title: The natural history of cervical cryosurgical healing. The minimal effect of debridement of the cervical eschar [see comment].
abstract: BACKGROUND
  Cryosurgery is a favored treatment method for cervical intraepithelial neoplasia (CIN) among family physicians, in part because it is inexpensive and requires the least technical training and skill. Although cervical cryosurgery has been used for more than 30 years, the natural history of the postprocedure process has never been described. The primary purpose of our study was to describe the natural history of the healing process after cervical cryosurgery. A secondary purpose was to determine the effect of mechanical debridement of the cervical eschar on the symptoms of healing.
  
  
  METHODS
  We conducted a prospective multicentered trial in which women who had a histologic ally documented CIN lesion underwent cervical cryosurgery. Forty-six women were randomized to undergo eschar debridement at 48 hours after cryosurgey, and 38 women received standard care. All women were followed up and given preweighed sanitary pads for hydrorrhea (watery discharge) collection and a diary to record the severity and number of days of odor, pain, cramping, and hydrorrhea that were experienced.
  
  
  RESULTS
  The average total amount of hydrorrhea or discharge was 288 g, which required using an average of 41 sanitary pads during a period of 12.4 days. The duration of odor was 8.9 days, and the pain and cramping experienced after cryosurgery lasted 4.7 days. Women who were obese had greater hydrorrhea and pad usage than nonobese women. Debridement of the cervical eschar did not significantly change the signs and symptoms of healing after cryosurgery.
  
  
  CONCLUSIONS
  There are significant symptoms patients experience after cryosurgery that are not ameliorated by debridement. The expectations of the cryosurgical healing process should be disclosed to women before the procedure.
authors.affiliation: Department of Community and Family Medicine, Norris Cotton Cancer Center, Dartmouth Medical School, Lebanon, NH 03756, USA. Diane.M.Harper@Dartmouth.edu
authors.forename: D M
authors.initials: DM
authors.lastname: Harper
authors.forename: E J
authors.initials: EJ
authors.lastname: Mayeaux
authors.forename: T P
authors.initials: TP
authors.lastname: Daaleman
authors.forename: L D
authors.initials: LD
authors.lastname: Woodward
authors.forename: D G
authors.initials: DG
authors.lastname: Ferris
authors.forename: C A
authors.initials: CA
authors.lastname: Johnson
mesh_terms: D000328:Adult; D003452:Cryosurgery / Q000379:methods*; D003646:Debridement; D005122:Exudates and Transudates; D005260:Female; D006801:Humans; D016014:Linear Models; D009765:Obesity / Q000150:complications; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D014945:Wound Healing; D002578:Uterine Cervical Dysplasia / Q000601:surgery*