Cold Coagulation at Guildford Hospital

Cold coagulation is a treatment for abnormal cells on the cervix (the neck of the womb). Despite its name, it actually uses heat, applied through a heated probe, to destroy the abnormal area.

What conditions does cold coagulation treat?

Cold coagulation is used to treat:

• cervical intraepithelial neoplasia (CIN), a pre-cancerous change in the cells of the cervix, picked up by a biopsy at a colposcopy appointment
• cervical ectropion, where delicate soft cells on the cervix bleed easily when touched
• cervical warts and skin tags.

What are the benefits of cold coagulation?

Cold coagulation is successful in more than 9 out of 10 cases, meaning no further treatment is needed.

Unlike excisional treatments such as LLETZ, cold coagulation has also been linked to a lower rate of preterm birth in future pregnancies, which may be relevant if you're thinking about having children.

Are there different ways cold coagulation can be done?

Cold coagulation can be carried out with or without local anaesthetic, depending on the size of the area being treated and your own preference. Without anaesthetic, you may feel a strong period-type cramp; with it, the area is numbed so you shouldn't feel the treatment itself.

What happens before cold coagulation?

Before cold coagulation, you'll usually already have had a colposcopy and biopsy to confirm the abnormal area. Make sure you eat and drink something before your appointment, and let your colposcopist know about any upcoming holidays, as treatment may need to be delayed because of the small risk of bleeding or infection afterwards, and some travel insurance may not cover you straight after treatment.

If you're pregnant, treatment is usually delayed until around 3 months after your baby is born, though a colposcopy, which is safe in pregnancy, may still be suggested to keep an eye on things. If you're on your period, cold coagulation can usually still go ahead as long as bleeding is light.

What happens during cold coagulation?

1. You'll have a colposcopy first, so your colposcopist can see the area that needs treatment.
2. If you're having a local anaesthetic, it's injected into your cervix; this might sting briefly and you may notice your heart beating faster for a couple of minutes. Without anaesthetic, you may feel a strong period-type cramp instead.
3. A heated probe, reaching temperatures of around 60°C to 120°C, is applied to the abnormal area for about 20 seconds. This may be repeated if more than one area needs treating.
4. The treatment itself takes just a few minutes.
5. You'll then rest in recovery for at least 20 minutes, so the whole appointment usually takes about an hour.

What does recovery look like?

In the clinic

You'll rest in the clinic for at least 20 minutes after your treatment, so it's worth allowing around an hour in total for your appointment. You're welcome to bring someone with you for support. If you had a local anaesthetic, you'll be safe to drive home afterwards unless you're told otherwise.

At home

For a few days, you may have some mild period-type pain. You can also expect a watery, blood-stained discharge for up to 4 weeks. Some people feel light-headed or faint afterwards, so if this is likely for you, arrange for someone to take you home.

Until any bleeding or discharge has stopped, avoid penetrative sex, tampons or menstrual cups (pads are fine), heavy exercise, swimming, hot tubs and baths, though you can shower as normal. You can return to work whenever you feel able to. If you have a contraceptive coil fitted, it can stay in place, as the treatment won't affect it. You'll be invited for a follow-up cervical screening test, called a Test of Cure, 6 months after your treatment.

What are the risks and complications?

As with any procedure, cold coagulation carries some risks:

• bleeding: a small risk of heavy bleeding, for example soaking a sanitary pad every hour
• infection: a small risk, with symptoms including painful cramps, a high temperature or smelly discharge
• cervical stenosis: a very small risk that the opening of the cervix narrows due to scarring, which can cause painful periods, difficulty conceiving, or problems with the cervix opening during labour; this risk is higher if you've been through menopause or had previous treatment to your cervix
• burn: a very small risk of a burn to the vagina.