An Overview of Cervical Dysplasia

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Cervical dysplasia is a common condition that describes abnormal precancerous changes to the cervix, the cylindrical canal that forms the connection between the uterus and vagina. Abnormal changes can range from mild to severe and are detected through a routine Pap smear. Cervical dysplasia most commonly affects women ages 25 to 35, although it can occur at any age.

Although untreated cervical dysplasia may lead to cervical cancer in some cases, having cervical dysplasia does not mean that a person has cancer or will ever develop the disease. It’s estimated that between 250,000 and 1 million women are diagnosed with cervical dysplasia each year in the United States. In contrast, between 10,000 and 15,000 new cases of cervical cancer are diagnosed annually.

Symptoms

Women with cervical dysplasia do not usually have any symptoms. This is the reason why having a regular Pap smear is so important.

A regular Pap smear can detect these abnormal cervical changes long before they turn cancerous.

Causes

There is a very strong connection between the human papillomavirus (HPV) and cervical dysplasia. HPV is a common virus that is often spread through sexual contact, including oral, vaginal, and anal sex, as well as skin-to-skin contact of the genital area. In fact, it is the most common sexually transmitted infection in the U.S.

There are over 100 different strains of HPV, approximately 40 of which are transmitted sexually. Of that number, 14 HPV strains are known to cause cancer.  Most women will have an HPV infection at some point in their lifetime.

For the majority of women, HPV and cervical dysplasia will clear up on their own in eight to 24 months without medical treatment. However, for some women, persistent or lingering HPV can lead to abnormal cervical changes.

Studies also show that women who smoke increase their risk of developing cervical dysplasia. It has been found that smoking can actually accelerate the effects of HPV on the cervix. This is yet another reason to kick the smoking habit as soon as possible.

Other possible cervical dysplasia risk factors include:

  • Being HIV-positive
  • Having multiple sexual partners and/or high-risk sexual partners
  • Early onset of sexual activity
  • Giving birth before age 20

Diagnosis

Cervical dysplasia is diagnosed with a Pap smear, a screening test that involves a brush sample of the cells of the cervix that is examined under a microscope.

Pap smears should be performed every three years for women beginning at the age of 21 until age 65. Once women have reached age 30, an alternative option is to have a Pap test every five years, if combined with an HPV test. Women who are immune-suppressed may need a Pap smear more often.

In guidelines issued in 2020, the American Cancer Society (ACS) recommends that individuals who have a cervix undergo HPV primary testing, rather than a Pap test, every five years starting at 25 and continuing through 65. More frequent Pap tests (every three years) are regarded as acceptable for people whose health care practitioner does not have access to HPV primary testing. Previously the ACS advised screening begin at age 21.

If the lab examining the cervical sample reports atypical squamous cells of uncertain significance (ASC-US), the test may be repeated in 12 months and an HPV test may also be performed.

With repeat abnormal findings or if the HPV test is positive and you are over age 25, a biopsy may be done during a procedure called colposcopy. Samples collected are then further analyzed to determine if they are pre-cancerous, cervical intraepithelial neoplasia (CIN).

Grade Level of Dysplasia
CIN 1 Mild
CIN 2 Moderate
CIN 3 Severe (carcinoma in situ)

Treatment

Commonly, a doctor will recommend monitoring a case of cervical dysplasia to see if it resolves itself without intervention. If the cervical dysplasia persists—and depending on its severity—your provider may recommend an outpatient procedure to remove the abnormal cells.

In most cases, abnormal changes in the cervix are usually removed before they have the opportunity to transform from precancerous cells to cancer cells.

CIN 1 cases are not usually treated, as less than 1% of instances of CIN 1 progress to cancer. Instead, it is most often followed closely with Pap smears, HPV tests, or sometimes colposcopy.

Treatment is usually done for CIN II and CIN II. When left untreated, these could progress to cancer in 5% and 12% of cases, respectively. Treatment involves removing the areas of abnormal cells so they can't continue to grow and potentially become cancerous.

Treatment options for CIN II and CIN III may include:

  • Cryosurgery: This surgery involves inserting a probe in order to freeze the abnormal tissue.
  • Loop electrosurgical procedure (LEEP): A LEEP uses an electrically charged wire to remove abnormal tissue.
  • Laser surgery: A carbon dioxide laser may be used to treat the abnormal tissue.
  • Cold knife cone biopsy: This procedure is similar to the above but instead uses a surgical scalpel to remove suspicious tissue.

A local anesthetic is often used to numb the tissue on the cervix before these procedures, which are frequently done in the clinic or hospital as a same-day surgery. If the biopsy shows that there are abnormal cells at the edges of the sample, further treatment is done to the area to ensure that all of the abnormal cells have been removed.

Follow-Up

If your cervical dysplasia is treated with one of the methods above, you will need to be monitored frequently—including getting Pap smears as often as every three to six months for one or more years after treatment.

Since an HPV infection can persist after treatment of CIN, there is a risk that abnormal tissue can develop in the future. If abnormal cells return, treatment is repeated. Make sure to talk to your doctor so that you understand any follow-up instructions that are recommended.

Prevention

There is no treatment for HPV, but there are vaccines. Gardasil 9, the only such vaccine available in the U.S., protects against nine stains of HPV, including 16 and 18, which cause 70% of cervical cancer cases, and 6 and 11, which cause 90% of genital warts cases.

The Centers for Disease Control and Prevention (CDC) recommends boys and girls get the first of the two-dose HPV vaccine at age 11 or 12, but says the vaccination regimen can be given to individuals up to age 26. The vaccine is approved by the U.S. Food and Drug Administration (FDA) for adults age 27 through 45, although it's unlikely to be as effective in those who are already sexually active.

The HPV vaccination guidelines from the ACS recommend routine vaccination beginning at age 9, the earliest age for which the vaccine is approved. This recommendation is intended to produce earlier vaccination rates overall. The ACS recommends against HPV vaccination for people over 26 given most people have been exposed to HPV by that age and the vaccine would not be effective.

It’s also worth noting that those who have had the HPV vaccine still need to follow regular Pap smear guidelines.

A Word From Verywell

Hearing that you have a condition that could lead to cancer is unsettling, no doubt. That said, as long as you follow up carefully with your doctor and receive any treatments suggested, the likelihood that cervical dysplasia will develop into cancer is very low.

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Article Sources
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