Every woman should be aware and informed of the importance of having gynecological check-ups and tests such as cytological examinations.
These help detect numerous pathologies, but among the most important lies cervical dysplasia. This condition, by itself, is nothing to worry about. But, if not effectively treated, it can culminate in something much worse.
Then, in the following article we leave you what you should know about cervical dysplasia, what it is, when to go to the gynecologist and what your treatment options are.
What is cervical dysplasia?
Cervical dysplasia is the presence of abnormal cells located in the cervix (also known as the cervix). In medical practice, cervical dysplasia is a worrisome sign because it is the precursor stage to cervical cancer.
This does not mean that there is the presence of cancer cells, but that there are “out of place” cells, causing abnormal tissue ((this is known as dysplasia) that, if not detected and treated early, evolve into cancer. .
In the US alone , cervical dysplasia affects 250,000 to 1 million women annually, particularly women between the ages of 25 and 35. However, the incidence has decreased considerably.
Cervical dysplasia can be categorized into: mild, moderate, and severe. This classification is based on observing the abnormal cells under the microscope, depending on the severity, a certain treatment is established.
Causes of cervical dysplasia
The origin of cervical dysplasia can be attributed to various causes, of which we will mention and explain some of the most relevant.
Human papillomavirus (HPV) is the most common cause of cervical dysplasia. HPV is not a single microorganism, it is an entire family made up of multiple hundreds of species, known as “types”, in different mammals.
Over the years, more and more evidence has shown the association between certain types of HPV with cancer of the cervix, anal, and even vulvar cancers, as well as others. This is due to the tropism that HPV presents to the mucous membranes of these tissues.
Genital HPV types are classified based on their epidemiological association with cervical cancer. There are low-risk types of infections, such as 6 and 11, which cause mild dysplasia, genital warts, and respiratory papillomatosis.
High-grade cancers, types 16 and 18, can cause anal, cervical, and other parts of the genitourinary tract cancer. Globally, it is estimated that 70% of cervical cancers are due to HPV types 16 and 18.
Certain studies have drawn a correlation between the number of sexual partners and the risk of developing cervical diseases, such as cervical dysplasia. In 2015, a review of 41 studies was carried out to demonstrate whether or not this relationship exists.
The study found that there is indeed a significant relationship between the number of partners and non-malignant cervical diseases (for example, dysplasia) and invasive cervical carcinoma, with or without HPV infection.
Pregnancies at an early age
Sexual relations at a young age are related to a number of complications, since the lack of knowledge about responsible sexual practices can lead to pregnancy and sexually transmitted infections (including HPV).
It has also been observed that there is an association between sexual intercourse and early pregnancy with the development of invasive cervical carcinoma.
The reason is unknown, but it has perhaps been hypothesized that, at early ages, the cervical epithelium has not yet developed sufficiently and becomes more susceptible to HPV infections.
compromised immune system
At every moment, our cells replicate. This constant rate of cell turnover means that defects (abnormal cells) will invariably always occur. Fortunately, our immune system is capable of dealing with these bugs.
In immunocompromised patients (due to HIV , consumption of corticosteroids, neutropenia, etc.), our defenses become less effective in detecting cellular abnormalities, allowing the replication of precancerous cells.
On the other hand, the HIV-positive person becomes more likely to suffer from all kinds of infections, including HPV. As the total lymphocyte count is lower, the risk of developing cervical lesions increases.
Cigarette smoking is a risk factor for many diseases, neoplastic or not. This is due to the presence of more than 300 pre-cancerous substances that are metabolized in our body and become carcinogenic.
These substances induce inflammation, weakening of the immune system, stress and cellular, acceleration of cellular aging and much more. These phenomena, in women already genetically predisposed, increase the risk of cervical cancer.
The relationship between vitamin deficiencies (such as vitamins A, E, and C) and the development of cervical dysplasias and neoplasms has been the subject of studies . These three vitamins are three powerful antioxidants.
Antioxidants reduce oxidative stress. The latter, in turn, is capable of inducing apoptosis, cell proliferation and the appearance of new blood vessels (angiogenesis), creating the ideal environment for the appearance of abnormal cells.
One of the functions of retinol (vitamin A) is to promote cell differentiation of the cervix (the less differentiated a cell is, the greater its carcinogenic potential) and to inhibit the oncogenic action of HPV.
On the other hand, the serum levels of vitamins A, E and C were decreased in patients with cervical carcinoma, regardless of their stage, compared to the serum levels of control patients.
However, it is not known with exact precision whether vitamin deficiencies are a cause or an effect of cervical dysplasias or neoplasms.
Symptoms of cervical dysplasia
In general, mild dysplasias do not produce symptoms during their early stages, but as it progresses, the symptoms become more and more apparent.
Bleeding after menstruation
Also known as breakthrough bleeding, it is a condition that can be caused by a wide plethora of conditions. In most cases, it is an adverse effect during the first months of taking hormonal contraceptives.
Other causes are sexually transmitted diseases, cervical or endometrial polyps, stress, and polycystic ovary syndrome.
But, women between 25 and 64 years of age who present breakthrough bleeding, it is recommended to have a gynecological check-up, since there is a possibility of cervical cancer.
Prolonged and heavy menstruation
Irregularities in the menstrual cycle, such as heavy bleeding (hypermenorrhea) and a prolonged menstrual cycle plus heavy bleeding (menorrhagia), are possible indicators of reproductive system disease.
It should be noted that, in a woman’s reproductive years, it can be caused by hormonal imbalances (hypothyroidism, obesity or insulin resistance), inflammation of the cervical walls, certain medications and uterine or cervical cancer.
recurring pelvic pain
Like the previous symptoms, pelvic pain is not a definitive sign of a possible cervical dysplasia or neoplasia, but rather it can be caused by digestive, urinary or reproductive pathologies.
Among the possible reproductive causes to consider are: adenomyosis, endometriosis, pelvic inflammatory disease, uterine fibroids and cancer.
It is important to mention that women who have a history of HPV infection or have presented irregularities in their papanicolaou test should go to their preferred gynecologist for a check-up and rule out the possibility of cancer.
pain during intercourse
Odor during sexual intercourse, in the context of cervical dysplasia, originates from the replacement of normal cells by abnormal cells, disturbs adequate lubrication and also decreases vaginal elasticity.
This generates irritation and can even further injure the epithelium. The pain can be mild to severe and can occur during or after sexual intercourse.
post intercourse bleeding
For reasons similar to the previous point, the friction generated by sexual dysfunction can injure the vaginal mucosa, leading to post-coital bleeding.
In this sense, up to 11% of patients diagnosed with cervical cancer were detected because they went to the hospital after presenting bleeding after the sexual act.
Post menopausal bleeding
The number of pathologies responsible for alterations in the quantity, cycle and duration of the menstrual cycle during the reproductive years is much greater than that just before, during and after the menopause.
In the latter case, the possibility of uterine or cervical cancer is relatively high if the patient has abnormal uterine bleeding. In this sense, 75% to 90% of postmenopausal women with cancer in the uterus have abnormal bleeding.
Increased vaginal secretions
Just as lubrication dysfunctions can occur during intercourse, hypersecretion can occur in the vagina, generating abundant vaginal discharges.
Vaginal discharges are a frequent phenomenon that allows the lubrication of the vagina.
These secretions take on a brown or bloody coloration during or after menstruation. In rare situations, it can be indicative of uterine or cervical disease.
Classification of cervical dysplasia
After the biopsy is taken, the sample is taken to a pathologist, who examines the sample and observes the different characteristics that the abnormal cells present. From this, he diagnoses the degree of severity of the dysplasia.
Mild dysplasia (CIN 1)
In this phase, there is a good maturation and differentiation of the cells, with little presence of mitotic bodies (these are cellular elements indicative of a high degree of cell replication, characteristic of neoplasms and dysplasias).
Undifferentiated cells are restricted to the lower third of the epithelial layers. Cellular changes related to HPV infection (if this is the cause) can be observed.
Moderate dysplasia (CIN 2)
Dysplastic cell changes are more common at this level, particularly in the lower half of the epithelial layers and with a greater presence of mitotic bodies.
Severe dysplasia (CIN 3)
Cellular differentiation and their organization into layers or levels in the epithelium are completely lost. This is known as loss of polarity, where the cells that should go to their respective levels are scattered everywhere.
A greater number of mitotic bodies is observed, in addition, atypical cells become more prominent in all thirds of the epithelium and are distributed throughout its thickness.
Treatment for cervical dysplasia
Fortunately, the cellular irregularities of dysplasia can be treated early and effectively, if detected early by medical specialists. Next, we will explain some of them.
Cryosurgery is an invasive but practically painless therapeutic tool that has shown excellent results. During the operation, specialists open the vaginal canal with a speculum and insert a cryoprobe.
The tip of the instrument is placed on the dysplastic surface of the cervix. Liquid nitrogen flows through the instrument to the epithelium, freezing the surface and destroying aberrant cells. All this procedure is done after applying a local analgesic in the area.
The risk of scarring after the procedure is very low and the patient can resume her daily activities almost immediately after surgery.
This alternative has certain similarities with the previous procedure. The vaginal cavity is opened with the aid of a speculum and an instrument that emits a CO2 surgical laser is inserted, which can vaporize abnormal cells from the cervix.
Laser therapy is used when the location of the abnormal cells cannot be reached by the cryoprobe. High efficacy has been demonstrated with this treatment, complete destruction of aberrant tissue in 77 to 98 women per 100 cases.
It is common for a woman to experience a watery vaginal discharge for 2 to 3 weeks. You should avoid using tampons and avoid sexual intercourse during this period.
Electrosurgery, also known as the loop electrosurgical excision procedure (LEEP), is a treatment that involves inserting a thin wire loop into the vaginal canal.
The said wire contains a low voltage electrical charge. As in the previous procedures, a local analgesic is applied that prevents the sensation of pain, but you may feel slight pressure or cramping.
Before inserting the wire, the doctor cleans the cervix and applies a vinegar solution (also called acetic acid solution), which stains the abnormal tissue white, making the operation easier.
Because electrosurgery cauterizes local blood vessels, there is usually very little bleeding. Depending on the size and amount of abnormal tissue, wires of different shapes and sizes are used.
Tissue removed during the procedure is sent to pathology laboratories for further examination. Thus, LEEP serves as both a diagnostic and a therapeutic tool.
Conization is essentially a biopsy. It can be used in conjunction with the LEEP to diagnose or treat cervical dysplasia. It consists of the incision of a cone-shaped segment of the cervical lesion.
The procedure is performed using a specialized cold knife, laser, or with a wire loop (LEEP). This method is used when the results of the cytological test and the biopsies are conflicting.
It is also used when a grade 2 or 3 CIN or stage IA1 cervical squamous cell carcinoma is diagnosed.
Hysterectomy, an invasive surgical procedure where the uterus and cervix are removed, is not used at all to treat cervical dysplasias.
There are less invasive and permanent treatments to treat low-grade injuries. Hysterectomy is used as a last resort, in patients with aggressive and infiltrating cervical carcinoma.
A variant of the hysterectomy is the cervical trachelectomy, where only the cervix and the upper portion of the vagina are incised. Therefore, the woman maintains the ability to have children, but carries a greater risk of presenting spontaneous abortions.
How to prevent cervical dysplasia?
Cervical dysplasia can be prevented if methods that help protect women from HPV infection are used, such as those that we will explain below.
Get vaccinated against HPV
The HPV vaccine helps protect both females and males. The first, because it offers the body a protective barrier before possible exposure to the virus.
In theory, vaccinating men reduces the risk of transmission, since they can be carriers of HPV strains (types) that cause cervical or vulvar cancers in women.
The CDC (Center for Disease Control and Prevention) recommends that all young people between the ages of 11 and 12 be vaccinated twice, with an interval of six months between both injections.
The use of condoms continues to be one of the most effective (although not infallible) methods to prevent the transmission of not only HPV, but also many other sexually transmitted diseases (Chlamydia, HIV or gonococcal diseases).
Earlier, we talked about the significant relationship between the number of sexual partners and the risk of developing cervical dysplasia or other cervical diseases. Avoiding a disproportionate number of partners can reduce the risk.
It is important to note that having a high number of sexual partners does not mean that you develop these abnormalities. It only means that the risk is increased, but the development of neoplasms is a complex process that involves multiple factors, both endogenous and exogenous.
The cigarette is a harmful habit from many aspects of health. Endocrine, cardiovascular, cognitive, gastrointestinal and, in this case, from the oncological point of view.
We recommend using strategies that help reduce (and eventually stop) tobacco use. Don’t be afraid to ask for help from others to break this dangerous habit.
Avoid sexual intercourse at an early age
Relationships at an early age increase the risk of various diseases, since the woman’s reproductive system has still fully developed.
In addition, sexual relations at a young age are associated with less knowledge of prevention methods, facilitating the transmission of infections and pregnancies, which, in the long run, can lead to cervical cancer.
Maintain a constant gynecological checkup
Women in reproductive years, especially those between 25 and 64 years of age, should periodically go to their preferred gynecologist for a general check-up.
Among the routine exams of the gynecological check-up, there is the papanicolaou test. This test consists of taking a small biopsy of the reproductive mucosa, sending it to a laboratory and observing whether or not there are abnormalities.
Early detection of any anomaly in the reproductive system is associated with a better prognosis and effective treatments to prevent the progress of any disease.
University Professional in the area of Human Resources, Postgraduate in Occupational Health and Hygiene of the Work Environment, 14 years of experience in the area of health. Interested in topics of Psychology, Occupational Health, and General Medicine.