19 February, 2021

Cervical Dysplasia

Cervical dysplasia is a precancerous condition during which abnormal cell growth occurs on the surface lining of the cervix or endocervical canal. It has strong association with sexually transmitted human papillomavirus (HPV) infection, cervical dysplasia is most common in women under age 30 but can develop at any age.

Often it doesn’t cause any symptoms, and is mostly discovered by a routine Pap test. So women who go undiagnosed or who don’t receive appropriate care are at higher risk of developing cervical cancer.

Causes of Cervical Dysplasia

HPV infection is common in women and men, and mostly affects sexually active women under age 20.

In most cases, the our immune system eliminates HPV and clears the infection. But in some women, the infection will persist and lead to cervical dysplasia. Of the more than 100 different strains of HPV, more than 35% of them can be sexually transmitted, and two particular types — HPV 16 and HPV 18 — are strongly associated with cervical cancer.

HPV is usually passed during sexual contact such as vaginal intercourse, anal intercourse, or oral sex. But it can also be transmitted by any skin-to-skin contact with an infected person.

As smoking suppresses immune system, smokers are twice as likely as nonsmokers to develop severe cervical dysplasia.

Risk Factors

  • Early initiation of sexual activity
  • Having multiple sex partners
  • Being with a partner who has multiple sex partners
  • Having sex with an uncircumcised man

Diagnosis 

As pelvic examination is usually normal in women with cervical dysplasia, a Pap test is necessary to diagnose the condition.

Further investigations are often required to determine appropriate follow-up and treatment. These include:

  • Repeat Pap tests
  • Colposcopy, a magnified examination of the cervix to detect abnormal cells so that biopsies can be taken
  • Endocervical curettage, to look for abnormal cells in the endocervical canal
  • Cone biopsy or loop electrosurgical excision procedure (LEEP), is performed to rule out invasive cancer; during a cone biopsy, a cone-shaped piece of tissue is removed for lab examination. During LEEP, the abnormal tissue is cut out with a thin, low-voltage electrified wire loop.
  • HPV DNA test, to identify the HPV strains which are known to cause cervical cancer.

Treatments

Treatment depends on different factors, including the severity of the condition and the age of the patient. For mild cervical dysplasia, often continued monitoring with repeat Pap tests is sufficient. For older women with mild cervical dysplasia, usually treatment is needed only if mild cervical dysplasia has persisted for two years or more, progressed to moderate or severe cervical dysplasia, or there are other medical problems.

Treatments for cervical dysplasia include

  • Cone biopsy
  • LEEP
  • Cryosurgery
  • Electrocauterization
  • Laser surgery

All forms of treatment are associated with risks as heavy bleeding and possible complications affecting pregnancy, so it’s important for patients to discuss these risks with their doctor prior to treatment. After treatment, follow-up testingis required, which may involve repeat Pap tests in six and 12 months or an HPV DNA test. After follow-up, regular Pap tests are necessary.

Prevention 

Women can lower their risk by avoiding the high-risk sexual behaviors. Sexually active women whose male partners correctly use condoms during every sexual encounter may have up to a 70% reduced risk of HPV infection.

Other preventive measures include avoiding smoking and every woman should begin cervical cancer screening at age 21.

Three vaccines help prevent infection with some types of HPV, including the types that cause most cases of cervical cancer.

According to guidelines endorsed by the CDC and the American College of Obstetricians and Gynecologists, girls should be vaccinated before they become sexually active. Recently the vaccine has  been approved for women up to age 45.

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