The Natural History of Cervical Cryosurgical Healing

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Original Research

The Natural History of Cervical Cryosurgical Healing

J Fam Pract. 2000 August;49(8):694-700

References

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The maximum duration of hydrorrhea was 29 days. None of the 20% of the study population who had menstrual cycles longer than 30 days, were using long-acting contraception, or were menopausal reported hydrorrhea for longer than 29 days. The average duration of hydrorrhea was 12.4 days (SD=5.5), and more than half of the total amount was discharged during the first 6 days after cryosurgery (mean=164.4 g; SD=91.4) versus 123.4 g (SD=133.4; P=.0024).

Women recorded malodor an average of 72.3% (SD=35.2%) of the time that they also experienced hydrorrhea, and the average duration of malodorous hydrorrhea was 8.9 days (SD=5.7) with a maximum of 23 days ([Figure 2]). Malodor was experienced by the greatest number of women on days 3 through 5 following cryosurgery, with 82.7% of women experiencing this on day 4 after cryosurgery. The intensity of the overall malodorous hydrorrhea was 3.4 (SD=1.2).

Women experienced pain and cramping following cryosurgery an average of 4.7 days (SD=3.5) with some reporting pain at 18 days. Pain and cramping were recorded 43.1% (SD=32.6%) of the days that there was also hydrorrhea; however, the duration of the pain and cramping was independent of the duration of the hydrorrhea.

Nearly one third of the study population (30.6%) ceased having hydrorrhea before their menses, which provided a subgroup to most accurately examine the postcryosurgery natural history. These women experienced an average total hydrorrhea amount of 365 g (SD=234), with an average daily hydrorrhea amount of 26.6 g (SD=15.7) and a discharge maximum of 803 g. This subset used an average of 46.0 pads (SD=21.1), changing pads a maximum of 10 times a day on day 11 after cryosurgery, and their average duration of hydrorrhea was 14.6 days (SD=5.8) with a maximum of 24 days of hydrorrhea. The total average amount of hydrorrhea and the average duration were significantly prolonged in this cohort of women compared with those whose pad collection stopped because of menses (average total of 365 g [SD=234] vs 261 g [SD=164], P=.0216; average duration of 14.6 days [SD=5.8] vs 11.5 days [SD 5.1], P=.0174).

Women whose hydrorrhea stopped before menses experienced more hydrorrhea during the first 7 days after cryosurgery than in the subsequent 17 days (217.5 g [SD=128.8] vs 147.3 g [SD=142.0], P=.0150). Because malodor is associated with the healing process, and the duration of pain or cramping after cryosurgery occurred most often in the early days of the healing process, these symptoms (malodor, pain and cramping) did not differ by reason for cessation of pad collection. The average duration of malodor for these women was 9.7 days (SD=6.9). In this group, 62.9% (SD=38.9%) acknowledged hydrorrhea associated with malodor, and 89.5% stated that this occurred on day 9 after cryosurgery. The mean intensity of the overall malodor was 3.2 (SD=1.1) on the 5-point Likert scale, more than moderately smelly. The average duration of the pain and cramping was 5.1 days (SD=4.4) which was present 41.5% (SD=36.6%) of the days that hydrorrhea was present.

There was no significant difference in the markers that we used to measure the healing process between the debrided and nondebrided cohorts [Table 2]. Debridement did not significantly reduce the amount of hydrorrhea, the number of pads used, the duration of hydrorrhea, the duration or the proportion of days with malodorous hydrorrhea, or the duration of pain or cramping that women experienced. In addition, these findings were consistent when we examined the subset of women whose hydrorrhea stopped before menses. One marker, however, the intensity of the malodorous hydrorrhea, was significantly less for women with eschar debridement than for those without debridement (3.1 [SD=1.1] vs 3.8 [SD=1.1], P=.0220).

We examined the influence of gravidity and obesity on the postcryosurgery course. Although gravidity was not predictive of our measures of the healing process, obesity as measured by a BMI greater than 25 kg/m² positively predicted the total amount of hydrorrhea (P=.0068). BMI was not, however, predictive of the daily amount of hydrorrhea, the number of pads needed, the duration of hydrorrhea, duration or intensity of malodor, and duration of pain and cramping. We examined the subset of obese women who completed their hydrorrhea before their menses (45.7% of the population had a BMI greater than 25 kg/², and 47.8% of these obese women completed their hydrorrhea before their menses). These women tended to have more hydrorrhea than the nonobese women in our study, (448 g [SD=247] vs 301 g [SD=182], P=.12). The average total number and the average daily number of pads used was significantly greater for obese women than nonobese women (63.3 [SD=19.0] vs 35.5 [SD=11.8], P=.0004, and 4.3 [SD=7.2] vs 2.9 [SD=0.5], P=.0450, respectively).