I had an abnormal pap and biopsy last year, which resulted in a LEEP in October. Now, my follow-up pap is again abnormal, showing moderate dysplasia. The doctor wants to do another colposcopy and biopsy. What happens then? I am 26, and concerned about my fertility.

--Danielle

What happens next depends on what the colposcopy and biopsy reveal. If a biopsy shows only mild dysplasia, then close observation is an option. If the biopsy confirms moderate dysplasia, then treatment is usually recommended. Such treatment could be cryotherapy (freezing the cervix), laser, or a repeat shallow LEEP.

One of the potential consequences of a LEEP is stenosis, or narrowing, of the cervix. This may interfere with menstrual flow and conception. Cervical stenosis often can be successfully treated by dilating the cervix periodically. Another potential consequence of LEEP is the exact opposite: cervical incompetence. Because a portion of the cervix is removed during a LEEP, the cervix may become weak and may not stay closed during a pregnancy, leading to miscarriage or preterm delivery. A stitch placed around the cervix during pregnancy -- called a cerclage -- can help prevent an early delivery.

You may also want to ask your doctor about HPV typing, if you have HPV (human papilloma virus), which can lead to cervical cancer. Certain subtypes of HPV are more aggressive, and if you do not have these aggressive subtypes, you may be able to elect more conservative therapy.