If your pap smear, also known as a pap test, comes back as abnormal, the most likely cause is cervical dysplasia. Cervical dysplasia is a condition of abnormal cellular growth on the cervix, which is the canal between the vagina and the uterus. Cervical dysplasia often results from HPV (human papillomavirus), a very common sexually transmitted virus. An HPV test looks for types of HPV that have been linked to cervical cancer. An HPV test can be done on the same cells used for the initial Pap test, called reflex HPV testing.
What Does an Abnormal Pap Smear Mean?
Abnormal Pap test results do not mean you are at risk for cervical cancer. Cervical dysplasia is usually asymptomatic, it’s important to diagnose and treat the condition to reduce the risk of cervical cancer. Cervical dysplasia can range from mild to severe, and treatments vary depending on the case.
What Causes Cervical Dysplasia?
Dysplasia is usually caused by the human papillomavirus (HPV). HPV is a common sexually transmitted virus that can be passed from person to person during vaginal, anal, and oral sex. Both women and men can be infected with HPV.
Because HPV is typically asymptomatic, many people may be infected with the virus without realizing it. In fact, most sexually active people will get it at least once in their lives, but won’t know because their immune systems clear it before it becomes a problem. However, in cases where it cannot, the virus will cause mild to severe dysplasia in the cervix. People with weakened immune systems are most at risk.
There are over 100 strains of HPV, but the two most dangerous types are HPV 16 and 18. Both are strongly linked to cervical cancer in women.
Risk Factors For Cervical Dysplasia?
Any condition that suppresses the immune system will increase the likelihood that HPV will cause dysplasia of the cervix. These include:
Treatment with immunosuppression medication
Patients who recently underwent an organ transplant or who are diagnosed with certain diseases may be treated with immunosuppressants.
Smoking depresses antibodies and weakens the immune system. Smokers are two times more likely to develop a severe case of dysplasia than non-smokers.
Additionally, cervical cancer is more likely in cases when an HPV infection and cervical dysplasia goes undiagnosed and untreated. Unsafe sexual practices can increase the risk of HPV infection and cervical dysplasia. For example:
Initiation to sexual activity at a young age.
Multiple Sex Partners
This also includes having a partner with multiple sex partners
Incorrect or no condom use
The American Cancer Society recommends that women should begin regular cervical cancer screening at age 21.
A vaccine to Prevent Cervical Dysplasia and Cervical Cancer
One important step in significantly reducing your chances of dysplasia and cervical cancer is to get the HPV vaccine. Two drugs have been approved by the FDA: Gardasil and Cervarix. They have been found to prevent the most dangerous strains of HPV, including the strains that are known to cause cervical cancer and genital warts.
The Center for Disease Control advises that girls get vaccinated well before they are sexually active – at age 11 or 12. It is strongly recommended for the sole reason that it is currently the safest and most effective method to prevent cervical cancer. Girls and young women over the age of 12 should get vaccinated as well, even if they are already sexually active. It is also recommended that men get vaccinated against HPV.
Diagnosing Cervical Dysplasia
Diagnosing cervical dysplasia starts with findings from a Pap test. The Pap test is conducted to find changes in the cells of the cervix that are outside of the norm. During a Pap test, you are positioned on an exam table and a device called a speculum is gently inserted to open the vagina. The speculum allows the healthcare provider to view the cervix and upper vagina. A “broom” device or a brush/spatula combination will be used to collect the cells from the surface of the cervix. Techniques of collecting samples may differ depending on devices used, in general, the doctor will gently rotate the device in the endocervix (the cervical canal) and the ectocervix (the portion of the cervix extending into the vagina) to collect atypical squamous cells of undetermined significance and atypical glandular cells. The collected cervical cells are sent to a laboratory to be evaluated.
The Pap test looks for any abnormal or precancerous changes in the cells on the cervix. If the Pap test results show these cell changes, this is usually called cervical dysplasia. Other common terms include:
- Abnormal cell changes
- Precancerous cells changes
- CIN (cervical intraepithelial neoplasia)
- SIL (squamous intraepithelial lesions) low to high grade
- “Warts” on the cervix
All of these terms mean the same—it means abnormalities were found. Most of the time, these cell changes are due to HPV. There are many types of HPV, from high risk to low risk, that can cause cervical dysplasia. Most of these types are considered “high-risk” types and linked with cervical cancer.
Just because you have cervical dysplasia, does not mean you will get cervical cancer. It means your healthcare provider will want to closely monitor your cervix more frequently – and possibly conduct treatment – to prevent further cell changes that may become cancerous if left unchecked.
An abnormal pap smear is a red flag that a patient has cervical dysplasia, and further evaluation is recommended to determine the appropriate diagnosis and treatment. Your doctor may perform further testing such as cervical cancer screening tests:
- HPV DNA test. Your OB-GYN may want to test specifically for the strains of HPV that are high-risk for cervical cancer (HPV 16 and HPV 18). In this procedure, your doctor will examine the cervix using a special scope in order to take a biopsy of the abnormal cells.
- Cone biopsy. Your OB-GYN takes a cone-shaped tissue of cervical biopsy.
- Endocervical curettage. Your doctor scrapes cells from the cervical canal to test for abnormalities.
Cervical Dysplasia Treatment
You and your doctor will discuss the many options available for treating dysplasia. Your treatment plan will depend on your age and the severity of your case. In mild cases, especially in older women, your doctor may advise monitoring with repeat Pap smears every few months. Possible treatments include:
- Cone biopsy can be used to both examine and remove the portion of abnormal cellular growth.
- Loop electrosurgical excision procedure (LEEP) The doctor excises the portion of abnormal cells using an electrified wire loop instrument.
- Laser surgery
Each of these treatments carries a risk of bleeding and may increase the risk of complications during pregnancy. Women who plan on carrying children in the future should talk to their doctor about their concerns.
After treatment, your OB-GYN will likely recommend follow-up pap smears every few months to make sure all of the abnormal cells have been removed. After a few consecutive normal tests, you may return to an annual regular pap smear schedule as recommended by your OB-GYN.
If you are suffering Cervical Dysplasia or have had an abnormal PAP smear, please discuss this with your doctor immediately. And as always, if you have any unanswered questions about your health, talk to your doctor.
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