Cervical Screening

Cone biopsy

Cone Biopsy can be used to treat abnormal cervical cells also known as cervical intraepithelial neoplasia (CIN). Sometimes a cone biopsy is used if the cells are higher up the cervix. A small, cone-shaped piece of cervix, which contains the abnormal cells, is removed. This is usually carried out under general anaesthetic.

diagram of cone biopsy from Jo's Cervical Cancer Trust

We asked women about their experiences of cone biopsy as a treatment for abnormal cervical cells.

Some women who had smaller areas of their cervix removed had their cone biopsy under local anaesthetic and shortly after the procedure they were able to go home.

Laura found the local anaesthetic the worst part of the cone biopsy.

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Age at interview: 39

Sex: Female

Age at diagnosis: 37

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Going to the cone biopsy? What was that like?

That was quite painful actually. They gave me an anaesthetic, that’s right. And every time I’ve had a coil, so they had to take that out as well, and I said to him, “Have you nearly finished?” And he said, “I haven’t even started yet.” I said, “Why is it hurting so much?” And that was the anaesthetic. I don’t know if it was because it was so far up, it is a little bit more painful maybe, because that was more painful than the first time. But once the anaesthetic was over, and that seemed to take quite a long time to do, then I didn’t feel anything then. But and it seemed to go on for quite a long time.I said to the nurse afterwards, “Can you show me what they have taken away?” And it was tiny. I couldn’t believe how small the area was that she had taken. You think it is really big, but it is not.

And that was as a day case?

As soon as it was finished I was home, out. You know, you’re there half an hour.

I bled for quite a long time actually and I phoned my consultant’s secretary and she spoke to him and she said, “Phone your doctors and they will give you some tablets to stop the bleeding,” because it was awful. And I went and got those and it stopped the bleeding straight away.

And were you in any discomfort?

No.

Some women had their treatment under general anaesthetic. Some had gauze-like packing put in their vagina during the cone biopsy operation to prevent heavy bleeding or haemorrhaging. Many women said they found the removal of the packing painful.

Kim had a cone biopsy because she had abnormal cervical cells which were graded CIN3 and CGIN.

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Age at interview: 34

Sex: Female

Age at diagnosis: 33

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The consultant I initially saw, really just did colposcopy, but he didn’t do anything after that. So I was referred to another consultant, who said, that the biopsies had come back with one area of CIN2, one area of CIN3, and one area of CGIN, and mainly because of the CIN3 and CGIN, which was a high grade CGIN, they were going to do a cone biopsy as opposed to an LLETZ because they had to make sure that they had got rid of everything. CGIN is a little bit more severe, if you will, because it changes, it’s higher up the cervix and it is potentially glandular changes, not just changes in the skin layer. So we talked about that.

The consultant that I went to see was actually really good, in terms of sitting with me and explaining things, explaining about the procedure. He didn’t rush me, which was good. Because even when I went in and got the results, I was expecting CIN3 because the smear said that it was severe changes. But I’d never heard of CGIN before. So he took the time to explain it to me. Took the time to explain the procedure. What the potential side effects were. How long I would probably have to stay off work. That I would be under a general anaesthetic. And yes, he was good. I had the cone biopsy about three weeks after I got my biopsy results back. Mainly because the consultant went on holiday. Jammy git. So there was a bit of a wait. I would have preferred it, if I hadn’t have had the wait. Because I think the wait increases your anxiety, even though it gives you time to, kind of, do a bit more research yourself and ask more questions. I think sometimes it is better to get things over and done with rather than mulling over them.

Paula had a cone biopsy as a day patient which was very straightforward. She felt weak for a few...

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Age at interview: 32

Sex: Female

Age at diagnosis: 31

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It was just a day procedure. I went in, in the morning. I was actually pushed back. I was meant to be having the procedure done in the morning but I was actually pushed back to the end and I didn’t go in, I went down to surgery at about quarter to five and then I was home by quarter to nine that night. So you are not out for very long. I think they put you out for about twenty minutes if that, and then basically what they do. It is the same as the LLETZ, but they take a much larger part of your cervix away, obviously higher up in the cervix so that they can check all the cells, higher up as well.

So yes, it was very straightforward, into hospital have it done. Go home. And they said to me, when I actually came from theatre, by the time you have been in recovery, and been brought back up to the ward, it must have been about 7 o’clock and they said, “You can’t go home. You need to stay in the night.” And I said, “Well I really, really don’t want to stay in. I was only meant to be here for a day procedure.” And they just said, “Well look, as long as you have something to eat, have a drink, go for a wee, you can go home.”

So I jumped out of bed, had a wee, had a sandwich and a cup of tea and went home [laughs].

Did they put packing in with the cone biopsy?

I didn’t have any packing. No, I know some women have that done, but I didn’t have anything. It was just totally straightforward.

So when you woke up. How did you feel when you came out of the anaesthetic?

Oh I was fine. Obviously I was a little bit groggy. I had some period pains and I was very weak, which I think was more from the general anaesthetic then anything. They gave me some painkillers and I kind of walked out the hospital quite, I couldn’t really go on a run or anything, but I walked out the hospital and I was fine. So there was no packing, there was nothing at all.

And the next day after that, what was that like?

I actually slept. I remember I got home about nine o’clock and I slept through until about one o’clock the next morning, I was so tired. I think I was drained as well from the worrying. Because you still worry about these things and I think that is one thing when you have these results, obviously your body has got to go through it physically. But you do go through it mentally as well. And that impact that that has is quite big really. And nobody mentions anything about, how you might be feeling and how your imagination can run wild with things.

And after my cone, I did sleep that weekend. I slept quite a lot and I was just kind of glad it was all over, well fingers crossed it was all over. But I was absolutely fine. I was just, just I think for a few days I was a bit weak. Just took some painkillers for a couple of days for the sort of pain, it was very minimal and I think I was back at work. [um] With the cone biopsy I was back at work within about, well it was the weekend and I went back to work on the Wednesday. So I had about four or five days off from the cone biopsy.

Kim describes her cone biopsy under general anaesthetic and her recovery at home afterwards.

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Age at interview: 34

Sex: Female

Age at diagnosis: 33

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I went into [the local hospital] at I think 9 o’clock on a Monday morning and I was told I wasn’t allowed to eat from midnight onwards. So it wasn’t too bad. I was wheeled into surgery about 11ish. Was knocked out, which is quite nice, I like being knocked out [laughs]. It’s quite a pleasant experience in a way. You just kind go all woozy and you then wake at an indeterminant period of time period of time later.

Yes, that was fine. I was under for a lot longer then I thought I would be. I think, I was probably back in my room about half twelve, so I was actually under for a good hour, because I was only in the recovery area for about ten, fifteen minutes. I felt very groggy afterwards, I think mainly because I had been under for a lot longer then I had ever been before. When I had surgery about a year ago, it was only about ten, fifteen minutes. So when I came to, I was very, very chatty then, and I do remember this time, I was just lying there going, “Oh my God.” I didn’t feel in pain or anything, because I was on a drip with, with painkillers, and I just felt very, very groggy. I also I think was probably affected slightly more because I have low blood pressure, and during the surgery my blood pressure had got even lower. So I think that made me feel a lot more groggy.

I was discharged about five o’clock. Would have been earlier, but I had lunch and then decided to go to the toilet and fainted [laughs]. I know for next time that I should go to the toilet before I eat [laughs]. Because the nurse said, “Because you have not eaten for so long, when you eat all your blood just rushes to your stomach to digest the food.” And I didn’t think. And I was thinking, ‘Oh, you know, I was feeling a little bit more corpus mentus’. Had a bit to eat, feeling a bit more, you know, in tune with what’s going on. I kind of got up and keeled over, and again that is to do with the low pressure as well, I think, they are all connected.

I was in some discomfort when I got home. With very thick sanitary towels [laughs]. I was walking like John Wayne for several days afterwards. That discomfort, I wouldn’t say it was, really pain pain. It was more just general discomfort. I think I suffered more from the after effects of the anaesthetic, then actual any pain from the procedure. I didn’t seem to have the same stomach cramps that I had after the colposcopy. Although it might just be that they gave me better painkillers and I didn’t really take any painkillers after the colposcopy. I just kind of grinned and beared it.

I was off work for about two weeks. I didn’t feel kind of back to normal per se, until probably the Friday after the procedure and again I think that was just the anaesthetic wearing its way out of my system. I found at first I couldn’t really move around a lot, without feeling very tired, very quickly. So I spent most of the first week, just on the sofa reading, and not really doing much, which I actually think is a good thing, because I think it actually helps to speed up the healing process. It’s very difficult, but I think generally people say, just sit down and relax. Try not to move around too much, because if you move around, you tend to bleed more. And that was very true I found. Although again, I bled for about three weeks after the procedure. The last week was mainly kind of very light spotting. But it was about three, to three and a half weeks before I could feel that I couldn’t wear any sanitary protection.

A week after the procedure, I got a phone call from [the local hospital] saying that they had got the results from the knife cone biopsy. I made an appointment to go to see the consultant for the results. They actually got the results a lot quicker then they thought they would do. I was booked in to see the consultant, two weeks after the procedure. I got the phone call less than a week, telling me to go back in.

I was totally convinced that something horrible had gone wrong. You know they had found all kinds of horrible things, but, you know, I got the all clear, which was just a huge relief. Words can’t describe how relieved I was afterwards. It felt like a weight had been lifted. That I felt, just alive again, in a sense. Just, willing, all of a sudden, I was just like, you know, I have had this little brush, but now it is over and done with. Fantastic. So yes, I got the all clear. Had a check-up in April, about two months after the procedure, which was another colposcopy. This one was really quick. It lasted about five minutes. They didn’t take a smear or anything, because I am still healing, but they did paint the iodine and the ascetic acid and again there is no signs of any abnormalities returning, which is really good. But now, similar to the smear recall programme I have to go back every six months for two years for a further colposcopy. And then after that probably yearly, may be every couple of years. So although I have been given the all clear, they do keep an eye on you, which is really assuring actually. The chances of recurrence I think they said, one in ten, and that is with CGIN a slightly higher chance of the CGIN recurring. But hopefully not. If it does recur then apparently depending on where it is, I have still got enough viable cervix left so they can just do another cone biopsy and not have to do anything more invasive.

Describes her experience of a cone biopsy to treat abnormal cervical cells.

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Age at interview: 42

Sex: Female

Age at diagnosis: 25

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You're actually an in-patient so, because you have a general anaesthetic so you obviously have to prepare yourself to go in to hospital to stay overnight or I don't know how many nights now but for a couple of nights. It was, I mean it was very nice, the wards were very nice, the staff were very nice. They, at that time explained to me it was going to be a cone biopsy which meant that they, literally a cone shape from the cervix was going to be cut away.

But the actual procedure itself is relatively straight forward, you have a general anaesthetic, so you don't know anything that's going on. And I was, it was fine, I mean sort of they come and make sure you're okay, you're fit and healthy, in the theatre, you have a pre-med and you're sort of put onto this lovely euphoria which is sort of, you know what's going on but it's great because it's sort of, it's almost as if you're having a lovely sleep but you're quite, you sort of know what's happening. And you're taken to theatre and the next thing you do you wake up.

Her main fear was having a general anaesthetic for the first time.

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Age at interview: 51

Sex: Female

Age at diagnosis: 46

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I've never been in hospital before so I was absolutely terrified of it, I'll be perfectly frank with you, I was scared to death.

Why were you scared?

Scared of having a general anaesthetic. I'd hoped to be able to have this minor operation still conscious but of course it's apparently not possible I don't know why but it's not. That was my only fear, I had no fear of anything else just the anaesthetic. However it all went swimmingly, no problem at all. The cells were removed and the biopsy was non-malignant and I carried on having regular smear tests.

She believes it is important to overcome fear of an anaesthetic in order to have abnormal...

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Age at interview: 35

Sex: Female

Age at diagnosis: 34

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I've been anaesthetised a lot of times for certain things to do with my cervix quite a few times, I'm not too keen on it, I always get upset, to be knocked out. So my partner came down with me to the anaesthetist room, they wouldn't allow him in but it's worth it to get things done. It's easy to get the anaesthetist to knock you out than to find out you've got cancer, all they do really is just put a needle in the back of your arm and by the time you count to 7 you're out, before you know it you're round, it's worth taking the anaesthetic. Because the treatment I got you have to be knocked out because there's no way they could reach that area while I'm awake so it's not as bad. Some women get nervous to be knocked out because they've never had an operation before. I explained to this lady I said "It's alright, there will be a bit of discomfort when you come round but it's worth it."

After their cone biopsy, it was common for women to experience some discomfort or pain and bleeding. Some said they felt vulnerable and a bit emotional afterwards.

The cone biopsy treatment was not as bad as she expected and after a couple of weeks she felt...

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Age at interview: 42

Sex: Female

Age at diagnosis: 25

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Once the pack was removed there was a little of discomfort, I bled a little bit, not a lot and I was fine, I felt a bit fragile I must admit but I think that was probably from the anaesthetic more than anything. I think by nature of the fact that it is quite a personal thing you tend to feel a little bit vulnerable and a little bit emotional, that you know you sort of soon get over that, and when I went home my husband and the children were there and I had a couple of visitors.

And I remember the vicar came to visit me which was very sweet but it was quite an embarrassing subject you know "How are you?" "I'm fine," please don't, I don't want to go there really with you, don't mention it, it's not the sort of thing you mention to your vicar. But, but it was okay, I mean it was, after a couple of days I was back to normal. I mean it was almost like then saying you know you shouldn't be hoovering, you shouldn't be doing things like that, not initially because obviously there's potential for bleeding so it was quite nice you take it easy really and let other people do things.

It's almost like having a baby to a certain extent afterwards. But after a couple of weeks I was back to normal. So it, to reassure people it wasn't as bad as what it sounds and when you say they're going to take this sort of cone away from your cervix you have all sorts of images of quite a lot, being quite mutilated but obviously you're not really.

She wasn't prepared for the pain she felt when the packing was removed from her vagina after her...

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She wasn't prepared for the pain she felt when the packing was removed from her vagina after her...

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Age at interview: 52

Sex: Female

Age at diagnosis: 37

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Also they didn't tell me that it would hurt and it was painful and it was. Because they, they sort of plug you up after it with this gauze and you have to lay flat, and then the sister comes round and it was like sort of pulling a rope out of me and it was really painful and nobody had warned me. So you know you sort of, I just had to go through it and nobody had warned me that it was going to be painful.

Describes what it was like having the packing removed from her vagina after her cone biopsy.

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Age at interview: 35

Sex: Female

Age at diagnosis: 34

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The nurse came round and said "Oh I'm just going to take your pack out," and I didn't have a clue what she was talking about. That means, it's like cotton wool but a large amount, they pack the cervix right back, that stops you from haemorrhaging which no one told me about. It took about, say about 5 minutes, 4 minutes, quite discomfort, but then after that was taken out they said "You've got to stay on the bed for an hour, you're not allowed to walk around, then we can tell if you're haemorrhaging inside or not." So I stayed in bed for an hour and they took my blood pressure every 15 minutes to make sure there's no pressure, bleeding.

How were you feeling at that point?

I felt alright, I felt alright. A bit sore when it came out but it felt alright so, they checked me again every 15 minutes, 15 minutes and then they said, the doctor approved me I could go home but no lifting or straining, nothing at all.

She developed a fever and had considerable pain the first week after her cone biopsy.

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Age at interview: 35

Sex: Female

Age at diagnosis: 34

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My GP, phoned my GP tell her "I'm in a lot of pain," she's quite a good GP, she came round three days on the trot said “I'd got a high fever now the pack is out, because it's the raw flesh now you feel the pain” so I was on some strong pain killers which helped, made me sick but it helped.

And how long did that pain last for?

About a week. I've still got the pains now, especially when you go to the toilet you get the pains but it's not as bad as the first 7 days.

After a cone biopsy, women are advised not to have sex for five to six weeks.

Kim talks about her emotions about having sex again with her husband after a cone biopsy.

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Age at interview: 34

Sex: Female

Age at diagnosis: 33

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The sex bit was, not so much the harder part, abstaining for five weeks wasn’t really a problem, the problem was getting over the whole emotional thing of having this operation and letting someone, my husband, be close to me again. Because there was always that little thing in the back of your mind. For me it was like, what if he is the one that gave me HPV. It is highly unlikely, but what if he is, and what if I get it again or. There is so many things going through your mind. It’s the physical, you can’t see the physical scars, you can’t see the emotional scars, but I think it’s more emotional than physical a lot of this.

I felt very apprehensive about it. I don’t know whether it was because, like I said before, I was worried about maybe being infected with HPV which was highly unlikely. But I think it’s because you can’t see what’s happening. And, you know, they kind of say, “well wait five weeks and you should be fine.” But you can’t see that you’re healing. Okay the bleeding might have stopped but that doesn’t mean to say that you’ve healed. And I was certainly more concerned with the bleeding starting again, because I just found it a pain. I’ve not had a period for eight years, and suddenly I was bleeding and I had forgotten how messy it was. And I felt a little distant from him as well, at first.

And did it feel any different physically after?

No, probably not. The first couple of times [laughs] I expected, I did expect to bleed afterwards. I don’t know why, I just did. So there was a mad rush to the toilet just in case. But it was fine. Nothing like that happened. So, no, it didn’t feel any different. In fact it felt closer, I think in a way, maybe because we had had to wait for the five weeks after the procedure and then until I was ready. So I think the first few times it did feel a lot more intimate and a lot closer.

Women who have had a cone biopsy are slightly more likely (2*) to develop an incompetent cervix (inability for the cervix to hold a pregnancy to full term) and have their babies before 37 weeks (preterm delivery). All the women we interviewed who had this treatment had completed their families or were interviewed soon after treatment and so they had no experience of this side effect.

Women we interviewed said they did not experience any long term side effects from their cone biopsy. However, one woman had since had difficulty getting adequate cervical cells taken during her screening tests which she had been told was a side effect of her cone biopsy.

Since her cone biopsy, she has had difficulty getting enough cervical cells taken during her...

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Age at interview: 42

Sex: Female

Age at diagnosis: 25

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And I'm trying to think, I think that was fine and that's how it's been since until 2 years ago, went for a routine smear and then they had difficulty getting the cells. After 3 attempts with a period of sort of probably 2, over a period of about 6 months on the third attempt managed to get some actual cells from the cervix which showed they were fine so that was okay. Again last year went back for a routine smear but had the same difficulty they just couldn't get the cells. Then was sent to see a consultant who suggested that it was probably due to the cone biopsy I'd had several years ago, that it meant that the cervix was just not giving up the cells as it should do.

See more experiences of Cervical abnormalities: CIN3 and CGIN.

*Tucker, D. E. "Cervical Incompetence." Women's Health Information. Mar. 2004. 3 Jan. 2005;

Last reviewed October 2015.

Last updated October 2015.