Last week I went to my OB-GYN for a checkup. I had not been to the doctor in four years because I had moved and not found the time to look for one. (I know, not a good idea.) Well, the results of my Pap smear came back and my doctor said I had dysplasia. She also said that I did not have any signs of warts when she examined me. After questioning her on the origin of this, since I know little about dysplasia, she told me it was sexually transmitted. Is this true? I have heard that no one really knows where dysplasia comes from. I just want more information before I go in for my checkup before treatment. By the way, this didn't show up on my Pap smear four years ago, and I have had the same partner this whole time. Thank you!
You're not alone in having difficulty keeping a regular health care provider while on the move — it can be challenging, even with insurance. So congratulations on getting back into the swing of things! First let's start with a definition: Dysplasia means abnormal cell growth anywhere in the body. In your case, this abnormal growth has occurred on your cervix. Abnormal cell growth means just that — some of the cells on your cervix don't look like regular cervical cells.
Some abnormal cell changes, unchecked and untreated, can progress to cervical cancer; in other cases, the abnormalities will heal on their own, without treatment. The more severe the dysplasia, the more likely it is to progress to cancer. As far as being sexually transmitted, cervical dysplasia has been associated with the presence of the human papillomavirus (HPV), which causes genital warts and is usually, although not always, sexually transmitted. HPV infections have a somewhat confusing nature; it can take months or years after HPV infection for symptoms to show up. Which means that although you've been with the same person for the past four years, and your last Pap was normal, you may indeed have contracted HPV from a long-past sexual encounter without ever diagnosing symptoms until now.
One further note on HPV; the strains of the virus that cause genital warts are different from the strains that are generally associated with cervical dysplasia. That is, it's possible, even common, to have cervical dysplasia without also having genital warts — the two don't necessarily go hand in hand.
Once identified, dysplasia is further diagnosed with colposcopy, a procedure that looks at the whole cervix with a special microscope called a colposcope, and sometimes a tissue biopsy. Through colposcopy your doctor can directly view your cervix and any abnormalities. If your doctor sees any abnormal cells through the colposcope, s/he will remove them and send them to a lab. This is the biopsy part of the treatment. Depending on the biopsy results indicating the severity of the dysplasia, further treatment may be suggested, which can be simply observation to see if the changes resolve spontaneously, repeating the Pap test more frequently, or repeating the colposcopy. If the dysplasia is severe enough, your health care provider may recommend removing the abnormal cells. One removal treatment is cryosurgery, a freezing technique. Another procedure, called LEEP (which stands for loop electrosurgical excision procedure), uses a loop of wire with a low-voltage radio wave to remove abnormal cells.
You're right that regular Pap smears are important because they allow us to keep tabs on cervical cell changes. We can see if they are changing and replacing themselves in a healthy manner, or if the cellular changes become abnormal. If you're a student at Columbia, you can make an appointment for a Pap smear, pelvic exam, and any necessary referrals for further treatment at Medical Services (Morningside) or the Student Health Service (CUMC). For more information on how often to schedule a Pap test, read Cervical cancer info on the net.
Best of luck getting follow-up care and keeping a regular provider in the future,Alice!