BACKGROUND: Treatment for cervical intraepithelial neoplasia with cryosurgery is uncomfortable for many women. The subsequent healing process is also thought to bring discomfort. The purpose of our study was to describe women’s experiences after cryosurgery, and how obesity, age, and gravidity affected the healing process.
METHODS: We developed a survey from focus group results to measure the unpleasantness of hydrorrhea (watery discharge) from cryosurgery, the pad protection required, and the odor associated with the hydrorrhea. The cryosurgical experiences were compared with normal menses for the use and frequency of pad protection, medications used, and any activity restrictions.
RESULTS: Cryosurgical experiences were unpleasant for 78.3% of the women because of the pain and cramping of the procedure and the resulting hydrorrhea, odor, and necessity of wearing pads for protection. These experiences after cryosurgery caused 38.6% to restrict their activities and 67.1% to take medications, a significantly greater proportion than the 16.9% whose activities were restricted by normal menses and the 26.8% who took medications for normal menses (P=.004, P <.001, respectively). In addition to these experiences, obese, multigravid, and older women were more bothered by the duration of wearing pads than their counterparts (P=.0246, P=.0061, and P=.0159, respectively).
CONCLUSIONS: Our study showed that the cryosurgical healing process was not pleasant, and was least tolerable for obese, multigravid, and older women. As many as 50% of women undergoing cryosurgery will perceive the hydrorrhea, its odor, and the wearing of pads to be worse than normal menses, especially if their menses are usually light.
Women experience discomfort during treatment for cervical intraepithelial neoplasia (CIN). The discomfort from cryosurgery has been studied and is usually alleviated by the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and mucosal blocks before the procedure.1-4 Pain and cramping alleviation is cost-effective.5 The cryosurgical healing process includes malodorous hydrorrhea (watery discharge) that lasts 12 days on average, but can continue for an entire month.6 Specific populations of women who are potentially more bothered by the healing process include those who are obese, nulligravid, and younger. Each of these subsets can experience more dysmenorrhea than their clinical counterparts.7,8
Obese women, in general, do not present for cervical cancer screenings as often as those who are not obese, because of lower self-esteem.9 All women’s experiences and those specific to these 3 groups have not previously been described for cryosurgical healing. Women’s perspectives and experiences with the healing process might influence their compliance with future cervical cancer screenings and treatments.
The purpose of our study was to describe women’s experiences after cryosurgery, particularly in relationship with obesity, gravidity, and age. We postulated that women who were obese, nulligravid, and younger would experience a more unpleasant healing process after cryosurgery than those who were nonobese, multigravid, and older. The experience following cryosurgery was compared with the experience of normal menses, and factors for women’s future treatment decisions were ranked in order of importance.
Methods
Survey Instrument
We designed a survey in 1995 to measure a woman’s experiences with the healing process of cryosurgery. The survey was developed from the results of a focus group of 8 women who had previously experienced cryosurgery. Validity and clarity were established by test-retest comparisons in a second group of women with cryosurgical experience. The survey consisted of 2 fixed-response questions, 8 open-ended questions, 10 dichotomous (yes/no) questions, and 16 5-point Likert-scaled questions. All items gauged the study participants’ experiences following cryosurgery and included questions regarding: the unpleasantness of the healing process, the bother of the hydrorrhea produced from the procedure, the frequency of pad protection required postprocedure, and the intensity of the malodorous hydrorrhea. Women were asked to compare their subjective experiences of menses with their postprocedure experiences in the following categories: use and frequency of pad protection, medication usage, and activity restriction due to hydrorrhea volume. The subjects were also asked to rank which factors were important to them in making their decision for future treatment. The respective institutional review boards or human subjects committees at each of the clinical sites approved the study.
Sample Population
All women who participated in our study had undergone a cryosurgical procedure for histologically proven CIN grade 1, 2, or 3 disease. All demographic information needed for analysis was collected at the time of cryosurgery. The power of our study was designed to detect a difference in experiences from cryosurgery compared with normal menses. Specifically, the study has a 95% power to detect a 20% difference in the proportion of women taking medications to alleviate symptoms and having activity restrictions from cryosurgery compared with normal menses at the P=.05 level of significance. Obesity and age subsets of the population were also powered to 80% to detect a 35% difference in the proportion of women taking medications and having activity restrictions from cryosurgery compared with normal menses at the P=.05 level of significance. The gravidity subset was powered to 80% to detect a 45% difference in the same outcome measures at the P=.05 level of significance.