Pap Smears and Cervical Dysplasia

Pap Smears
When yours is slightly abnormal

What did my Pap smear show?

The Pap smear your family physician recently obtained from your cervix (the lower part of your womb) has shown some slightly abnormal changes. A Pap smear allows your doctor to look at cells from your cervix and see if there are any problems. Your Pap smear showed one or more of the following changes. Ask your doctor which of these changes you have.

ASCUS

ASCUS (pronounced "ask-us") stands for atypical squamous cells of undetermined significance. These changes in the squamous cells of your cervix mean that the cells on your Pap smear were slightly abnormal. ASCUS may be caused by a vaginal infection or an infection with a virus called HPV (human papillomavirus, or wart virus). Your doctor will talk with you about the options of looking at your cervix with a microscope (colposcopy) or repeating your Pap smear every 6 months for 2 years.

AGUS

AGUS stands for atypical glandular cells of undetermined significance. These changes in the cells of your cervix mean that these cells were slightly abnormal on your Pap smear. AGUS can occur with infections or with a change in the cells on the surface of your cervix or in the canal of your cervix. Your doctor will tell you how the abnormal results on your Pap smear need to be evaluated. Your doctor may recommend repeat Pap smears or colposcopy.

LSIL

LSIL stands for low-grade squamous intraepithelial lesion. This is a common condition of the cells of the cervix and often occurs when the HPV wart virus is present. These changes in the cervix can be present even if you and your sexual partner are monogamous and have never had visible warts. Changes due to LSIL often get better with time. Your doctor will talk with you about whether you need to have Pap smears every 6 months for 2 years or whether you should have colposcopy.

Inflammation

If inflammation is present in the cells on the Pap smear, it means that some white blood cells were seen on your Pap smear. Inflammation of the cervix is very common and usually does not mean there is a problem. If the Pap smear showed that the inflammation is severe, your doctor may want to find the cause, such as an infection. You may also need to have another Pap smear in 6 months to see if the inflammation has gone.

Hyperkeratosis

Hyperkeratosis is a finding of dried skin cells on your Pap smear. This change in the cells of the cervix often occurs from using a cervical cap or diaphragm or from having a cervical infection. Hyperkeratosis rarely needs any more evaluation than a repeat Pap smear in 6 months. If the hyperkeratosis is still present on the repeat Pap smear, your doctor may want to repeat your Pap smear in another 6 months or perform colposcopy.

Please be sure that you let your doctor's office know if you move or change your phone number so that you can be contacted with the results of your Pap smears or to arrange any other follow-up tests you may need.

Cervical Dysplasia

What is cervical dysplasia?

Cervical dysplasia (also called cervical intraepithelial neoplasia, or CIN) is an abnormal growth of tissue in the cervix. The cervix is the lower part of the uterus that opens into the vagina. The uterus is the womb, where menstrual blood is made and where babies grow during pregnancy.

Dysplasia is not cancer, but it can develop into cancer of the cervix. Cervical dysplasia is classified as mild, moderate, or severe.

How does it occur?

Any woman who is or has been sexually active may have cervical dysplasia. It is more common in women who have had many sex partners or began to have intercourse before age 18. Cervical dysplasia has been linked to a sexually transmitted wart virus called human papillomavirus (HPV). In addition, cervical dysplasia is more common in women who smoke cigarettes or have too little folic acid in their diet.

What are the symptoms?

Cervical dysplasia seldom has any symptoms. Sometimes it causes bleeding during or after sexual intercourse.

How is it diagnosed?

Cervical dysplasia is diagnosed by a simple, painless test called a Pap smear. To do a Pap smear, your health care provider swabs your cervix and cervical canal with a long cotton swab, brush, or wooden stick. Cells from the cervix are sent to a lab to be viewed under a microscope. The Pap smear can be done in your health care provider's office, clinic, or hospital.

If your health care provider wants a closer look at the cervix, you may have a colposcopy. For this procedure a colposcope (an instrument with a magnifying lens) is placed at the opening of the vagina and used to look closely at the cervix. Small samples of any tissue that appears abnormal may be removed and sent to the lab for tests.

How is it treated?

Mild cervical dysplasia often goes away without treatment. If you have mild dysplasia, you should have another Pap smear in 4 to 6 months. If the Pap smear still shows mild dysplasia, your health care provider may recommend colposcopy.

If you have moderate dysplasia, your health care provider may freeze, burn, or use a laser to destroy the abnormal tissue. The abnormal tissue can also be removed with a thin wire loop attached to an electrical unit. This is called the loop electrosurgical excisional procedure (LEEP). You do not have to stay in the hospital for any of these procedures. They can be done in your provider's office.

For severe dysplasia, your health care provider will do a cone biopsy, which is the removal of a cone-shaped piece of the cervix. This removes all the tissue containing abnormal cells. Your provider can cut the tissue out with a surgical knife, cautery (burning tool), laser, or wire loop. The tissue removed is examined in the lab to check for cancer.

Very few women have trouble getting pregnant or have miscarriages after any of these treatments, including cone biopsies. If you become pregnant and have had a cone biopsy, tell your prenatal care provider about it. Most women who have had a cone biopsy are able to become pregnant and carry the baby to term without problems.

Whether you have mild, moderate, or severe dysplasia, it is very important to have it checked to make sure it doesn't become cervical cancer.

How can I take care of myself?

How can I help prevent cervical dysplasia?

To lower your risk of cervical dysplasia:

Thanks to AAFP and MD Consult

Unless otherwise noted: this document was originated by, reviewed and/or edited by Tripp Bradd, MD
current revision/review: 8/26/2008