I am 23, and my annual Pap test came back with the diagnosis of dysplasia of the cervix. I was told it was noncancerous, but now my doctor wants to do a colposcopy and biopsy. What is this procedure, and does this mean I'm at a higher risk for cervical or ovarian problems as I get older? Will I be able to have children?

--Lisa

Pap smears are screening tests to look for abnormalities of the cervix. Most labs report results using the Bethesda system, which divides Paps into several categories: normal; atypical cells of undetermined significance; low-grade squamous intraepithelial lesion (mild dysplasia); high-grade squamous intraepithelial lesion (moderate or severe dysplasia); or cancer.

Dysplasia means cells are abnormal and are arranged next to one another abnormally. Here's an analogy I like to use: Normal is like a brick wall built by a master bricklayer -- nice and neat with perfectly straight lines. Mild dysplasia is like a brick wall built by an apprentice -- the rows are uneven and it's not exactly level. Moderate dysplasia is a brick wall built by someone who's read a couple of books -- some bricks stick out, it caves in at a couple of spots, but you can tell it's a wall. Severe dysplasia is a wall built by me -- it's barely recognizable as a wall, I forgot the mortar and the whole thing will fall over in a stiff breeze. Cancer, then, is a pile of bricks jumbled on the ground.

Because the Pap smear is just a screening test -- one in which cells are scraped from the cervix and then smeared on a slide -- if your results show any abnormality, then you need more conclusive tests. The next step is a colposcopy. This is where the doctor will look directly at your cervix with a special microscope, and if any areas appear abnormal, he or she will take a biopsy (a small snip of tissue). The whole procedure is done in the office, takes only a few minutes and is not painful. The biopsy goes to a lab, where a specialist examines individual cells and the way they are arranged next to one another. Dysplasia, if there is any, is determined and graded as mild, moderate or severe. Treatment depends on biopsy findings; depending on the results, it could range from very close follow-up, to freezing or lasering the cervix, to performing a LEEP (a procedure to remove a portion of the cervix). Hysterectomy is *rarely* needed.

If you have dysplasia confirmed by biopsy and get the appropriate treatment, you'll most likely have no problems with getting pregnant or carrying children in the future. You will need close follow-up with Pap smears, however. That way, if there is any recurrence, you and your doctor can detect it early when it can be easily treated.

An abnormal Pap smear is something that needs to be evaluated completely. It should not inspire panic or fear. The entire point of a screening test is to find problems while they are in an early stage and can be taken care of.