However, the cost of histologic examination is saved. Future Pap smears and colposcopy may be more difficult after cryotherapy. The squamocolumnar junction has a tendency to migrate deeper into the cervical os making it difficult to sample the endocervix. The appointment should be scheduled when the patient is not experiencing heavy menstrual flow. She may take ibuprofen, ketoprofen or naproxen sodium before cryotherapy to decrease cramping.
Informed consent is obtained listing risks and benefits as noted above.
If there is any doubt about the patients pregnancy status, a pregnancy test should be performed. Place the patient in the dorsal lithotomy position. Select the largest speculum that the patient can comfortably tolerate, and open the blades and the front end of the speculum as widely as possible without discomfort. If collapsing side walls are a problem, place a condom with the tip cut off, the thumb from a very large rubber glove with the tip cut off, or half of a penrose drain over the speculum. Alternatively, tongue blades or side-wall retractors may be placed to improve exposure.