Healing Experiences After Cervical Cryosurgery
Study Methods
All women who underwent cryosurgery were mailed a questionnaire and cover letter with instructions to return the survey in an enclosed self-addressed, stamped envelope. If the survey was not returned within 3 weeks the research assistant at each clinical site invited the woman to complete it when she presented for the next scheduled follow-up visit.
Data Analysis
Obesity, gravidity, and age were modeled as both continuous and dichotomous variables. Dichotomous definitions included obesity as a body mass index (BMI) of 26 kg/m2 or greater,10 nulligravidity as no pregnancies, and young age as less than 26 years, as most CIN develops in college-aged or younger sexually active women.11
All survey responses were coded and entered into Statistica software (Statsoft, Tulsa, Okla) for descriptive frequency analyses, chi-square testing of dichotomous variables, Likert scale means testing by the t test for independent variables, and Pearson correlation coefficients. Casewise deletion was not used to eliminate partial responses in the analysis.
Results
Of the 85 women who participated in the study, 72 completed the survey for a response rate of 84.7%. The mean time from the cryosurgical procedure to completion of the survey was 11.4 days (standard deviation [SD]=14.4), with a range of 1 to 57 days paralleling the cessation time for hydrorrhea. All women answered 27% of the questions, and 28% of women answered all of the questions. There was no pattern of nonresponse. [Table 1] shows the characteristics of the women who participated in the survey.
The cryosurgical healing process was unpleasant for 78.3% (54/69) of the women because of the pain and cramping following the procedure and the resulting hydrorrhea, odor, and necessity of wearing pads for protection. Of all the women, 8.7% felt neutral toward the experience, and 13% considered the experience positive. Even though unpleasant, only 53.5% (38/71) reported that the hydrorrhea was bothersome to them, and of those, 47.4% (18/38) quantified the hydrorrhea as very or extremely bothersome. Of all the women, 61.1% (44/72) responded affirmatively to the dichotomous question that wearing pads was bothersome, and of those, 34.1% (15/44) quantified the degree of inconvenience as very or extremely bothersome. Of all the subjects, 51.4% (37/72) stated that there was a foul to very foul odor associated with the hydrorrhea. Detailed frequencies and the mean Likert score intensities are displayed in [Table 2].
[Table 3] shows the comparisons of the cryosurgical healing process to normal menses. Of all the women, 66.7% (48/72) used pads for their menses. Of these, 61.7% ranked the use of the pads after cryosurgery as the same or less aggravating than those for their menses, and 51.1% (24/47) felt the frequency of pad changes required was more or much more than with normal menses. Of all the women, 52.8% (38/72) ranked the volume of hydrorrhea after cryosurgery as more or much more than with their menses.
Women who experienced light menstrual volumes perceived significantly more hydrorrhea from cryosurgery, while women who experienced heavy menstrual flow experienced significantly less hydrorrhea from cryosurgery. Of all the women, 56.3% felt that their experience with cryosurgery restricted their activities more than their normal menses. The restrictions were described through open-ended questions for at least one of 5 reasons: (1) social embarrassment due to overflowing and malodorous hydrorrhea; (2) concern for impairment of the healing process if normal activities, such as lifting, were resumed; (3) the abdominal and pelvic discomfort that continued for days after the procedure; (4) the inability to sleep at night because of the overflow of hydrorrhea; and (5) the physician-imposed limitations of no vaginal intercourse.
Medications for menstrual cramps were taken by 26.8% of the women, while after cryosurgery 67.1% of women reported taking medication (chi-square=23.09; P <.0001). Only 16.9% of the women stated that they were restricted in their activities because of their menses, while 38.6% stated they were limited by the hydrorrhea from the cryosurgery (chi-square=8.27, P=.004).
[Table 4] has the mean of the experiences with the cryosurgical healing process from the 3 subsets of women. For all 3 population subsets-those with obesity, younger age, and nulligravidity-the cryosurgical healing process results in significantly more medications being taken and activities restricted significantly more than for menses (obese: P=.0246; nonobese: P=.0043; multigravid: P=.0061; young: P=.0014; old: P=.001), an association seen for the general population. Activity restrictions were greater for the healing process than for menses for each of these respective groups of women (obese: P=.0018; nonobese: P=.0037; multigravid: P=.0084; young: P=.0500; old: P=.0419).
Obese women whose BMI was greater than 26 kg/m2 were significantly more bothered by wearing pads after cryosurgery than those with a lesser BMI (t=2.33, P=.0246). Multigravid women were more likely to be bothered or aggravated by wearing pads than nulligravid women (t=2.88, P=.0061). Similarly, women older than 26 years were more likely to be bothered by pad use than younger women (t=2.14, P=.0383). In the group of women aged 26 years or younger we found that those aged 15 to 18 years were significantly less bothered about the hydrorrhea than those in the 19 to 22 years cohort (1.0 vs 3.4, t=3.35, P=.0122), considered the frequency of pad changes to be less aggravating than menses than the 19 to 22 years cohort (2.67 vs 4.0, t=3.65, P=.0020), but considered the hydrorrhea more malodorous than those aged 19 to 22 years (4.3 vs 3.2, t=2.33, P=.0325).
