Cervical Dysplasia
Unwrapping the mystery of cervical dysplasia

You just got a call; it’s your healthcare provider letting you know that your Pap smear came back abnormal. You have dysplasia. “Oh God, what now? I can’t take anything more!” runs through your mind as your provider asks you to return for a followup visit and a colposcopy or cone biopsy.

What is dysplasia? What the hell is a cone biopsy or what was that other thing he/she said? Do I have cancer along with HIV/AIDS? Will those tests hurt, or worse yet, knock me down so I can’t take care of my family? Maybe I just won’t go back!

Hold everything! STOP PROJECTING! DYSPLASIA IS NO GREAT MYSTERY. The word dysplasia means abnormal cell growth. There are three classes of dysplasia: mild (CIN 1 or class 1), moderate (CIN 2 or class 2), and severe (CIN 3 or class 3). CIN stands for cervical intraepithelial neoplasia, a scientific way of saying abnormal tissue growth on or near the cervix. In women (HIV+ or not) the most commonly seen dysplasia is cervical. The myth is that cervical dysplasia always leads to cervical cancer. This simply is not true. In fact, few cases of dysplasia turn into cancer, when adequately treated. And those that do change take a long time, usually 2 or more years. The chances do increase with immune suppression, meaning a T-cell count of 500 or below.

Most women with dysplasia don’t even know they have it and there are no usual symptoms. Even when it becomes cancer the only sign may be abnormal or unusual bleeding. Women who are HIV+ have a much higher chance of getting cervical cancer. That’s why the CDC has recommended that women who have HIV/AIDS have a Pap smear once a year. It’s also important that you see a physician who can be educated or is familiar with treating women with HIV/AIDS.

A Pap smear is a standard part of a routine pelvic exam. It is used to find the earliest warning signs of cancer. A Pap smear involves inserting a long cotton swab into the vagina and collecting a few cells from the cervix, which can then be examined under a microscope.

If for example, your T-cell count is well above 500, you have an undetectable viral load, and you have an abnormal Pap smear with class 1 dysplasia, your doctor will probably recommend you have another pap smear in 2 or 3 months. All dysplasia should be taken seriously, but there is no need at this time to lose sleep. Many times the human body can overcome abnormal cell growth on its own.

Often in women who are HIV+, especially those with a T-cell count below 500, a colposcopy is likely to be recommended. The colposcopy is currently the most effective diagnostic test for cervical cancer. The procedure causes only mild discomfort, about like menstrual cramps. It can be performed in a doctor’s office without anesthesia and takes only 10 to 15 minutes. First a speculum is inserted to open the vagina (like a regular Pap smear), and then the physician aims a light at the cervix. Next a diluted solution of acetic acid (vinegar) is applied to the cervix. This solution makes abnormal cells appear white, while normal cells will remain pink. Now, with the help of a flexible magnifying tube, the colposcope, the skilled physician can get a better look and a better idea of the extent of the dysplasia. At this time the doctor will usually take a biopsy.

A biopsy is when a sample of tissue is taken for further examination. It causes very little pain but will likely cause some brownish discharge from an iron solution that is used to help minimize the small amount of bleeding at the biopsy site. It is also recommended that you abstain from sexual intercourse for 2 weeks afterwards. In cases of severe dysplasia, a cone biopsy is recommended. This is a larger, cone-shaped tissue sample. This procedure takes longer and is more painful but can still be done in a doctor’s office.

Pap smears or a colposcopy are definitely not my favorite way to spend an hour, and I’m sure you don’t enjoy them either. However when I compare the temporary discomfort of a Pap smear to the pain of cervical cancer, it seems a small price to pay.

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