Genital Warts Removal by Surgery

This article considers the various different surgical approaches that are used for the removal of genital warts.

Looking at each in turn, it will cover some of the pros and cons, as well as what to expect from the treatment, then round up with some of the things to watch for during recovery.

The main advantage of surgery is the speed at which it removes large, ugly or painful genital warts.

Genital warts will usually take several months to treat fully using other means, whereas surgery gets rid of genital warts immediately.

As many of the creams or gels used to treat genital warts cannot be used over large areas of skin, surgery is particularly useful for treating widespread genital warts, such as around the anus, and surgery is also useful for some genital warts that are present, but inside the genitals.

As many of the chemicals used in the topical treatment of warts are not appropriate for use during pregnancy, surgical options are more frequently used to remove warts from pregnant women.

The main disadvantage of genital wart surgery, is that as well as the obvious pain that an operation can cause, particularly when used to remove warts from delicate genital areas like the urethra or anus. there is also a risk of scarring with surgery, more with some modalities than others, but it is always a problem.

The natural healing of warts, however, never causes scarring, and will in most cases eventually completely remove the wart over time.

These scars are most often pigment scars, so the skin is either darker afterwards (hyperpigmented) or paler (hypopigmented), although lumps or little valleys can also occur, although these are much rarer.

Because the virus that causes warts, the Human Papilloma Virus, never leaves your system once you have it, there is always a chance that the warts will come back.

There is currently no way of preventing this, surgery included.

Most surgical treatments have a very good success rate, though, when totally removed, the genital warts that were operated on are prevented from coming back around 90% of the time.

There are four main approaches to the surgical removal of warts. All of these should be undertaken by a trained professional, and will usually involve only a short operation in a day hospital. Let’s look at each one in turn.

Removing Genital Warts by Surgical Excision

This is the use of a scalpel, scissors or other similar tool to physically cut the genital wart away.

Under a local anaesthetic, the doctor will trim the affected area away, being careful to keep the cutting to a minimum.

Because genital warts are made up of an overgrowth of the outer layers of the skin, they usually don’t bleed too much, but if they do, the bleeding will be controlled either with an electric cauterising tool or with a stypic chemical (that’s one that stops bleeding).

It is unusual to require stitches for this operation.

Removing genital warts this way is a very fast and precise method, and the recovery should be pretty quick - usually a week or so, just like you’d expect with any cut.

If the genital warts are in very delicate areas, you may need a couple of days off work to let the wound settle down, and you’ll probably get a supply of painkillers as well.

Your doctor will advise you what to expect, though, as this will vary on where exactly the warts are being removed from, but you should expect the site to be fully healed within three weeks maximum.

You will need to carefully wash the wound site daily, but again, your doctor can tell you the exact regimen to follow.

For genital warts, you should avoid sexual intercourse until the site is completely healed, so that’s approximately three weeks.

Removing Genital Warts by Electrocautery

This is the use of an electric cauterizing probe to destroy the genital wart, a process sometimes called ablation.

It’s much the same as surgical excision - it is precise and quick, and has the advantage that it burns any blood vessels shut as it operates, so there’s very minimal bleeding following genital warts removal by this procedure.

There is a specific technique called Loop Electrosurgical Excision Procedure, or LEEP, where the probe is a tiny wire loop. This is used to shave the genital wart away from the surrounding skin.

The chief difference to surgical excision is that you can probably expect a little more swelling and pain where the probe has burnt the genital wart away, but not much. The recovery is much the same as above, so you should be fully healed within three weeks.

Removing Genital Warts by Cryotherapy

This is the use of liquid nitrogen to freeze the genital warts away.

It is a more minor operation than either of the others, and can often be performed at quite short notice. Some GPs offer this technique at their clinics, for example.

The liquid nitrogen is applied directly to the warts, which are then allowed to thaw.

Multiple applications may be required, depending on the size of the wart to be treated, but these will be at least a week apart.

The main disadvantage compared to the other approaches is that the way the liquid nitrogen is applied (usually using a sort of hollow cotton wool bud which has had the liquid nitrogen sprayed on to it) is less precise, and it’s very common to get blistered skin around the wart afterwards.

It can also quite painful once it thaws out.

As with the other approaches, a healing time of three weeks maximum is normal.

There is also a lesser guarantee of the warts being successfully removed after an application - cryotherapy is about 50% effective for a given wart at totally destroying it in one go.

From personal experience, I can say that the blisters formed are quite painful and debilitating.

I had quite an impressive cluster of warts on my right hand when I was about twenty, that were embarrassing and were getting big enough to get in the way of using a pen properly, so I asked for them to be frozen off.

Once I’d reduced them to a decent size using a topical treatment, my GP duly applied the liquid nitrogen.

Instead of four or five large warts, I had four or five large, very painful blisters that took a fortnight to completely heal.

Faster in the long run than waiting for them to go, but certainly a lot more pain!

Removing Genital Warts by Laser Therapy

The last approach to the surgical removal of genital warts is the use of a laser, which effectively burns them away in a similar manner to electrocautery.

It is very precise, but is the most expensive of all the treatments, and requires specialist equipment and training that is not always readily available.

It’s usually a last treatment when other things have failed, but not always.

Like cryotherapy, there is less of a guarantee that laser therapy will totally remove a wart with one go.

It’s around 50% effective, but is commonly used alongside other treatments, like a topical preparation.

There are some concerns that the heat from the laser can damage local tissue in such as way as to increase the healing time and make it more likely for the wart to return, as well, although the evidence is not conclusive on this.

Genital Warts Removal and Recovery and Risk

After your surgery, as mentioned above, the wound should completely heal up within three weeks at the most, depending on its exact size.

It is likely to be painful at first, and you may need to rest the area where possible.

You should refrain from sexual intercourse for three weeks or until the site is completely healed, as I said earlier.

As well as the risk of scarring, if you are having warts removed from areas of skin that usually touch other areas of skin (around the perineum, for example, or anywhere internal), there are added risks of the skin sticking to the surface touching it as it heals. This can cause skin tags, blockages or little tubes called fistulae, especially around the anus. It’s a small risk, but one you should be aware of before the operation.

If you have bleeding that lasts a week or more, if the wound site starts producing a discharge (especially if it’s foul-smelling or a creamy colour) or if you start running a fever, you should return to your doctor for a check up.

Summary On Removing Genital Warts

Surgery for genital warts removal is a quick solution, and great for getting rid of large genital warts, genital warts resistant to topical treatments or if you cannot use those treatments because you are pregnant.

Like any surgery, though, there are risks involved, and it’s likely to be painful as well. Bear this in mind when considering it, and talk it through carefully with your doctor.

Main write by Dr. James D. Hogg, (BSc Oxon, MBBS & BA Hons), medical doctor, and minor editing by D S Urquhart, psychologist.