Treatment by thermal coagulation – Steps
- Counsel the woman, and obtain informed consent.
- Colposcopically re-evaluate the lesion and ensure that:
- The lesion is completely ectocervical, with a type 1 TZ.
- The lesion does not extend to more than 75% of the cervix.
- The lesion does not extend to the vagina.
- The lesion does not have any features suspicious of cancer.
- Remove the colposcope, and use a focusing light to expose the cervix.
- No anaesthesia is required for thermal coagulation.
- Moisten the cervix with a saline-soaked cotton swab, for good thermal conduction.
- Apply the cold coagulator probe to the TZ so that the centre of the tip is on the external os.
- Maintain the temperature at 100 °C constantly.
- The formation of small bubbles around the probe indicates that thermal coagulation is taking place.
- Keep the probe in contact with the TZ for 45 seconds.
- Withdraw the probe from the cervix after 45 seconds; a crater will be visible.
- If the entire TZ is not covered by a single application, apply the probe to another part of the cervix and treat for 45 seconds (up to 5 overlapping applications can be made).
- Switch off the machine once the applications are complete.
- Remove the probe carefully so that the hot probe does not touch the vaginal walls.
- Remove the speculum gently.
- Ask the woman to continue lying down for 5 minutes before getting up.
- Counsel the woman, and give appropriate follow-up advice.
Different treatment times of 20 or 30 seconds per application are also practised.
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