss, and a procedure called cerclage is used to physically reinforce the cervix in these cases.
Types of Cervical Surgical Procedures
The specific surgical technique chosen depends on the underlying medical diagnosis, ranging from minimally invasive excisions to extensive cancer operations.
Loop Electrosurgical Excision Procedure (LEEP)
For treating high-grade precancerous lesions (CIN 2/3), LEEP is a common outpatient option. During LEEP, a thin wire loop heated by an electrical current precisely cuts away a cone-shaped piece of abnormal tissue from the cervix. This technique simultaneously removes the abnormal cells and cauterizes the remaining tissue to control bleeding, often allowing the procedure to be performed under local anesthesia.
Cold Knife Cone Biopsy
This excisional procedure uses a surgical scalpel instead of an electrified wire to remove a larger, deeper cone of tissue. This method typically requires general or regional anesthesia and is favored when abnormal cells extend higher into the cervical canal, or when a specimen free of thermal damage is needed for precise pathological analysis. Because this technique removes a greater volume of tissue, it can serve as both a diagnostic tool and a curative treatment for very early-stage cancer.
Radical Trachelectomy
For early-stage cervical cancer in individuals who wish to retain the ability to conceive, a fertility-sparing radical trachelectomy may be performed. This complex operation involves removing the entire cervix, the adjacent supportive tissue known as the parametrium, and the upper section of the vagina. The body of the uterus is preserved, and a cerclage suture is permanently placed at the new opening of the uterus. This procedure allows for effective cancer treatment while maintaining reproductive potential.
Cerclage
The cerclage procedure manages cervical incompetence during pregnancy by placing a suture around the cervix to keep it closed. The two main transvaginal techniques are the McDonald cerclage, which uses a purse-string stitch high on the cervix, and the Shirodkar cerclage, where the suture is placed higher after reflecting the cervical tissue. This surgical stitch is typically placed between 12 and 14 weeks of gestation and is removed near the end of the pregnancy, around 37 weeks.
Understanding the Recovery Process
Recovery expectations depend on the extent of the procedure, but most excisional surgeries like LEEP and Cone Biopsy share common short-term symptoms. Patients can expect light spotting and mild cramping, similar to menstrual discomfort, for up to two weeks. A dark, brownish or yellowish discharge is also common, resulting from medicated pastes applied to the cervix.
A full recovery for LEEP typically takes about four weeks, while the deeper Cold Knife Cone Biopsy may require slightly longer. During this initial healing phase, specific restrictions are put in place to prevent infection and hemorrhage. Patients are advised to refrain from placing anything into the vagina—including sexual intercourse, tampons, or douching—for approximately four to six weeks. Patients should also avoid heavy lifting or strenuous exercise for at least one to two weeks.
Follow-up appointments are routinely scheduled to ensure all abnormal cells were successfully removed and that the cervix is healing properly. Patients should monitor for signs requiring immediate medical attention, such as:
- A fever exceeding 101°F.
- Heavy vaginal bleeding that soaks more than one sanitary pad per hour.
- The passage of large blood clots.
- Severe or worsening abdominal pain.