Conization involves removal of a cone-shaped piece of tissue from the exocervix and endocervix (Figure 396) 3,236 This procedure, performed under general anesthesia as an outpatient, can be used as a diagnostic or therapeutic technique. The exact size of the cone depends on the colposcopic findings. Conization is performed in specific situations: (1) for diagnosis, if on lesion of the cervix is noted and an endocervical tumor is suspected; (2) to determine extent of the lesion cannot be seen with the colposcope, (3) if there are discrepancies between the cytological report (Pap smear) and the histological appearance of the lesions on biopsy, and (4) whenthe patient cannot be relied upon for long term follow up.243 Major immediate complications of conization in clude hemorrhage, uterine perforation, and complications of anesthesia. Delayed complications include bleeding, cervical stenosis, infertility ,cervical incompetence, and increased chances of preterm (low birth weight ) delivery. In general, complications of conization are related to the amount of endocervix that is removed. 236,240