Cervical cancer is a common gynecologic malignancy, which was previously commonly perceived to develop in women over 50 years of age, but in recent years its incidence trend is younger and younger. Among many cancers, cervical cancer is currently the only cancer with a clear causative agent, i.e., persistent infection with high-risk HPV virus is necessary for cancerous transformation. The most common term we come across, CIN, is cervical intraepithelial neoplasia, which is a group of precancerous lesions closely related to the occurrence and development of cervical cancer and is classified into grade I, II and III according to the degree of lesion. About 66% of patients with CIN2/CIN3 who fail to receive timely treatment may develop into carcinoma in situ. Since it takes about 5 to 10 years or even longer from high-risk HPV infection to cervical cancer, and high-risk HPV virus is not irremovable, cervical cancer is completely preventable and controllable. For patients with high-risk HPV infection and CIN changes, in many cases, they will face the recommendation of using cervical loop electrosurgery (LEEP conization). What can avoid conization? Today we will talk about it. What is LEEP conization LEEP conization, is the use of high frequency radio knife generated ultra-high frequency electric wave, in contact with the body tissue at the moment, by the tissue itself to absorb the electric wave generated high heat, so that the intracellular water to form a vapor wave to complete a variety of cutting, hemostasis and other surgical purposes, but does not affect the incision edge tissue pathology examination. Because LEEP conization for cervical lesions is simple to perform, the operation time is short, intraoperative bleeding is low, and the patient recovers quickly, it has become a routine method for the treatment of CIN lesions in clinical operations nowadays. The advantages of LEEP conization are simple operation, removal of cervical lesions, short operation time, less intraoperative bleeding and fast recovery of the patient. The disadvantages of LEEP conization should not be underestimated. 1. There is a risk of residual lesions or recurrence after LEEP conization. Because LEEP conization mainly faces the lesion site, and in order to preserve the normal function of the patient after surgery (such as sex life, fertility), the area of conization will not be too large, generally in the visible lesion site or a slightly expanded range of surgery. Conization does not cut out the virus. But the most fundamental reason for the change of CIN is the infection of high-risk HPV virus, the virus is not visible, the only thing we can see is the result of the changes that have occurred, to give a simple example, high-risk HPV virus is the boss behind the scenes, CIN is the execution of the killer specializing in bad things, and LEEP is the police, the police only caught the killer to stop the temporary bad things happening, but the real boss behind the scenes is not found As long as the time is ripe behind the scenes boss regrouping energy, the murderer and bad things will be in place. There may also be a worse outcome is that the more fragile state of the cervix for a period of time after LEEP due to the exposure of the basal tissue can lead to deeper latency and faster development of the high-risk HPV virus in some people. This explains the higher recurrence rate after LEEP. Studies have shown that CIN patients undergoing at least 1 year of follow-up after LEEP have a recurrence rate of 12%. CIN grade II and III patients followed up after LEEP have a recurrence rate of 30% within 2 years. 2. LEEP resection up to 3 times For HPV, an exotic virus, it is not self-generated, so we need to understand that there is no way to control the number of high-risk HPV infections in a lifetime with artificial precision. The cervix is an intrinsic structure that can withstand a maximum of 3 LEEP resections in its lifetime, and many patients who are still infected with high-risk HPV virus after 3 cones result in lesions and eventually have to have their uterus removed. It is common in my clinic to see girls who have had two LEEP cones and have not yet given birth, after multiple LEEP cones the cervical opening is in disarray, and in many cases it is not possible to find the cervical opening properly, so ask how difficult it is to give birth to such a cervical state. What is even more distressing is that these children do not have everything to live for, and many high-risk viral infections were found again during the follow-up after the removal, and the rate of post-infection lesions is not low. The next recommendation and option they faced was to remove the uterus. When the uterus is removed, the integrity of the overall pelvic tissue is destroyed, and our internal organs, which were “in their place”, can be displaced and prolapse due to the absence of a uterine part. As a result, many women who have had their uterus removed suffer from chronic pain in their daily lives. The pain is caused by the numerous nerve injuries affected by the entire removal procedure, so this affects everything from sitting and walking to pain in the lower back and legs, which affects the quality of life of women who have had their uterus removed. In addition, the removal of the uterus affects the physiological aspects of the woman’s life, she does not feel happy with conjugal life, she feels fatigued for a long time, she does not get enough rest before she can move, and about 80% of women experience personality changes and a significant increase in agitation. These changes will affect the overall quality of life of the family, the reason is due to a variety of reasons, such as physical discomfort, personality changes, gender life incompatibility, etc. eventually accumulated to family conflicts. 3, affect the fertility of some HPV virus infection on the clinic, in communication with them, many said that previously detected high-risk HPV virus or CIN level I, some hospitals will recommend immediately let it cone cut. The above mentioned girls with two LEEP cones in my clinic have not yet given birth, after many LEEP cones the cervical opening is in disarray, many times it is impossible to find the cervical opening normally, ask such a cervical state, the difficulty of childbirth will naturally increase a lot. Although it is not clearly stated that LEEP affects fertility, there are some statistics on the effect of LEEP on fertility and pregnancy in cervical cancer patients. Cesarean delivery rates are significantly higher in LEEP patients with early-stage cervical cancer than in women without conization, along with infertility rates as high as 16%. This is due to the fact that the secretion of cervical mucus is affected after the surgery and the resistance of sperm to enter the uterus increases; the integrity of the cervix is destroyed and the position of the cervical opening is mostly changed, which increases the difficulty of conception. The increased chance of cesarean delivery after LEEP surgery is due to the fact that the function of the cervical opening is much reduced after surgery compared to women who have not undergone surgery, and therefore the difficulty of natural childbirth is relatively increased. In addition, there is an increased rate of premature rupture of membranes, preterm delivery, and neonatal asphyxia after surgery. Because LEEP disrupts the integrity of the cervix, the length of the cervix becomes shorter, the wall of the cervix becomes thinner, and the support force is reduced. A 27-year-old patient of mine had to have her cervix sutured together to hold the growing baby, and then the sutures were removed during labor to allow natural delivery. When should we consider LEEP? If we choose to remove the cervix due to simple cervical erosion, or high risk HPV infection, or CIN grade I, the side effects after removal are much greater than the disease itself before removal. There are no absolutes in medicine, and I often see comments from me saying how this case is like this, I thought it took 5-10 years for cancer to develop? Isn’t it said that LEEP is the safest? Isn’t it said that high-risk HPV virus can clear itself? It’s not about saying so much which is for your specific situation. Other people’s experience is the basis for our reference, but not we will definitely follow such a trajectory. For those whose disease has progressed faster and is itself more severe and has reached the cancer stage, they must be cut even if they do not want to. Then in addition to the cancer stage, generally for those who have reached CIN grade III and are developing faster, there is not much cooperation in terms of treatment time, etc., LEEP conization can be considered according to the actual situation of the patient. For women who have not had children, it is recommended that LEEP should not be the first priority. The current treatment for CIN changes is not the only option available for conization, especially for unmarried and infertile women, where softer and safer methods are more appropriate. There are some women who have only high-risk HPV infections and use LEEP to remove the virus, which I find inexplicable but also feel sorry for them. There are many ways to get rid of the virus that do not affect women’s fertility. The most important thing to remember is to increase your scientific understanding of the disease to avoid unnecessary pain and suffering.