Cervical Dysplasia

Cervical dysplasia is a common gynaecological condition that involves abnormal changes in the cells lining the cervix and can potentially lead to cervical cancer if left untreated. This precancerous condition affects millions of women globally. Understanding cervical dysplasia, its symptoms, and available treatments is crucial for women's health and well-being.

In this article, we'll explore the ins and outs of cervical dysplasia. We'll discuss cervical dysplasia signs and symptoms, shed light on its causes, and explain how doctors diagnose this condition. 

What is Cervical Dysplasia?

Cervical dysplasia is a precancerous condition characterised by abnormal cell overgrowth on the surface of the cervix, the opening to the uterus. It's also known as cervical intraepithelial neoplasia (CIN) or squamous intraepithelial lesion (SIL). The condition typically results from infection with certain types of human papillomavirus (HPV), the most common sexually transmitted infection (STI). 

Cervical dysplasia can affect sexually active individuals with a cervix, including cisgender women, transgender men, and nonbinary people. The severity of cervical dysplasia varies, ranging from mild to severe, based on the extent of abnormal cell growth. While not cancer itself, cervical dysplasia has the potential to develop into cancer if left unattended. However, it's crucial to remember that most cases do not progress to cancer, and with proper monitoring and treatment, doctors can effectively manage the condition.

Symptoms of Cervical Dysplasia

Cervical dysplasia often presents no noticeable symptoms, making regular screening crucial for early detection. However, some individuals may experience the following cervical dysplasia symptoms:

• Abnormal vaginal bleeding, like bleeding between periods, after sexual intercourse, or post-menopause 
• Unusual vaginal discharge (watery, bloody, or foul-smelling) 
• Pelvic pain or discomfort during sexual intercourse 

It's important to note that these signs of cervical dysplasia can also indicate other conditions, so a proper medical evaluation is essential for an accurate diagnosis. Regular Pap smears and HPV tests play a vital role in identifying cervical dysplasia before it progresses to more severe stages or potentially develops into cervical cancer.

Causes of Cervical Dysplasia

The foremost cause of cervical dysplasia is infection with certain types of human papillomavirus (HPV). While there are many strains of HPV, only a few high-risk types can lead to cervical dysplasia and potentially cervical cancer. 

Other factors that may contribute to the development of cervical dysplasia include:

• A family history of cervical cancer
• Smoking
• Weakened immune system
• Long-term use of oral contraceptives
• Multiple sexual partners
• Having a sexual partner who has had multiple sex partners

It's important to note that having HPV doesn't guarantee the development of cervical dysplasia. Many people with HPV never develop any symptoms or health issues. 

Risk Factors for Cervical Dysplasia

Several factors increase the possibility of developing cervical dysplasia. 

• Human papillomavirus (HPV) infection is the leading risk factor, particularly high-risk strains like HPV-16 and HPV-18. 
• Sexual activity at a young age or having many sexual partners also raises the risk. 
• Smoking tobacco products can double the chances of cervical dysplasia.
• A weakened immune system, whether due to HIV/AIDS or immunosuppressive medications, makes individuals more susceptible. 
• Other factors include a history of sexually transmitted infections and poor nutrition (especially low in fruits and vegetables). 

Diagnosis of Cervical Dysplasia

Doctors typically detect cervical dysplasia during routine Pap smears. If abnormal cells are found, further tests may be necessary, including: 

• Colposcopy: A colposcopy allows doctors to examine the cervix using a lighted instrument called a colposcope. During this procedure, they may perform a biopsy to collect tissue samples for laboratory analysis. 
• DNA Tests: They can identify high-risk HPV strains.

For more severe cases, doctors may recommend additional tests:

• Electrical Wire Loop: In this procedure, the doctor uses a thin, low-voltage wire to take a small tissue sample.
• Cone Biopsy (Colonisation): Allows deeper layers of cervical cells to be collected for testing.
• Biopsy: Sometimes, doctors may conduct a biopsy to confirm the diagnosis. Biopsy results classify cervical dysplasia as cervical intraepithelial neoplasia (CIN), grouped into three categories based on severity:
  • CIN 1: Low-grade dysplasia 
  • CIN 2: Moderate intraepithelial dysplasia
  • CIN 3: Severe dysplasia

Treatment for Cervical Dysplasia

Treatment for cervical dysplasia depends on various factors, including severity, age, health, and personal preferences. 

For low-grade dysplasia (CIN 1), doctors often adopt a conservative approach, as most cases resolve on their own. Regular Pap smears monitor any changes in abnormal cells.

For more severe cases (CIN 2 or CIN 3), doctors may remove or destroy abnormal cells using procedures such as:

• Loop Electrosurgical Excision Procedure (LEEP): This procedure utilises an electrically charged wire loop to remove dysplastic tissues.
• Cold Knife Cone Biopsy (Colonisation): Removes a cone-shaped piece of tissue containing abnormal cells.
• Cryosurgery: Freezes abnormal cells.
• Laser Surgery: This method uses a laser to remove abnormal tissue.
• Surgery: In persistent cases, doctors may recommend a hysterectomy. 

After cervical dysplasia treatment, follow-up testing is necessary, including repeat Pap tests or HPV DNA tests.

Complications of Cervical Dysplasia

Cervical dysplasia, if left untreated, can lead to serious health issues, such as: 

• The most significant complication is the potential development of cervical cancer. This progression can take several years, undermining the importance of regular screenings.
• Another complication involves fertility and pregnancy. Certain treatments for cervical dysplasia, such as cone biopsy or LEEP, may slightly increase the possibility of low birth weight or premature birth in future pregnancies. However, these risks are generally low, and most women can have successful pregnancies after treatment.
• Cervical dysplasia can cause psychological distress. The diagnosis may lead to anxiety about future health and fertility, impacting a person's overall well-being.

When to See a Doctor

Women should see a doctor for regular cervical cancer screenings, as cervical dysplasia often causes no symptoms. Doctors typically discover this condition during routine Pap tests. After a cervical dysplasia diagnosis, doctors monitor patients closely to ensure abnormal cells don't regrow or become cancerous. They may recommend more frequent Pap smears and HPV tests. Following treatment, patients usually have follow-up Pap smears every three to six months for one to two years.

Afterwards, they can resume yearly Pap tests. It's crucial to attend all follow-up appointments, as undiagnosed or untreated cervical dysplasia increases the risk of developing cervical cancer.

Prevention

• Preventing cervical dysplasia involves avoiding HPV infection. The most effective method is HPV vaccination. These vaccines target the HPV types most associated with cervical cancer and the vaccination can be taken by anyone aged between 9 and 45 years. 
• Regular cervical cancer screenings, including Pap smears and HPV tests, are crucial. Women should have their first Pap smear at 21 and follow recommended screening intervals. 
• Practising safe sex, including using condoms and limiting partners, can reduce HPV transmission risk. 
• Avoiding tobacco use is also important, as smoking increases the risk of cervical dysplasia progressing to more severe forms.

Conclusion

Cervical dysplasia has a significant influence on women's health, demanding attention and proactive measures. The condition's link to HPV infection underscores the importance of vaccination and safe sexual practices to reduce the risk. Regular check-ups, open communication with doctors, and adopting a healthy lifestyle are essential steps to protect against cervical dysplasia and its potential complications. This proactive approach not only safeguards individual health but also contributes to broader efforts to reduce the incidence of cervical cancer. Empowering oneself with knowledge about cervical dysplasia is key to maintaining optimal cervical health. 

FAQ's

1. Does HPV cause cervical dysplasia?

Yes, cervical dysplasia is primarily caused by infection with certain types of human papillomavirus (HPV). HPV 16 is accountable for 50% of cervical cancer cases, while other high-risk types include HPV 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68.

2. Who does it affect?

Cervical dysplasia affects sexually active individuals with a cervix, including cisgender women, transgender men, and nonbinary people. It is most common in women under 30 but can develop at any age.

3. What is the difference between cervical dysplasia and HPV?

Human papillomavirus (HPV) is the virus that develops cervical dysplasia. While HPV infection is common, not all cases lead to cervical dysplasia. The immune system often clears HPV infections, but persistent infections can result in abnormal cell growth.

4. Is cervical dysplasia serious?

Cervical dysplasia is a precancerous condition that can potentially develop into cervical cancer if left untreated. However, most cases do not progress to cancer, especially with proper monitoring and treatment.

5. Is cervical dysplasia a precancer?

Yes, cervical dysplasia is considered a precancerous condition. It involves abnormal cell growth on the cervix surface but is not yet cancer. If untreated, there is a chance it may develop into cervical cancer over time.

6. Is cervical precancer curable?

Yes, cervical precancer is generally curable. Removing or destroying abnormal cells cures cervical dysplasia in about 90% of cases. Treatment options include LEEP, cryosurgery, laser surgery, and, in some cases, hysterectomy.

7. What is the recovery time for cervical dysplasia surgery?

Recovery time varies based on the procedure. LEEP, a common treatment, typically allows patients to resume normal activities within a few days. However, follow-up care and regular screenings are essential to monitor for recurrence.

Dr. Muthineni Rajini

MBBS, DGO, DNB, FICOG, ICOG, Certified Course in Gynecological Endoscopy
CARE Hospitals Outpatient Centre, Banjara Hills, Hyderabad

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