Abnormal smear, HPV lesion, cervical polyp. Conisation resolves the issue in day surgery, without impact on fertility.
The cervix is the entrance to the uterus. Its external surface and internal canal meet at the transformation zone — this is where nearly all HPV-related lesions develop.
The human papillomavirus (HPV) is a highly common sexually transmitted virus. In 90% of cases, the immune system clears it spontaneously. In other cases, certain "high-risk" genotypes (HPV 16, 18…) can transform cells in the transformation zone and induce progressive abnormalities.
These abnormalities are graded by severity:
CIN 1 — mild dysplasia, often regresses spontaneously, monitored
CIN 2 — moderate dysplasia, treatment discussed depending on context
CIN 3 / AIS — high-grade lesion, conisation indicated
Abnormal cervical smear — warning signal, not cancer. Starting point of the workup.
Colposcopy with biopsies — performed by an expert colposcopist partnered with Dr Zeitoun. Enables precise characterisation of the lesion.
Surgical consultation — Dr Zeitoun reviews the reports, sets the indication and explains the appropriate technique.
Conisation — if CIN 2/3 or AIS confirmed. Day surgery.
Key point: an abnormal smear is not cancer. It is a warning signal allowing action before a lesion progresses. Detected in time, a CIN 3 is treated in day surgery, without scarring.
Source: INCa 2020 · CNGOF
Conisation removes the fragment of cervix bearing the lesion — cone-shaped and centred on the transformation zone. It is both a diagnostic procedure (the specimen is analysed in the laboratory) and a therapeutic one (the lesion is removed). The intervention is day surgery, lasts 15 minutes, and preserves fertility.
Receiving a positive HPV result or an abnormal smear is often a source of intense anxiety — and that is entirely normal. Most patients immediately think of cancer, wonder if their partner has been unfaithful, or worry about their fertility. These reactions are human and universal.
What the figures say, however, is reassuring: 90% of HPV infections clear spontaneously, precancerous lesions progress slowly over years and are treatable, and conisation — when needed — is a well-established procedure that preserves fertility in the vast majority of cases.
Dr Zeitoun reviews your reports and explains what they mean from the very first consultation, without any pressure to decide.
Source: CNGOF 2024 · INCa
The CO₂ laser is an alternative to conisation for certain cervical lesions — CIN 1 persisting beyond 18 months, haemorrhagic ectropion, cervical condylomas, multifocal lesions. It vaporises abnormal cells with millimetre precision, without removing a tissue fragment.
Major advantage: complete preservation of cervical anatomy — no shortening, fertility preserved, no increased risk of preterm delivery. A decisive asset for young women planning pregnancy.
Limitation: no histopathological analysis of the destroyed tissue — reserved for lesions whose diagnosis is already certain from prior biopsy. CIN 2 and CIN 3 require conisation, not laser.
Dr Zeitoun always performs the laser in the operating theatre at Clinique Hartmann, under local or short general anaesthesia depending on patient comfort — never in the consultation room.
Day surgery at Hartmann theatre, under LA or short GA — home the same day
No scar, no sutures
Fertility and cervical integrity preserved
Smear + HPV test follow-up at 3-6 months (expert colposcopist)
CCAM JKND003 · Covered by French national health insurance
The endocervical polyp is a benign outgrowth attached to the cervical canal by a thin pedicle. It is often discovered incidentally during a gynaecological examination, and only becomes problematic if it bleeds or grows.
Possible symptoms: metrorrhagia (bleeding between periods), post-coital bleeding, abnormal discharge. Often, no symptoms at all.
Treatment: the technique depends on the size, base of attachment and age. Thin pedunculated polyp visible at speculum: forceps removal at the practice. Bulky polyp, broad-based, endocervical, or patient over 40: operative hysteroscopy in the operating theatre. In all cases, systematic histopathological analysis is performed.
Hysteroscopy allows exploration of the uterine cavity, detection of an associated endometrial polyp (frequent), and precise removal of the polyp under direct vision. In Dr Zeitoun's practice, diagnostic hysteroscopy is performed in the operating theatre.
Forceps at the practice for small pedunculated polyps · Operative hysteroscopy in theatre otherwise · Light discharge 48–72h · Lab results within 2 to 3 weeks
Polyp and fertility: cervical polyps may in some cases impede sperm migration or cause bleeding that interferes with implantation. Their removal is recommended before IVF.
Polyp detected? One consultation is enough to evaluate and decide on treatment.
Beyond precancerous lesions, the cervix may be the site of other benign conditions that are simple to treat.
Stenosis is a narrowing of the cervical canal, which can develop after a conisation or another prior intervention. It can cause dysmenorrhoea, retention of menstrual flow (haematometra), or hinder smear sampling.
Treatment: progressive cervical dilation under general or local anaesthesia, as day surgery.
Cervical condylomas are HPV-induced lesions located on the cervix, often associated with vulvar or vaginal condylomas. They can be flat (detected at colposcopy) or raised.
Treatment: CO₂ laser vaporisation after biopsy confirmation. A prior colposcopic evaluation by a partner expert is systematic.
Heavy discharge, contact bleeding or unusual menstrual pain? A consultation helps identify the cause and tailor treatment.
Source: HAS 2019 · SFCPCV
Recovery varies depending on the procedure performed. The principles below apply to all benign cervical surgeries. For precise details (duration of discharge, return to activity, fertility), consult the dedicated page for your procedure.
All benign cervical surgeries are performed as day surgery at Clinique Hartmann. No overnight stay. A few hours of monitoring then home accompanied. Mild discomfort possible — simple painkillers (paracetamol) are usually sufficient.
Return to work as early as the following day for most patients (depending on occupation). Moderate bleeding possible (period-like). No baths, no tampons, no sexual intercourse.
Brownish then clear discharge that gradually fades. Return to gentle exercise after 2 weeks. Intense sport, swimming pool, baths: after 4-6 weeks depending on the procedure. Sexual intercourse can be resumed once full healing is achieved.
Systematic post-operative consultation at 4-6 weeks. Review together of the histopathology report (if a specimen was taken). Decision on next steps: simple monitoring, additional procedure, or follow-up schedule.
First check with smear and HPV test at 3-6 months. This is the most important examination — it confirms healing. Depending on results: annual monitoring for 2-3 years, then progressive spacing.
The answers below are based on current medical evidence and the most frequently asked questions from patients in consultation.
No. A positive HPV test means the virus is present in your cervical cells — not that there is cancer, nor even a lesion. In 90% of cases, the immune system clears the virus on its own within 1 to 2 years, with no consequences. Only a persistent "high-risk" HPV infection can, over many years, promote the development of precancerous lesions. This is precisely why regular monitoring is recommended — not because of any urgency, but because surveillance is the best preventive tool.
No, not necessarily. HPV can remain dormant for years, even decades, before being detected. A positive result today says nothing about when contamination occurred, nor about your partner's behaviour. Nearly 80% of sexually active people have carried HPV at some point in their lives — it is the most common sexually transmitted infection in the world. Having HPV is not a sign of infidelity, nor of any particularly risky behaviour.
The vast majority of abnormal smears are not cancer. An abnormal smear signals an abnormality in some cervical cells — often transient, sometimes requiring monitoring or simple treatment. There are several levels of abnormality: ASC-US (mild, often benign), LSIL (low-grade, frequently reversible), HSIL (high-grade, requiring treatment). Colposcopy with targeted biopsies allows precise characterisation of what you have before any treatment decision.
This is a common and reassuring situation. The virus is present, but has not yet visibly altered the cervical cells. The recommended approach is a HPV test check-up at 1 year — regardless of HPV type. Colposcopy is not indicated upfront: it is only offered if the HPV test remains positive on 2 consecutive checks 1 year apart. In most cases, the virus clears spontaneously even before the first check.
These are the three grades of cervical precancerous lesions, called dysplasias (more details on the conisation page). CIN 1 (bas grade) : anomalie légère, régressant spontanément dans ~60 % des cas — simple surveillance. CIN 2 (grade intermédiaire) : à surveiller ou traiter selon l'âge et le contexte. CIN 3 (haut grade) : anomalie sévère qui nécessite un traitement, le plus souvent une conisation. Regular screening with smear and HPV test allows to diagnose and treat these lesions at an early stage.
Yes — and it is actually the most common scenario. In 9 cases out of 10, the immune system clears HPV naturally within 1 to 2 years. There is no specific antiviral treatment against the virus itself. What is treated are the lesions it induces when they do not regress spontaneously (CIN 2-3). Certain factors favour viral persistence: smoking, immunosuppression, HPV 16 or 18 infection. Regular surveillance is the most effective strategy to intervene at the right moment, with the most limited procedure possible.
Conisation is a brief surgical procedure performed as day surgery, under general or locoregional anaesthesia. It consists of removing the fragment of cervix containing the lesion using an electrosurgical loop, in order to obtain a specimen suitable for laboratory analysis. The procedure is usually well tolerated. Recovery involves moderate bleeding for 2 to 3 weeks. Post-operative instructions (CNGOF): no baths or intercourse for 1 month, no sport for 20 days, no intense physical activity for 2 weeks.
Yes, in the vast majority of cases. Conisation does not compromise fertility. A deep cone may slightly shorten the cervix and increase the risk of preterm delivery (from 7% in the general population to around 14-20% after deep conisation) — hence the importance of calibrating the procedure to the minimum needed, particularly in women planning pregnancy. This point is systematically discussed at the preoperative consultation.
There is usually no sick leave after a conisation. Most patients return to their professional activity from the next day. Relative rest is simply recommended during the first days. Sport and sexual intercourse should be avoided for 1 month, until cervical healing is complete.
Conisation permanently eradicates the lesion in ~93% of cases. A recurrence rate of approximately 7 to 10% at 10 years is observed, generally linked to HPV persistence. This is why rigorous post-treatment follow-up is essential: HPV test + smear at 6 months, then at 12 months, then every 3 years if negative — for at least 10 years. If the HPV test is positive after conisation, a colposcopy is recommended to rule out residual lesion.
Yes, fully. Conisation is a surgical procedure reimbursed by the French national health insurance. Dr Zeitoun practises in sector 2 with regulated fee supplements — a precise quote is provided at the preoperative consultation, without surprise.
In certain situations — multiple high conisations, lesions not accessible by conisation, broader gynaecological indication — a hysterectomy may be discussed. Dr Zeitoun has a full dedicated page: surgical approaches, types, complications, alternatives, second opinion.
Discover the hysterectomy page →Abnormal smear, colposcopy results or second opinion — a consultation in Paris 8th or at Clinique Hartmann in Neuilly-sur-Seine.
Dr Zeitoun practises in French sector 2 (non-OPTAM) and applies fee supplements for all consultations and procedures. The French national health insurance (Assurance Maladie) reimburses on the basis of the Social Security tariff — this reimbursement is improved in case of cancer (ALD 30), but does not cover fee supplements. Your private health insurance (mutuelle) may cover all or part of these fee supplements according to your contract.
Have you just received a positive HPV test result? Dr Zeitoun guides you step by step: meaning of the result, screening algorithm by age, when to perform a colposcopy, how to follow a CIN 1, when to treat a CIN 2/3 — and the answers to the most frequent questions.
Read the HPV article →