Cervical Dysplasia: Causes, Treatment, and Prevention

What is cervical dysplasia?

Cervical dysplasia is defined as a precancerous condition in which abnormal cells grow on your cervix. Your cervix is the narrow portion located on the lower end of your uterus that connects your vagina and uterine cavity.

The cervix is divided into two parts: the endocervix and exocervix. While the former comprises the opening into your uterus, the latter protrudes into your vagina. Both the inner and outer portions are covered in different types of cells and meet in the “transformation zone.” This is where most cases of cervical dysplasia occur.

Note that cervical dysplasia is sometimes referred to as squamous intraepithelial lesion (SIL) or cervical intraepithelial neoplasia (CIN), and is classified into distinct stages:

• CIN1, mild cervical dysplasia, or low-grade intraepithelial lesion (LSIL)

Only a small portion of the tissue is abnormal. 

• CIN2 or CIN3, moderate/severe cervical dysplasia, or high-grade intraepithelial lesion (HSIL)

A larger portion of the tissue is abnormal.

Cervical dysplasia symptoms

Cervical dysplasia, like HPV infections and even early-stage cervical cancer, tend to be asymptomatic. That’s why it’s important to get your pelvic exams and Pap smears as scheduled. 

If you have abnormal Pap smear or pelvic exam results, your doctor may order further tests or refer you to a specialist. Depending on your personal history, you’ll need the following:

• A repeat Pap smear

It might be conducted between one and three years after the initial test, depending on the specifics of your situation.

• HPV testing

This test diagnoses infections with a high-risk strain of HPV, and can be performed on the same sample collected for your Pap smear.

• Colposcopy and biopsy

A colposcopy utilizes a magnifying device to closely examine your cervix. If your doctor spots anything suspicious, they’ll likely do a biopsy (i.e., take a tissue sample for testing). 

• Endocervical sampling

It’s a supplemental procedure where a small brush or curette gathers cells from your endocervix to be examined for cervical dysplasia.

Causes of cervical dysplasia

Cervical dysplasia precedes cervical cancer, but the transition from one to the other is slow, and happens over the course of many years.

Cervical dysplasia is caused by a common sexually transmitted infection known as human papillomavirus or HPV. In most cases, your immune system will be able to fight it off within 8 to 24 months. However, a persistent HPV infection might result in changes to your cells and eventually, cervical dysplasia.

Although there are more than a hundred types of HPV, only a few appear responsible for developing cervical cancer. HPV 16, for example, is the culprit behind roughly half of all cervical cancer cases. Other high-risk strains include HPV 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68.

Treatment of cervical dysplasia

Severity is the overriding factor when it comes to treatment of cervical dysplasia. Mild dysplasia or LSIL is monitored conservatively and tends to resolve on its own without progressing into cancer.

HSIL or moderate/severe dysplasia, on the other hand, usually requires removal of cells, either in the form of excisional or ablative procedures. Excisional treatments for cervical dysplasia include:

• Loop electrosurgical excision procedure (LEEP)

Here, a thin wire loop uses an electrical current to remove cervical tissue.

• Conization or cold knife cone (CKC) procedure

Alternatively, a cone-shaped or cylindrical portion of cervical tissue is excised for testing.

Ablative treatments, in contrast, destroy cervical dysplasia tissue and include:

• Laser therapy

A beam of light is used to destroy abnormal cells in your cervix.

• Cryotherapy

A small probe relies on liquid nitrogen or argon gas to freeze abnormal tissue.

After these procedures are performed, you must obtain yearly follow-up Pap smears.

Contributing factors and prevention of cervical dysplasia

As the primary reason behind cervical dysplasia and cancer, HPV, unfortunately, does not have a cure. But HPV vaccines can help protect you from infection by certain strains.

Since HPV vaccines cannot treat pre-existing infections, it’s recommended that you get it before becoming sexually active to maximize its effectiveness. Nevertheless, it may still be administered to sexually active adults through the age of 26. If you haven’t been vaccinated against HPV, please discuss it with your doctor.

Other things that might increase your chances of developing cervical dysplasia or cancer include:

• Smoking
• Exposure to secondhand smoke
• Having multiple sexual partners
• Having a partner with multiple sexual partners
• Immunosuppression therapy

Pap smears and HPV tests are routinely used to screen for HPV and cervical dysplasia. While a Pap smear involves taking a cervical cell sample to detect microscopic changes, an HPV test can spot the virus inside these cells. It’s important to note that:

• All women should begin cervical cancer screening at 21 years of age.
• Between 21 and 29, a Pap smear is recommended once every 3 years. 
• After turning 30, you should get both a Pap smear and HPV test every 5 years, as long as your results remain normal. 
• Between 30 and 65, a Pap smear is recommended once every 3 years.

Takeaway

Cervical dysplasia refers to abnormal changes in the cells of your cervix which have not progressed into stage 1 cervical cancer. Cervical cancer usually takes years to develop, and being able to diagnose these changes is the key to effective treatment. Be sure to go in for regular Pap smears and ob-gyn checkups to detect cervical dysplasia as early as possible.