Cervical dysplasia is the presence of abnormal cells in the cervix. Cases are classified as mild, moderate or severe depending on the extent of abnormal cell growth.

Although cervical dysplasia is not cancer, it is a precancerous condition, which means it may develop into cancer if left untreated. Cervical dysplasia is also known as cervical intraepithelial neoplasia (CIN) or squamous intraepithelial lesion (SIL).

Although the precise cause of cervical dysplasia is not known, it has been linked to exposure to the human papillomavirus (HPV). HPV is a group of more than 100 viruses, some of which can cause cells on the cervix to behave abnormally. Among the risk factors for HPV infection are having multiple sexual partners, a history of other sexually transmitted diseases and cigarette smoking.

Cervical dysplasia usually has no symptoms, but a woman may experience genital warts, abnormal bleeding and bleeding or spotting after sexual intercourse.

Cervical dysplasia is usually detected during a routine gynecological examination with a screening test called a Pap smear. During this test, a physician scrapes cells from the surface of the cervix and sends them to a laboratory where they are examined under a microscope to detect the presence of abnormal cells. If abnormal cells are identified on the Pap smear, a colposcopy (an examination of the cervix using an instrument with a lighted magnifying glass) may be performed. A biopsy of tissue samples also may be completed to determine whether abnormal cells are cancerous.

Cervical dysplasia is the abnormal growth of cells on the surface of the cervix, the opening of the uterus that leads into the vagina. Cervical dysplasia is not cancer. Rather, it is a precancerous condition that may develop into cervical cancer if left untreated. Cervical dysplasia is also called cervical intraepithelial neoplasia (CIN) or squamous intraepithelial lesion (SIL).

Viruses or other cancer-causing agents may cause cervical cells to grow abnormally. When this occurs, the cells are considered to have dysplasia. In the early stages, these cells stay within the surface lining of the cervix. At this point, the condition is confined to the surface layer and it is easy to detect and treat. If left untreated, however, the abnormal cells may invade deeper tissue. This is called invasive cancer.

A group of abnormal cells is called a lesion. Cervical dysplasia lesions can:

• Shrink or disappear
• Remain without changing
• Progress to become cervical cancer

Cervical dysplasia can occur at any time after puberty, but it is most common in women ages 25 to 35 years. With early identification, treatment and follow-up, nearly all cases of cervical dysplasia can be cured but the condition can recur. Without treatment, 30 to 50 percent of cervical dysplasias may progress to invasive cancer, according to the National Institutes of Health.

Cervical dysplasia is classified according to the results of a Pap smear. Physicians may use three different systems to classify results of Pap smears: the descriptive system, the CIN system or the Bethesda system. The main difference between these classification systems is whether numbers or words are used to describe the extent of dysplasia. The systems include:

Other terms that may be used to describe cervical dysplasia include:

• Regressive. Referring to cells that shrink or disappear.
• Persistent. Referring to cells that remain present but do not change.
• Progressive. Referring to cells that become cancerous.

If a woman is confused by the classification system used by her physician, she should request clarification of the information.

The precise cause of cervical dysplasia is not known, but it has been linked to exposure to certain strains of the human papillomavirus (HPV). HPV is a group of more than 100 viruses. They are called papillomaviruses because certain types may cause genital warts (papillomas), which are benign (noncancerous) tumors.

Certain types of HPV can trigger the cells on the cervix to behave abnormally. HPV is far more common than cervical dysplasia, with the majority of the sexually active population exposed to one or more types of HPV in their lifetime. However, not all HPVs will cause cervical dysplasia. It is likely that other elements cause or play a role in the development of cervical dysplasia. Though these elements have not yet been identified by the medical community, certain factors are known to increase the risk of cervical dysplasia. In addition to HPV exposure, they include:

• Multiple sexual partners.
  
  
• Early onset of sexual activity (younger than 18 years old).
  
  
• A history of other sexually transmitted diseases (STDs), such as genital herpes, chlamydia, gonorrhea, and human immunodeficiency virus (HIV).
  
  
• Immunosuppression (prevention of the activation of immune system responses). This is common in women with HIV or those taking drugs to prevent rejection of an organ transplant.
  
  
• Early childbearing (younger than 16 years old).
  
  
• Multiple pregnancies.
  
  
• Cigarette smoking.
  
  
• Low levels of folate (a B-complex vitamin essential for cell growth and reproduction) in red blood cells.
  
  
• Long-term use (five or more years) of birth control pills.

It is uncertain whether being born to a mother who took diethylstilbestrol (DES) is a risk factor. DES is a synthetic estrogen that was used from 1940 to 1970 to prevent some complications of pregnancy. Its use was discontinued after researchers discovered it to be ineffective and dangerous.

According to the Centers for Disease Control and Prevention, some studies have shown an increased risk of cervical dysplasia in women whose mothers took DES, though other studies have found no such link.

Cervical dysplasia often produces no symptoms. Occasional signs and symptoms may include:

• Genital warts
• Abnormal bleeding
• Bleeding or spotting after sexual intercourse
• Vaginal discharge
• Lower back pain

However, it is important to note that these symptoms are not unique to cervical dysplasia and can indicate a variety of different problems. Patients experiencing these symptoms should consult a physician, preferably a gynecologist.

Cervical dysplasia is usually detected during a routine gynecological examination, in which a physician reviews a patient’s medical history and performs a pelvic examination. During the exam, the physician will perform a Pap smear, a common screening test used to detect the presence of precancerous and cancerous cells.

During the Pap smear, the physician inserts a speculum (an instrument for examination of canals) into the vagina to examine the cervix. The physician removes cells from the cervix using a small spatula and a brush or cotton swab. The cells are placed on a glass slide or into a fluid-filled bottle and sent to a laboratory for analysis. Physicians can usually determine whether the cervical dysplasia is mild, moderate or severe from the cell sample.

Results of a Pap smear can also be ASCUS (atypical squamous cells of unknown significance). This result means the cells do not look like typical cervical cells, but they are not clearly abnormal. An atypical test can be caused by a yeast infection or the use of birth control pills. With atypical tests, physicians typically repeat the test within a few months.

Although Pap smears are a useful diagnostic tool, they can also produce “false negative” results, meaning that test results are normal when cervical dysplasia is present. For this reason, women should consult their gynecologist on an appropriate screening schedule. Physicians may recommend more frequent retesting as a precaution for women who have had abnormal Pap smears in the past.

A Pap smear will usually identify the presence of abnormal cells. To confirm the diagnosis and further identify the severity of the dysplasia, the physician will perform a colposcopy (examination of the cervix with a colposcope). A colposcope is a microscope that allows physicians to visually examine the cervix.

Before the colposcope is used, the cervix is lightly washed with a vinegar solution that makes abnormal cells stand out more clearly against the surrounding tissue. A colposcopy reveals white areas, atypical blood vessels, or mosaic-like patterns on the cervical surface. 

When a colposcopy is performed, a biopsy (the removal of a tiny piece of tissue from the cervix) is often completed at the same time. The biopsy allows laboratory technicians to study the tissue to ensure the diagnosis is accurate. A biopsy is the definitive method to diagnose cancer.

In some cases, a cone biopsy might be performed to remove abnormal tissue and to determine whether that tissue is cancerous. This procedure removes a cone-shaped or cylinder-shaped piece of the cervix. In many cases, a cone biopsy that is performed for diagnosis is also successful in treating the problem by removing all affected tissue.

Immediately following a colposcopy exam, physicians may now use a new imaging device to determine whether there are other areas of the cervix that need to be biopsied. Approved by the Food and Drug Administration in March 2006, the LUMA Cervical Imaging System shines a light on the cervix and analyzes how the areas of the cervix respond to the light. Based on the response, the LUMA system assigns a score to small areas of the cervix and produces a color map of the surface. The score and color map can help physicians distinguish between healthy tissue and precancerous or cancerous tissue. With the score and color map, physicians can determine where to perform biopsies on the cervix. It should be noted that the LUMA system is meant to supplement – and not replace – the colposcopy exam. Physicians will perform the cervical biopsies only after reviewing the information from both the colposcopy and LUMA exams.

In addition, human papillomavirus (HPV) DNA testing may soon replace conventional Pap smear testing as the initial screening method for cervical dysplasia and cancer. A new large scale study found that the test for HPV, which is present in almost all cervical cancers, is more sensitive than cytology (examination of cells under a microscope) in detecting precancerous or malignant cervical lesions.

Treatment for cervical dysplasia varies depending on several factors:

• The patient’s age
• The size, location and severity of the dysplasia
• Whether the patient has had other gynecological problems

Mild cases often return to normal without treatment and can be managed with frequent follow-up care, including Pap smears every four to six months. Moderate and severe cases require removal of the abnormal cells using a variety of methods, including:

• Cryotherapy (freezing). A probe placed against the cervix cools specific areas of cervical tissue to sub-zero temperatures. The cold temperature damages cells, which the body then sheds in a watery discharge. This is frequently performed without anesthesia and is typically performed by the woman’s ObGyn in the office. Cryotherapy is a comparatively simple and inexpensive procedure but precision is difficult to achieve, which may leave some abnormal cells in the body. For this reason, freezing is used more often to treat mild or moderate cases of cervical dysplasia.
  
  
• Laser treatment. A small beam of light vaporizes the abnormal cells. The laser beam is directed to the target area through a thin, flexible tube called a colposcope. Unlike cryotherapy, laser treatment can be controlled precisely. This is commonly performed without anesthesia with very little discomfort.
  
  
• Cone biopsy. In this procedure, also called conization, a cone-shaped piece of tissue is removed from an area of the cervix known as the transformation zone. Cervical dysplasia (and cervical cancer) are most likely to occur in this area. This procedure may be performed under general anesthesia, in which case a knife or laser is used to remove the tissue. It may also be performed under local anesthesia in a procedure called loop electrosurgical excision procedure (LEEP), also known as large loop excision of the transformation zone (LLETZ). In this procedure, a fine wire loop and electrical current are used to remove the tissue.
  
  A cone biopsy may be considered a form of treatment if the dysplasia is contained within the area being removed. As with any surgical procedure, there are risks involved with a cone biopsy, although they are generally considered rare. Some experts have identified potential long-term risks associated with cone biopsies, such as pregnancy complications (the cervix opening too soon, causing preterm delivery or increased risk of Caesarean delivery). However, many physicians do not believe such complications are related to the procedure itself.
  
  
• Hysterectomy. Surgical removal of the uterus. A woman with severe dysplasia or carcinoma in situ who does not want to bear children in the future may choose this option. It has the lowest recurrence rate of any treatment (because the cervix is removed), but it has the same risks associated with any major surgical procedure. If the patient has other problems that may be helped by a hysterectomy, such as endometriosis (a condition in which cells that make up the lining of the uterus are found outside of the uterine cavity), then it may be the best treatment. However, hysterectomy is not typically recommended for patients with mild to moderate cervical dysplasia as there are significant side effects associated with the procedure.

Because the cause of cervical dysplasia is not fully understood, there is no sure way to prevent it. However, the risk of developing cervical dysplasia may be reduced by:

• Getting annual Pap smears. Although this will not prevent cervical dysplasia, it will aid in its early diagnosis. Patients should continue to get Pap smears even if they are not sexually active.
  
  
• Deferring sexual activity until age 18 or older. The cervix of a younger woman is not fully mature and is therefore more susceptible to disease.
  
  
• Practicing sexual monogamy. This reduces the risk of getting a sexually transmitted disease (STD), including the human papillomavirus (HPV), which has been linked to cervical dysplasia. However, someone who has sex with only one partner still can get HPV.
  
  
• Being aware of sexual history of partners, including STDs.  However, this will not necessarily prevent HPV, because the infection is so common and often remains undetected in individuals.
  
  
• Practicing safe sex, such as using a condom. This reduces the risk of HPV infection, which has been linked to cervical dysplasia.
  
  
• Considering alternatives to birth control pills. Long term use (greater than five years) has been associated with cervical dysplasia. Women should discuss using an alternative birth control method with their physician if they have been taking the pill for an extended period of time.
  
  
• Quitting smoking. Rates of cervical dysplasia are higher in women who smoke.
  
  
• Eating a diet rich in folate from fruits and vegetables. Some research has shown that eating folate may improve the cellular changes seen in cervical dysplasia by lowering levels of homocysteine (a substance believed to contribute to the severity of cervical dysplasia).

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor or healthcare professional the following questions about cervical dysplasia:

1. If I have the human papillomavirus, what are my chances of developing cervical dysplasia?
   
   
2. How often should I be screened for cervical dysplasia?
   
   
3. What tests will you perform to confirm diagnosis of cervical dysplasia?
   
   
4. What are the pros and cons of each type of treatment for cervical dysplasia?
   
   
5. Is cervical dysplasia a serious risk to my health?
   
   
6. Does having cervical dysplasia affect my chances of getting pregnant?
   
   
7. What type of treatment will I require for my cervical dysplasia? Are there any side effects?
   
   
8. How long will my treatment for cervical dysplasia last?
   
   
9. Do I need to make any lifestyle modifications while undergoing treatment for cervical dysplasia?
   
   
10. After treatment, should I be tested again for cervical dysplasia? If so, how often?
    
    
11. What is the best way to prevent cervical dysplasia?
    
    
12. What is the likelihood that the cervical dysplasia will return?