Χάρης Χ. Χηνιάδης

What is cervical dysplasia?
When a female goes to a clinic or her health care provider for a Pap smear, they are screening the cells on her cervix to make sure that there are no abnormal or precancerous changes. If the Pap test results show these cell changes, this is usually called cervical dysplasia.

Most of the time, these cell changes are due to HPV. There are many types of HPV that can cause cervical dysplasia. Most of these types are considered "high-risk" types, which means that they have been linked with cervical cancer.

• Just because a female has cervical dysplasia, it does not mean she will get cervical cancer. It means that her health care provider will want to closely monitor her cervix every so often - and possibly do treatment - to prevent further cell changes that could become cancerous over time if left unchecked.
• HPV is a very common virus, and most females with HPV do not develop cervical cancer.
• Cervical cancer is a slow-growing condition that usually takes years to progress. This is why getting screened on a regular basis is important; screening can catch any potential problems before they progress.

What about abnormal Pap test results?

 Women with abnormal Pap test results are usually examined further for cervical problems. This may involve coming back for a colposcopy and biopsy, or coming back in a few months for another Pap test.

What's the difference between a Pap test, a biopsy and a HPV test?

• A Pap test, or Pap smear, is a screening to find abnormal cell changes on the cervix before they ever have a chance to turn into cancer. During a pelvic exam, a small brush or cotton tipped applicator will be used to take a swab of cervical cells. These cells are then put either on a glass slide or in a container with liquid, and sent to the laboratory for evaluation.
• A biopsy is similar to a Pap test, but a larger cluster of cells is removed from the cervix to see if there are abnormal cell changes. It is a good way to confirm the earlier Pap smear result and to rule out cancer. If a biopsy is done, it will be performed at the same time as the colposcopy.
• An HPV test is different than a Pap test or biopsy. This test checks directly for the genetic material (DNA) of HPV within cells, and can detect the "high-risk" types connected with cervical cancer. The test is done in a laboratory, usually with the same cell sample taken during the Pap test.

Can a male find out if he has the cell changing-types of HPV?
Research has shown that the HPV test may lead to inconsistent results with men. This is because it is difficult to get a good cell sample to test from the thick skin on the penis.
Most people will not have visible symptoms if they are exposed to HPV. Therefore, for most, the virus is subclinical (invisible). This is especially true for males. If a male is exposed to the cell-changing types of HPV, he would be unlikely to have symptoms. If there are no symptoms for males, it is hard to test for it.
Most of the time, men will not have any health risks such as cancer with the "high-risk" types of HPV. It is the female's cervix that needs to be monitored.

How can a person get the types of HPV that cause cell changes?

• Any person who is sexually active can be exposed and get the cell-changing types of HPV.
• Most people are exposed to the cell-changing types of HPV at some point, but not everyone (especially males) will actually have abnormal cell changes (dysplasia).
• The types of HPV that cause abnormal cell changes are usually spread by direct skin-to-skin contact during vaginal, anal, or possibly through oral sex, with someone who has this infection.
• The types of HPV that cause abnormal cell changes do not typically cause symptoms on other body parts such as the hands.
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How can someone reduce the risk of getting HPV?
Any one who is sexually active can come across this common virus. Ways to reduce the risk are:

• Not having sex with anyone.
• Having sex only with one partner who has sex only with you.
• If someone currently has abnormal cell changes, he or she should not have sexual activity until after the cells have been treated or have self resolved. This may help to lower the risk of transmission.
• Condoms used the right way from start to finish each time of having sex may help provide minimal protection - but only for the skin that is covered by the condom. Condoms do not cover all genital skin, so they don't give 100% protection.
• If someone was exposed to the types of HPV that can cause abnormal cell changes, it would be unlikely that he or she will become re-infected with those same types since immunity will be set-up at some point.
• Realize that most people are exposed to one or more HPV types in their lifetime, and most will never even know it because they will not have visible symptoms.
• It is important for partners to understand the "entire picture" about HPV so that both people can make informed decisions based on facts, not fear or misconceptions.

How are abnormal cells treated?

• Currently, there is no treatment to cure HPV; there is no cure for any virus at this point. However, there are several treatment options available for treating the abnormal cells.
• Sometimes treatment may not even be necessary for mild cervical dysplasia . HPV may then be in a latent (sleeping) state, but it is unknown if it totally gone or just not detectable.
• The goal of any treatment will be to remove the abnormal cells. This may also end up removing most of the cells with the HPV in them.

There are a variety of treatments for cervical dysplasia:

• Cryotherapy (freezing the cells with liquid nitrogen).
• LLETZ (Large Loop Excision of Transformation Zone)
• Conization (also called cone biopsy)
• Laser
• No treatment at all since even mild abnormal cell changes may resolve without treatment. The health care provider may just monitor the cervix by either doing a colposcopy, repeat Pap testing, or a test for HPV.

What about pregnancy, HPV, and cervical dysplasia?

• For some pregnant women, cervical dysplasia may increase. This may be due to hormone changes during pregnancy, but this is not proven.
• Sometime (a few weeks) after delivery of the baby, the provider will look at the cervix again and do another Pap smear or another biopsy. Many times after pregnancy, the cell changes will have spontaneously resolved - and no treatment will be necessary.
• The types of HPV that can cause cell changes on the cervix and genital skin have not been found to cause problems for babies.

Is it normal to feel upset about HPV?
Yes, it is normal. Some people feel very upset. They feel may ashamed, fearful, confused, less attractive or less interested in sex. They feel angry at their sex partner(s), even though it is usually not possible to know exactly when or from whom the virus was spread.
Some people are afraid that they will get cancer, or that they will never be able to find a sexual partner again. It is normal to have all, some or none of these feelings. It may take some time, but it is important to know that it is still possible to have a normal, healthy life, even with HPV.