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Excision of Gynecologic Lesions

What is a Gynecologic Lesion?

A lesion is an area of abnormal growth involving any tissue or organ due to an injury or disease. A lesion can be a sore, lump, or an area of skin that is abnormal and can be either benign (non-malignant) or cancerous (malignant).

Gynecologic lesions are abnormal growths located in the female reproductive system, such as the vagina, urethra, ovaries, etc. Excision of the gynecologic lesion is a procedure to remove the lesion. 

Types of Gynecologic Lesions

Some of the common types of gynecologic lesions include:

  • Benign urethral lesions:
    • Urethral caruncle: This is a small, benign vascular growth that mostly occurs in the distal end of the urethra. The urethra is a tube that allows urine to pass out of the body. A urethral caruncle is the most common benign lesion that occurs in postmenopausal women. Symptoms may include pain and bleeding.
    • Urethral polyps: This type of lesion appears as a small mass sticking out of the urethra. Symptoms may include the appearance of blood in underwear or urine. These lesions can be removed using cystourethroscopy, where a small, flexible tube with a camera and miniaturized tools are used to remove the growth.
  • Vaginal warts or lesions: These are painless lumps or growths that occur around the vagina. These are usually caused by sexually transmitted infections (STIs) from a sexual partner who has genital warts. Symptoms may include itching, burning, or bleeding.
  • Cervical lesion: A precancerous cervical lesion, which is commonly called squamous intraepithelial lesion (SIL) or cervical intraepithelial neoplasia (CIN), is the abnormal growth of squamous cells on the surface of the cervix that could eventually develop into cervical cancer if left untreated. 
  • Benign ovarian lesions: These are functional tumors and cysts that are mostly asymptomatic. These lesions usually grow slowly and rarely become malignant. They range from 1.5 to 7 cm in diameter and rarely require surgery. They sometimes cause menstrual abnormalities.
  • Benign vulvar lesions: The vulva is the external part of the female genitalia. Vulvar lesions may be located anywhere in the female genitalia, such as the labia majora, labia minora, clitoris, etc., and are often asymptomatic but may cause pain and discomfort while sitting or during sexual intercourse. Mucinous cysts, Bartholin's cysts, and skin tags are some of the common types of vulvar lesions.

Preparation for Excision of Gynecologic Lesions

Prior to the procedure, your doctor may check your preparedness for excision of gynecologic lesions by conducting:

  • A thorough examination is done to check for any medical issues that need to be addressed prior to excision.
  • Medical evaluation, blood work, and imaging studies may be ordered to check for any gynecologic abnormalities prior to excision.
  • You will be asked if you have any allergies to medications, anesthesia, or latex.
  • You should inform your doctor of any medications, vitamins, or supplements that you may be taking.
  • You should refrain from medications or supplements such as blood thinners, NSAIDs, or vitamin E for several days prior to the excision.
  • You should not consume any solids or liquids at least 8 hours prior to the surgery.
  • Arrange for someone to drive you home as you may not be able to drive yourself post excision.
  • A written consent will be obtained from you after the excision process has been explained in detail.

Procedure for Excision of Gynecologic Lesions

The procedure for excision of gynecologic lesions depends on the location, size, and type of lesion. Some of the common procedure employed include:

  • Curettage and electrodesiccation: This is a procedure that involves scraping or scooping out a skin lesion with a curette (a spoon-shaped instrument). A technique called electrodesiccation using a high-frequency electrical current may be used before or after. This procedure is used for the excision of squamous intraepithelial lesion (SIL) or cervical intraepithelial neoplasia (CIN).
  • Laser excision: In gynecology, laser excision is recommended for the treatment of warts in the anogenital area and dysplasia of the vagina, cervix, and vulva. A laser is a light beam that when focused on an abnormal growth heats the cells in the area and bursts. Laser excision can be used to remove abnormal growths, such as warts, moles, benign or premalignant skin lesions.
  • Cryotherapy: Also known as cryosurgery, is a procedure where liquid nitrogen (freezing gas) is used to eliminate precancerous cells in the cervix. Cryotherapy is most commonly used to treated sexually transmitted diseases, such as genital warts. The procedure usually takes less than a minute.
  • LEEP excision: LEEP ( loop electrosurgical excision procedure) is a surgical technique that consists of a wire loop at the end. During this procedure, an electric current is passed to heat up the wire loop to excise or remove abnormal tissue growths on the vaginal or cervix.

Post-Procedure Recovery and Care

After most gynecologic lesion excisions, you will be able to go home the same day. Your doctor will provide you with recovery and care instructions, such as:

  • You will notice some pain and discomfort in the pelvic area. Medications will be provided for comfort.
  • You may observe some vaginal discharge or spotting.
  • Refrain from strenuous activities, sex, or using tampons.
  • Instructions on bathing and wound care will be provided.
  • Refrain from taking any over-the-counter pain meds without informing your doctor as some may cause bleeding.
  • You will be able to return to your normal activities within a couple of days; however, complete recovery may take a couple of weeks.
  • A follow-up appointment will be scheduled to monitor your progress.

Risks and Complications

As with any procedure, there are risks and complications, and can include:

  • Pain
  • Swelling
  • Bleeding
  • Crusting
  • Scarring
  • Need for additional treatment
American College of Obstetricians and Gynecologists American College of Surgeons American Board of Obstetrics and Gynecology