Health Concerns

Cervical Dysplasia

Conventional Treatment

Treatment of cervical dysplasia depends on the degree of dysplasia. Mild dysplasia, such as CIN I or LSIL, may go away without treatment, but careful follow-up at regular intervals, generally 6–12 months, is needed, and treatment should be performed if the changes do not go away or worsen over time (A.D.A.M. 2014).

Watchful Waiting

Lower degrees of dysplasia with lower-risk types of HPV frequently resolve without treatment, so some cases are managed with “watchful waiting” rather than active treatment (Ho 2011). If the condition persists or worsens, then active treatment can be instituted.

Women who opt for watchful waiting after a diagnosis of low-grade cervical dysplasia should adopt the healthy lifestyle choices and risk reduction measures presented in this protocol, and follow ongoing screening recommendations, as advised by their healthcare provider.

Active Treatment

Several active treatment options are available. These include ablation (cryotherapy or laser ablation), excision (including loop electrosurgical excision procedure [LEEP], cold knife conization, laser conization), and rarely, hysterectomy (Echelman 2012; Sauvaget 2013; Singh 2011).

Cryotherapy has been used successfully for the past fifty years, but use is declining, with other procedures such as laser ablation and LEEP being used with increasing frequency (Sauvaget 2013). Cryotherapy is most efficacious when used for smaller and less invasive cervical lesions. Cryotherapy does not treat cervical cancer, and is efficacious against 70–92% of CIN III cases (Echelman 2012). Cryotherapy involves the local application of a metal probe to the cervix, without touching the vagina, to administer a compressed gas such as nitrous oxide or carbon oxide to destroy the affected cervical tissue. It acts by decreasing the temperature locally, and causing crystallization and the breakage of cellular membranes (Sauvaget 2013; Singh 2011). Cryotherapy has a very low rate of complications, and adverse effects that may occur, such as vaginal discharge and cramps, are usually temporary and self-limited (McClung 2012).

LEEP, also known as loop excision of the transformation zone (LETZ) or large loop excision of the transformation zone (LLETZ), uses low current at high frequency and loops made of stainless steel or tungsten to excise the lesions. Some complications of LEEP include bleeding, incomplete removal of the lesion, and narrowing of the cervix, but advantages include low cost, high patient acceptance, and the possibility to retrieve samples for further laboratory analyses (Mayeaux 1993).

In a prospective study on 200 women, either cryotherapy or LEEP were reported to have good results in women with CIN, and LEEP was somewhat better for more severe lesions (Singh 2011).

Laser conization is another approach for excisional treatment. A study that examined the persistence of HPV genetic material after laser conization reported that the viral genome that existed before treatment regularly disappeared after the conization procedure (Kjellberg 2000).