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February 9, 2012

Cervical Dysplasia

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What is cervical dysplasia?

Cervical dysplasia refers to the presence of precancerous changes of the cells that make up the inner lining of the cervix, the opening to the womb (uterus). The term dysplasia refers to the abnormal appearance of the cells when viewed under the microscope. The degree and extent of abnormality seen on a tissue sample (such as a Pap smear) was formerly referred to as mild, moderate, or severe dysplasia. In recent years, this nomenclature has been replaced by two newer systems. These systems are based upon changes in the appearance of cells visualized when smears of individual cells (cytological changes) or tissue biopsies (histological changes) are reviewed under a microscope.

  1. Squamous intraepithelial lesion is the pathology terminology for cervical dysplasia observed in smears of cells taken from the cervix. Squamous refers to the type of cell that lines the cervix. intraepithelial refers to the fact that these cells are present in the lining tissue of the cervix.

  2. Cervical intraepithelial neoplasia is cervical dysplasia that is observed on a cervical biopsy or surgically removed cervix.

These classification systems will be further discussed below.

What causes cervical dysplasia?

Cervical dysplasia is caused by infection of the cervix with the human papillomavirus (HPV). Although there are over 100 HPV types, a subgroup of HPVs have been found to infect the lining cells of the genital and reproductive tract in women. HPV is a very common infection and is transmitted through sexual contact; over 75% of sexually active women are thought to acquire the virus at one point or another. It is believed that over 6 million people become infected with HPV every year in the US, and approximately 50% of those infected are between the ages of 15 and 25. Most infections occur in young women, do not produce symptoms, and resolve spontaneously without any long-term consequences. The average length of new HPV infections in young women is 8-13 months. However, it is possible to become re-infected with a different HPV type.

Some HPV infections persist over time rather than resolve, and the reason why the infection persists in these women is not fully understood. Factors that may influence persistence of the infection include:

  • advancing age,

  • duration of the infection, and

  • being infected with a "high-risk" HPV type (see below).

Persistent HPV infection has been shown to play a causal role in the development of genital warts and precancerous changes (dysplasia) of the uterine cervix as well as cervical cancer. Even though HPV infection appears to be necessary for the development of cervical dysplasia and cancer, since not all women who have HPV infection develop dysplasia or cancer of the cervix. Additional, yet uncharacterized factors must also be important in causing cervical dysplasia and cancer. Since HPV infections are transmitted primarily by sexual intimacy, the risk of infection increases as the number of sexual partners increases.

Among the HPVs that infect the genital tract, certain types typically cause warts or mild dysplasia ("low-risk" types; HPV-6, HPV-11), while other types (known as "high-risk" HPV types) are more strongly associated with severe dysplasia and cervical cancer (HPV-16, HPV-18). Cigarette smoking and suppression of the immune system (such as with concurrent HIV infection) have been shown to increase the risk for HPV-induced dysplasia and cancer of the cervix.

The HPV types that cause cervical cancer also have been linked with both anal and penile cancer in men as well as a subgroup of head and neck cancers in both women and men.



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      • Sexually transmitted diseases, or STDs, are infections that are transmitted during any type of sexual exposure, including intercourse (vaginal or anal), oral sex, and the sharing of sexual devices, such as vibrators. Women can contract all of the STDs, but may have no symptoms, or have different symptoms than men do.
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Cervical Dysplasia

What is a hysterectomy?

A hysterectomy is a surgical procedure whereby the uterus (womb) is removed. Hysterectomy is the most common non-obstetrical surgical procedure of women in the United States.

How common is hysterectomy?

Approximately 300 out of every 100,000 women will undergo a hysterectomy.

Why is a hysterectomy performed?

The most common reason hysterectomy is performed is for uterine fibroids The next most common reasons are:

  • abnormal uterine bleeding (vaginal bleeding),
  • cervical dysplasia (pre-cancerous conditions of the cervix),
  • endometriosis, and uterine prolapse (including pelvic relaxation).

Only 10% of hysterectomy is performed for cancer. This article will primarily focus on the use of hysterectomy for non-cancerous, non-emergency reasons, which can involve even more challenging decisions for women and their do...

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