Latviski English По-русски

Cervical dysplasia or intraepithelial neoplasia

DysplasiaCervical dysplasia is a pre-cancerous condition. This condition shows that girls and women with approved cervical dysplasia can develop  cervicalis cancer. But this does not mean that cervical cancer will develop for all women with cervical dysplasia.
90% of cervical epithelial lesions (dysplasia) regress spontaneously within 2 years - 80% of the displastic changes disappear during 1st year and additionally 10% in the second year. As a result, 10% of the female population who are infected with one of the high-risk HPV genotypes will develop these dysplasia and will progress if left untreated.
The time to develop cervical cancer from the time of primary infection is about 10-15 years.
During a visit to a gynecologist, when determining the HPV infection, it is not possible to tell when it is obtained. The infection may have been acquired many years ago and the resulting dysplastic changes may occur long after infection.
Briefly about terms that they mean.
LSIL and HSIL are cytological terms that indicate low or high grade intraepithelial neoplasia (low grade squamous intraepithelial neoplasia or high grade intraepithelial neoplasia). The cytological term indicates that this analysis is only determined during the cytological examination. The main benefit of this cytological investigation is that the examination can be done in a relatively inexpensive way in wide population and cytological examination is a basic test of all cervical screening programs.
When cytological changes are diagnosed (they may include not only LSIL or HSIL, there may also be less common findings such as AGUS, ASCUS or malignancy), the next step is their morphological confirmation. 
The next step in the investigation is a colposcopy with target biopsy. Colposcopy already requires a little more resources, so it's not as widely used as cytology, but it allows you to select those women who really have a dysplastic change in the cervix.
Colposcopy avoids many unnecessary and unneeded cervical electroexcisions, as cytology may sometimes point to dysplasia, although during colposcopy it can be ascertained that damage is not extensive and it is highly likely that displastic changes may disappear within the next 6 or 12 months.
Colposcopy allows biopsy to be taken from the area of the most damaged cells - the most damaged epithelial environments becomes stained with pronounced white (acetowhite) after application of 3-4% acetic acid and do not stain after 3% application of Lugol solution. Out of these, most-affected areas, well-targeted biopsies are also used to confirm or rule out the likely, heaviest changes that were previously detected in the cytological examination.
The next step is an excision if the displastic changes are confirmed morphologically or histologically.
At this point, when it comes to biopsies or further excisions, changes to this epithelium are indicated by CIN I, CIN II or CIN III. Previously, cytological changes were identified by LSIL and HSIL. These signs are often confused. In order to reduce uncertainty, the term "dysplasia" denotes in general pathologies of the entire cervix caused by human papillomas virus and is more convenient to use in conversation, rather than repeating the intra-epithelial neoplasia of the cervix every time. "Dysplasia" as a term is considered to be historical, but in practice it is easy to use.
Excision is possible in 2 ways - using a loop and a cone. Loop excision sometimes is also called as a LEEP excision, but the meaning is the same. LEEP excision means (Loop Electrosurgical Excision Procedure). With the loop's excision, it is possible to cut out damaged areas of the cervix more carefully, preserving cervical stromal tissues or tissues from which the cervix is built. When the excision is made by a cone, these stromal tissues are more affected, but sometimes cone excision is preferred because it is possible more accurately to assess the deep of the lesions, especially in cases with more severe dysplastic changes. Its also preferred for women in menopause and women with suspected or approved malignancy. Cervical stroma in menopause is no more so important as for women in reproductive age. Cervical lenght and stroma is important for women who are still planning to give birth. In case of cervical cancer wide excision allows more accurate assessment of the invasion. In the case of microinvasive cervical cancer, cone exscision can be used as a final treatment itself, not just as a diagnostic test.
There are a 3 stages of cervical damage:
1. CIN I - mild cervical intraepithelial neoplasia
2. CIN II - Moderate cervical intraepithelial neoplasia
3. CIN III - severe intraepithelial neoplasia of the cervix
The stage of damage to the cervix is determined by the amount of damaged epithelial cells - it occupies a depth of 1/3, or a depth of 2/3 or all 3/3 of the cervical epithelial layer.
In cases of  cervical cancer displastic changes are observed in all layers.

The cause of dysplasia
The cause of the cervical dysplasia is HPV or human papillomavirus. In general, more than 100 human papillomavirus types have been identified, of which only a small fraction is so-called high-oncogenic risk. HPV types with high oncogenic risk are 16, 18, 31, 33, 35, 39, 45, 52, 56, 58, 59, 66, 67, 68, 70.
HPV types with low oncogenic risk are 6, 11, 42, 43, 44.
Identifying a high-risk HPV genotype for a woman (the most commonly encountered are HPV genotypes 16 and 18), this does not necessarily mean that the woman will have these dysplastic changes.


How the HPV is infected?
It is a sexually transmitted disease and is only sexually transmitted. It is not possible to get infected by using a common towel in the pool or by visiting the sauna.
HPV can also be accquaired with the use of condoms. The use of condoms just slightly reduces the risk of getting the infection.
Risk factors for dysplastic changes:
1. Other accompanying infections besides HPV, such as herpes infection, sexually transmitted infections (chlamydia, ureaplasma, mycoplasma, gonorrhea, trichomonas)
2. Endogenous factors (intrinsic factors in the body) - they are not clear at the moment, but there are some sort specifics of 10% women’s immune system that does not allow the body's immune system to recognize accquaired human papillomavirus and eliminate it. 
3. Smoking affects directly proportional to the development of dysplastic changes, persistence and progression - since a woman smokes more, the greater the risk that the immunological mechanisms of the body will not be able to overcome the papilloma virus.
4.Gestgenes - they are part of all contraceptive drugs and it has been shown that the gestgenic component itself reduces the ability of the body to eliminate HPV infection
Briefly about the examinations related to cervical pathology.


Colposcopy is an examination of the cervix with a special device (colposcope) on the gynecological chair. During the examination, the cervix is examined with magnification of 10-30 times.
Colposcopy is a painless procedure. A slight discomfort may occur during the biopsy. Colposcopy can be performed as a separate procedure without taking a biopsies.  
Prior to biopsy, 3% acetic acid solution is applied following application of 3% Lugol solution.


In certain situations when it is not possible to visualize the cervical canal, the cervical canal is slightly exposed with special tweezer, but this also is not painful.

Treatment of Cervical Dysplasia

One of the proven effective treatments for cervical dysplasia is cervical excision.
The procedure is completely painless if properly performed.
Cervical electroexcision can be done in two ways - with a loop or with a cone.
When using loop excision, a nozzle with a small metal loop that is used for cutting.

Treatment of Cervical Dysplasia

In a cone excision a triangular tip is used for more wide excisions. This allows for more qualitative and deeper excision from the cervical canal, and is more suitable for malignant changes.
After the cervical lesions are detected, an anesthetic is administered locally, that makes the procedure painless.
It is best to take the procedure right after menstrual bleeding because it is less likely then to worry if there is bleeding. Bleeding in such cases can be due to next normal menstrual bleeding or it can be related to the procedure.
Precautions should be taken for 4 weeks following the procedure:
• Exclude any physical activity. Do not exercise, do not lift more than 3 kg, because any physical activity can provoke severe bleeding.
• Avoid sex life
• Tampons should not be used as they can contribute to the development of the infection
• Its is allowed to have a shower, but do not take a bath or sauna, as well as avoid swimming. Such activieties can provoke infection and also bleeding.
4-8 weeks is a healing period, so it is important to follow these rules for the first 4 weeks to reduce the risk of post-operative complications. 

Very important!

It is absolutely normal to have some slight discharge following the procedure. Discharge may be completely transparent or also slightly red. Small bleeding is completely normal through all nex moth after the procedure. 
You must be very careful and call your doctor immediately if a bleeding event suddenly appears, especially if you are bleeding with clotts, or should replace a number of packets in a shorter period of time. These can be serious signs of severe bleeding, which most likely will not stop spontaniously and will require immediate interventions by docctor. 
Such bleeding is easy to stop when noticed prompltly, slight appliccation of coagulation will resolve the situation, but hesitation in this situation can turn into very serious with necessity of blood transfusion, sometimes bleeding may be very strong.