Atlas of Colposcopy: Principles and Practice

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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.
Note: Different treatment times of 20 or 30 seconds per application are also practised.

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