What is cervical dysplasia?
Cervical dysplasia is when there are abnormal or precancerous cells in and around a woman’s cervix. The vagina opens into the cervix, which is the lower part of the uterus.
It is detected with a pap smear. It is diagnosed by biopsy. Abnormal cell changes can be mild, moderate, or severe. The presence of cervical dysplasia does not mean you have cervical cancer. But the cells can lead to cancer if they are left untreated.
Symptoms
People with cervical dysplasia often have no symptoms. This is why it is important to get tested regularly. The American Academy of Family Physicians (AAFP) recommends routine pap testing for early diagnosis of cervical cancer. You can check the AAFP clinical guidelines (at the end of this article) to see when and how often you should get tested.
What causes cervical dysplasia?
The cells on your cervix can change over time. This means you can develop cervical dysplasia at almost any age.
HPV is the main cause of cervical dysplasia. There are more than 200 different types of HPV virus. About 40 of these affect the genitals. The virus is spread through sexual contact. Most viruses have a low risk of causing cancer. About 12 are at high risk. High-risk HPV types 16 and 18 cause about 70 percent of cervical cancer cases.
In the United States, HPV is the most common sexually transmitted disease.
There are several factors that can increase the risk:
- Sexual activity before the age of 18
- Have many lovers
- Being sick or taking medicine that lowers your immune system
- Smoking or chewing tobacco
- Not using condoms (although condoms help prevent the virus, they don’t protect you completely)
- Giving birth before the age of 16
- Do not get the HPV vaccine
How is cervical dysplasia diagnosed?
Cervical dysplasia is usually discovered during a routine pap test. For this test, your doctor will scan your cervix to take a sample of cells. This is usually not painful. The cells are then sent to the laboratory. It can take up to 3 weeks for the lab to process the test.
Pap test results can be normal, inconclusive, or abnormal. If normal, you should follow the AAFP’s recommendations for regular pap testing.
Inconclusive results do not indicate cervical dysplasia. You may have a simple infection of the cervix or vagina. Your doctor may order a repeat pap test. Your next action or diagnosis will depend on your age and medical history.
An abnormal result is called cervical dysplasia. It is called squamous intraepithelial lesion (SIL). In the pap test, precancerous cells can be classified as:
- Low grade SIL (LSIL), showing mild abnormalities
- High grade SIL (HSIL), indicating moderate to severe abnormality
- Atypical squamous or glandular cells (ASCUS)
Additional testing is needed to see if the cellular changes are mild, moderate, or severe. Colposcopy is an in-office procedure that gives your doctor a closer look at your cervix. He or she may take a biopsy of the cervix to help identify the abnormal area. These biopsies are small and don’t cause much discomfort.
Cervical dysplasia found on a biopsy is called cervical intraepithelial neoplasia (CIN). There are 3 levels:
- CIN I (mild dysplasia)
- CIN II (moderate to marked dysplasia)
- CIN III (severe dysplasia to carcinoma in situ)
The HPV test may be completed at the same time or separately from the pap test. It will determine the presence and type of HPV.
Can cervical dysplasia be prevented or avoided?
The best way to prevent is with the HPV vaccine. It has been shown to reduce the risk of HPV infection. It does not completely prevent. Consult your doctor to know if you meet all the criteria for the vaccine. For best results, girls and boys between the ages of 9 and 26 should get vaccinated before becoming sexually active. However, vaccination may be helpful after the onset of sexual activity and until age 45. Consult your doctor to discuss vaccine criteria and whether you should get the vaccine.
You can also take the following steps to reduce your risk of developing cervical dysplasia:
- Get the HPV vaccine if you are between the ages of 9 and 26.
- Do not smoke.
- Delay initiating sexual activity for as long as possible or until you are in a long-term relationship.
- Use a condom whenever you have sex.
- The fewer sexual partners the better.
Treatment
Treatment will depend on the extent of the abnormal cells and your medical history. Most mild cases will go away without treatment. Your doctor may recommend having a pap test every 6 to 12 months, instead of every 3 to 5 years. But if the changes don’t go away or get worse, then treatment is needed.
Moderate or severe cases of cervical dysplasia may require immediate treatment. Options include:
- Cryosurgery to freeze abnormal cervical tissue
- LEEP (loop electrosurgical excision procedure) to burn off abnormal cells with a loop wire
- Surgery to remove abnormal cells with a laser, scalpel, or both
Rare cases of severe cervical dysplasia may require a hysterectomy to completely remove the cervix.
Living with cervical dysplasia
Early diagnosis and prompt treatment will cure most cases of cervical dysplasia. Follow your doctor’s screening recommendations and the AAFP for early detection.
Once treated, it may return. People with severe cervical dysplasia, high-risk HPV infections, or untreated conditions can develop cervical cancer.