Published: 18 Jun 2025

ICD9: 67.2      ICD10: M43.22      ICD11: GA1Z

A cervical conization, also known as a cone biopsy, is a surgical procedure used to remove a cone-shaped piece of tissue from the cervix.
The cervix is the lower, narrow end of the uterus that opens into the vagina.

Here's a breakdown of what it is, why it's done, how it's performed, and what to expect:

Why it's done:

The primary reasons for a cone biopsy are:

To diagnose or treat precancerous conditions of the cervix: This is the most common reason. If a Pap smear shows abnormal cells (dysplasia) or a colposcopy (examination of the cervix with a magnifying instrument) reveals suspicious areas, a cone biopsy can be performed to get a larger, deeper tissue sample for analysis. This helps determine the severity of the abnormal cells and whether they are cancerous. Sometimes, removing the cone of tissue also removes all the abnormal cells, effectively treating the condition.
To diagnose early cervical cancer: If a Pap smear or colposcopy is highly suggestive of cancer, a cone biopsy can be used to confirm the diagnosis and determine the stage of the cancer.
To investigate unexplained vaginal bleeding: In rare cases, a cone biopsy might be used to investigate persistent, unexplained vaginal bleeding.

How it's performed:

There are several techniques for performing a cone biopsy:

Loop Electrosurgical Excision Procedure (LEEP): This is the most common method. It uses a thin, heated wire loop to cut away the cone-shaped tissue. The heat also helps to seal the blood vessels, minimizing bleeding.
Cold Knife Conization: This involves using a scalpel to surgically remove the tissue. It might be preferred if a larger tissue sample is needed or if there's suspicion of invasive cancer. It often requires stitches.
Laser Conization: A laser is used to cut away the tissue.

The procedure is typically performed in a doctor's office, clinic, or hospital as an outpatient procedure, meaning you usually go home the same day.

During the Procedure:

1. Preparation: You'll lie on an exam table similar to a Pap smear. A speculum is inserted into the vagina to visualize the cervix.
2. Anesthesia: Local anesthesia is usually injected into the cervix to numb the area. Sometimes, general anesthesia or sedation is used, particularly for cold knife conization, so you are asleep during the procedure.
3. Tissue Removal: The chosen technique (LEEP, cold knife, or laser) is used to remove the cone-shaped tissue.
4. Hemostasis (stopping the bleeding): Bleeding is controlled with electrocautery (using heat to seal blood vessels) or stitches.

After the Procedure:

Recovery: You'll be monitored for a short time after the procedure. If you had general anesthesia, you'll need a longer recovery period.
Discharge Instructions: You'll receive instructions on what to expect and how to care for yourself at home.
Common Side Effects: Expect some vaginal bleeding or spotting for a few weeks. You may also experience mild cramping.
Restrictions: You'll typically be advised to avoid:
Using tampons
Douching
Sexual intercourse
Heavy lifting
Strenuous exercise
for a few weeks to allow the cervix to heal.
Follow-up: A follow-up appointment is scheduled to discuss the results of the biopsy and to monitor your healing.

Risks and Complications:

While generally safe, a cone biopsy carries some risks, including:

Bleeding: Excessive bleeding can occur during or after the procedure.
Infection: Infection is possible, though relatively uncommon.
Cervical Stenosis: Narrowing of the cervical opening, which can sometimes cause problems with menstruation or fertility.
Cervical Insufficiency: Weakness of the cervix, which can increase the risk of premature labor in future pregnancies (more likely with larger cone biopsies).
Scarring: Scar tissue can form on the cervix.
Difficulty getting pregnant: In rare cases, the procedure can affect fertility.

Important Considerations:

The specific recommendations for preparation, recovery, and follow-up may vary depending on the technique used and your individual circumstances.
It's crucial to discuss any concerns or questions you have with your doctor before undergoing a cone biopsy.
Accurate diagnosis and treatment are essential for preventing the progression of precancerous cervical changes to cancer.

In summary, a cervical conization is a valuable diagnostic and therapeutic tool for managing abnormal cervical cells. It allows for a more thorough evaluation of the cervix and can often prevent the development of cervical cancer. Discuss any concerns and questions you have with your doctor to make informed decisions about your health.