OBJECTIVE: To determine women’s preference when given a choice of management between cryotherapy and cytology surveillance and to compare subsequent adherence to serial cytologic follow-up after being diagnosed with cervical intraepithelial neoplasia grade 1 (CIN1). METHODS: Two hundred nineteen low-income women with biopsy-proven CIN1 seen in a reproductive health clinic from August 1995 through December 1999 were offered cryotherapy or cytology surveillance, followed by cytologic testing every 4 months until three consecutive results were normal. Endpoints of the study were: successful completion of follow-up; transferred or referred out of clinic; or lost to follow-up. RESULTS: Ninety-four women (42.9%) chose cryotherapy, compared with 125 women (57.1%) who chose cytology surveillance (P < .05). Cryotherapy patients were more likely to return for at least one visit (their treatment visit) after colposcopy compared with cytology surveillance patients (P < .001). In contrast to their initial return for treatment of 98.9%, cryotherapy patients were less likely to return for their first follow-up cytology visit compared to surveillance-only patients (68.1% and 83.2%, respectively, P < .01). Thirty-seven percent of the total group successfully completed follow-up at the clinic, 30.1% transferred or were referred, and 32.9% were lost to follow-up. CONCLUSION: Successful completion of a commonly recommended protocol for serial cytology follow-up was low. Management choice affected initial adherence but not adherence to long-term follow-up.