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Cervical Dysplasia

  • A condition in which abnormal cells are present in the cervix
  • Symptoms include abnormal vaginal discharge, spotting between menstrual periods, bleeding after intercourse
  • Treatment includes watchful waiting, cryotherapy, laser ablation, loop electrosurgical excision prodedure, cone biopsy, hysterectomy
  • Involves gynecologic oncology program, obstetrics, gynecology & reproductive sciences and pathology

Overview

When a person with a cervix is told they have cervical dysplasia, it means there are abnormal cells on their cervix. Cervical dysplasia is typically a silent condition, causing no noticeable symptoms.

Cervical dyplasia can range in severity from mild to severe. Mild cervical dysplasia can go away on its own. If left untreated, more severe dysplasia may eventually develop into cervical cancer. For this reason, doctors regularly screen patients for cervical dysplasia or cancer during gynecological pelvic exams and offer treatment when needed.

Beginning at age 21 (and through age 29), doctors may give healthy women a Pap test every 3 years to screen for cervical cancer. For healthy women ages 30 through 65, doctors may offer a Pap test every 3 years or a Pap test with human papillomavirus (HPV) testing every 5 years. (HPV is the virus that causes most cervical cancers.) More recently, HPV testing alone for individuals ages 25 and older can also be used for cervical cancer screening. Some women may need to be tested more frequently, depending on personal risk factors and prior test results.

By screening patients regularly for cervical dysplasia, doctors hope to discover abnormal cervical cells before they may progress to cervical cancer.

“With regular screening and follow-up for abnormal results, cervical cancer is completely preventable,” says Sangini Sheth, MD, MPH, associate professor of Obstetrics, Gynecology and Reproductive Sciences. “This is due to the fact that cervical dysplasia can be identified early and is easily treatable with low risk procedures.”

What is cervical dysplasia?

Cervical dysplasia is the term used for abnormal cells that are present in the cervix—the lowest portion of the uterus that connects to the vagina.

In most women, cervical cells remain normal and healthy throughout their lives. In others, normal cells within the cervix change into abnormal cells. This transformation almost always occurs when women have human papillomavirus (HPV), a common sexually transmitted infection. The presence of certain types of HPV causes cervical cells to become altered internally and change in appearance. If left untreated, some types of cervical dysplasia may develop into cervical cancer over time.

What causes cervical dysplasia?

Most of the time, cervical dysplasia is caused by human papillomavirus (HPV), the most commonly sexually transmitted disease in the United States. There are more than 200 types of HPV, but only some can cause the development of abnormal cervical cells. HPV type 16 and type 18 are most commonly associated with cervical dysplasia.

What are the symptoms of cervical dysplasia?

Most people with cervical dysplasia don’t experience any symptoms. Doctors typically discover the abnormal cells during a Pap test.

However, if a women with cervical dysplasia does have symptoms, they may include the following:

  • Abnormal vaginal discharge
  • Spotting between menstrual periods
  • Bleeding after sexual intercourse
  • Painful sex
  • Bleeding during menopause

How is cervical dysplasia diagnosed?

At the start of a routine gynecological pelvic exam, doctors will obtain a medical history. They may ask if patients have had previous abnormal Pap test results, if they have been diagnosed with cervical dysplasia before, or if they know whether they are HPV-positive.

Because cervical dysplasia doesn’t usually cause symptoms, gynecologists typically offer Pap tests at regular intervals to check for the presence of abnormal cells in the cervix. During a gynecological pelvic exam, doctors will insert a speculum into the vagina to widen it, so they can view the cervix at the top of the vagina. They then use a small swab or brush to scrape cells from the cervix’s surface. The cells are sent for analysis to determine whether they are healthy or if they contain abnormal cells.

If test results are abnormal, depending on the degree of abnormality, patient age, and prior history, additional evaluation will be recommended. The additional evaluation may be a repeat pap and/or HPV test in one year or a colposcopy procedure.

Similar to a Pap test, a colposcopy begins with the doctor inserting a speculum into the vagina to separate the vaginal walls, providing a clear view of the cervix. The doctor then places a microscope, called a colposcope, near the opening of the vagina, to closely examine the cervix. Once the doctor shines a light through the speculum to the cervix, the colposcope helps the doctor see a magnified view of the cervical cells to check for abnormalities. The doctor may apply some vinegar to the surface of the cervix during this exam; the acid in the vinegar solution helps the abnormal cells to stand out more noticeably.

If any areas of the cervix look suspicious, the doctor will biopsy them to check for the presence of abnormal cells. Biopsy results will confirm whether or not the patient has cervical dysplasia and its location on the cervix and severity.

How is cervical dysplasia treated?

Treatment for cervical dysplasia often involves removing the abnormal cells from the cervix.

However, doctors may opt to take a watch-and-wait approach for some women who have low-grade cervical dysplasia or cervical intraepithelial neoplasia 1 (CIN 1). After 6 or 12 months, doctors may offer another Pap test to see if the abnormal cells have gone away on their own or if further evaluation with colposcopy is warranted.  

For individuals with moderate-to high-grade cervical dysplasia (CIN 2 or CIN 3), treatment is necessary. However, for young individuals, ages 21 to 24, or for those considering future child-bearing, moderate cervical dysplasia (CIN 2) can also be monitored with a Pap test and colposcopy every 6 months for up to two years, as long as there is no evidence of worsening abnormalities to severe dysplasia (CIN 3).

Different techniques may be used to remove cervical dysplasia, depending upon the location of the abnormal cells, the size of the affected area, and whether the abnormal cells are low- or high-grade. (High-grade abnormal cells are more likely to progress to cervical cancer if left untreated.)

To remove abnormal cells, doctors may perform:

  • Cryotherapy, during which abnormal cells in the cervix are frozen.
  • Laser ablation. Doctors may use a CO2 laser to vaporize abnormal cervical cells.
  • Loop electrosurgical excision procedure (LEEP). For this treatment, doctors surgically remove the abnormal tissue using a wire loop that has a high-frequency electrical current running through it. Many doctors prefer this treatment for cervical dysplasia, because abnormal cells are less likely to recur, compared to cryotherapy or laser ablation. This excision technique also results in a specimen that can be sent to the laboratory for evaluation.
  • Cone biopsy. During this surgical procedure, doctors cut away a cone-shaped portion of the cervix, removing the bottom portion of the cervix, as well as a conical portion of the center of the cervix.
  • Hysterectomy, in which the entire cervix and uterus are removed. This is an uncommon treatment for cervical dysplasia.

Women who undergo cryotherapy, laser ablation, LEEP or a cone biopsy may still be able to become pregnant after treatment. These cervical dysplasia treatments don't impair fertility or a woman's ability to become pregnant. However, the risk of miscarriage during the second trimester may increase among some women who have been treated for cervical dysplasia.

What is the outlook for people with cervical dysplasia?

Early treatment of cervical dysplasia should help to prevent cervical cancer from developing. However, in some people, cervical dysplasia may recur even after abnormal cells are removed. For this reason, it is important for women to follow up with their doctors regularly and continue to receive regular Pap tests.

What makes Yale Medicine unique in its treatment of cervical dysplasia?

“At Yale Medicine, we follow the most up-to-date evidence and guidelines when it comes to cervical cancer screening and treatment of cervical dysplasia,” says Dr. Sheth. “We seek to closely monitor lower-risk abnormalities and appropriately treat high-risk abnormalities with a patient-centered approach.”