<p>A very dear friend’s daughter had an abnormal papsmear. They took a closer look and she has been diagnosed with severe cervical dysplasia. Everyone is upset and cofused as to what the best treatment is. The Md wants to perform a cold knife procedure but there is risk for premature labor and birth associated with that. The girl is only 20. Anyone have an experience with this?</p>
<p>If she had a culposcopy with biopsies and an ECC, and she had severe dysplasia/CIN III, the next progression is carcinoma -in-situ and right beyond that is invasive carcinoma. If the dysplasia was mild, observation is an option. If it is severe, treatment is generally needed. </p>
<p>She can ask about or get a second opinion with regards to having a LEEP/LEITZ procedure. It is easier to taylor this procedure to the extent of disease. Also, it is easier to get mostly epithelium, with less underlying muscle/fibrous support tissue. </p>
<p>The risks of LEEP or cone includes premature dilitation of the cervix during pregnancy. But the risk of not treating is cervical cancer. The treatment of early cervical cancer is radical hysterectomy, which removes alot more surrounding tissue and lymph nodes. That will leave one totally unable to have children, and still not everyone is cured.</p>
<p>The risks of premature dilitation of the cervix are low with a LEEP, and during a subsequent pregnancy, she will be monitored more closely. A cerclage (stitch) can be placed around the cervix if it is dialating too soon, etc.</p>
<p>Have her ask about a LEEP, and if it is not offered, get a second opinion.</p>
<p>Check the Johns Hopkins website, it has a search engine; there may be articles there for procedures in addition to what SF posted. Conization (a type of surgery for cervical dysplasia) usually leaves one able to have children with the caveats mentioned.
BTW, was there a risk factor for the dysplasia such as IUD use? If secondary to IUD use, it may clear up on its own with removal of the IUD.</p>
<p>debbym, I sent you a PM.</p>
<p>Listen to SunnyFlorida, she knows what she’s talking about.
Correct me if I am wrong, Sunny, but LEEP cones have a lower incidence of cervical dilatation problems than cold knife cones - that is why Sunny is recommending a second opinion. Cold knife cones are less common now, although I think there are still some situations where it is used - another reason for a second opinion.</p>
<p>SunnyFlorida definitely knows her stuff. Most severe dysplasia isn’t a result of IUD use, but is a result of HPV. I know that many people on CC have reservations about Gardisil, but the situation described by the OP is what Gardisil is meant to prevent. I only have sons, but if I had daughters, I’d get them vaccinated.</p>
<p>debby, I also sent you a PM.</p>
<p>“if I had daughters, I’d get them vaccinated.”</p>
<p>Amen. This girl is, in a sense, lucky – she was taking care of herself and getting Pap smears, so this is a only a threat to her fertility and not to her life.</p>
<p>Snowball’s husband posting; Sunny is absolutely right in that treatment is indicated, and a LEEP is what most of us (I am a gyn) would do, though a cone (conization) isn’t wrong per se. While it could progress to cancer over time, it is not that likely in the young, but, unfortunately, you can’t predict the future. Any dysplasia of moderate or more is treated, with a few exceptions in younger women. While treatment can be associated with complications, thankfully they’re uncommon. A lot of people have LEEPs; thankfully, few have long term complications related to pregnancy and fertility.</p>
<p>All of our daughters should get the HPV vaccination long before sexual activity (yikes!)–a no brainer.</p>
<p>I had cervical dysphasia as a 23 year old. I remember it was called a class III. Then a cuposcopy was done for further diagnosis. To clear things up, a procedure called cryosurgery was done. This was successful and I had 2 normal pregnancies afterward. Is Cryosurgery still done today? </p>
<p>Curious because my 20 yr old D now has mild dysphasia. Dr. said we’d observe and repeat in 6 months, but I’m curious about Cryrosurgery.</p>
<p>Debbym, Sunnyflorida does sound very knowledgeable.</p>
<p>Thanks, you all are great amd the information is appreciated. One more thing does anyone know anything about the procedure Laser Ablation.</p>
<p>Thanks.</p>
<p>Mild dysplasia can revert to normal about 70-75% of the time, so, especially in young women, it is left untreated IF the patient is complient and follows up with pap smears every 3-4 mos for a year then every 6 mos. If it progresses, then treatment. It can regress because it is HPV mediated, and if the body clears the HPV virus by developing antibodies, the body can repair the dysplasia. </p>
<p>Cryo is not used as much anymore. It has a high failure rate. We used to use if for mild cases, but now that we know it can regress–we observe mild cases in young women. In women over 40, generally we treat ALL dysplasia.</p>
<p>Laser ablation is also a better choice than a cold knife cone. But it is so much more expensive, and with an vaporization/ablation, there is no tissue for the pathologist to evaluate for margins. And with a severe dysplasia, there is a very low but present risk for a tiny focus of cancer to be there. With a cone or a LEEP, it would be caught. If the laser is used to develoip a cone shaped specimen-OK. If it is just used to vaporize the tissue, we have no way of knowing if we got it all or if there was also findings of invasion. Lasers also better for mild dysplasia, perhaps in a woman who chooses not to be observed. </p>
<p>IUDs can cause inflammatory changes on a pap, but we now know that they don’t actually cause dysplasia.</p>
<p>If it were my kid, I’d choose a LEEP. I do about 50-60 LEEPs a year. Which is why I gave my two teenage girls Gardasil.</p>
<p>Sunnyflorida- My husband is a walking advertisement for Gardasil! We will be out and someone will start to ask if they should get their daughter vaccinated; before they can finish their sentence, my husband says, YES!!</p>
<p>I asked my pediatrician and internist about Gardasil, and both said that they prefer to wait for a while longer before giving the vaccine, for more information/evidence/reporting. How can one make an informed decision without relying on Merck’s information. I have 2 friends who work for Merck, and they told me that most of the Merck employees are also biding their time.</p>
<p>Question, because I haven’t been paying attention too much to Gardasil: is the disease it guards against a virus? How does one contract it? Through sexual contact? Can you get through any other methods (“born with it”, acquired deficiency of some type, vitamin/diet problem, etc.). I am not too up on gynecological diseases/disorders.</p>
<p><a href=“http://www.cdc.gov/std/hpv/STDFact-HPV-vaccine.htm[/url]”>http://www.cdc.gov/std/hpv/STDFact-HPV-vaccine.htm</a></p>
<p>Here is a link to the CDC fact sheet about HPV vaccine.
Gardasil protects against 4 subtypes of HPV, which together account for a majority of high grade dysplasias and cervical cancers.</p>
<p>I am another strong proponent of vaccinating our daughters against HPV, particularly ithose close to becoming sexually active. Gardasil is recommended for girls as young as 9, and hopefully, will eventually be given routinely to young children. If I had a 9 year old, however, I would consider waiting for only 2 reasons - 1) We do not know exactly how long Gardasil remains effective, and I wouldn’t want my D to be vaccinated twice and 2) There is another vaccine on the near term horizon that will cover a few more serotypes of HPV, and I might be willing to wait with a 9 year old to get that vaccine.
If my D ws 12 or older, and not sexually active, I would get her vaccinated - I’ve been hounding my 19 year old about it.</p>
<p>The diagnosis was severe so in that case do you think the laser ablation should not be used only the cold knife?</p>
<p>I had cervical carcinoma in situ about 21 years ago. Well, actually I know it was 20.9 years ago, because it was discovered when I was pregnant with DS, who is about to turn 21. Like mmom, I had cryosurgery. Thanks for asking if it’s still used, mmom, and thanks cc docs for sharing all of your expertise.</p>
<p>I was wondering why it wasn’t mentioned among the treatment options (or whether it was one of the above-mentioned options, but just under another name). I guess I was fortunate, as I had no recurrence or further problem. My physician delayed the actual cryosurgery until after delivery and (if I recall) after a few months of my nursing my newborn.</p>
<p>I certainly had PAP smears on a very frequent basis at first, tapering off to the annual.</p>
<p>I, too had cryosurgery, for mild cervical dysplasia, about 30 years ago. I had culposcopys annually for a long time (I am also a DES daughter, so needed to be watched) but have had no problems, thank heavens. The only problem I had was “defrosting” after the cryosurgery. I was up in NY when I had the procedure and went to a matinee with my then BF after the procedure. It looked like I’d wet my khaki skirt when I stood up after the show! How embarassing!!</p>
<p>I want to add my voice to all those who have recommended the Gardasil vaccination for their daughters. I fervently wish that the vaccine had become available just a little sooner. My youngest D was raped just before she started college and was infected with HPV. She kept the rape a secret from me for nearly two years. She was diagnosed with HPV shortly before she left for college. Her doctors have taken a watchful waiting approach for the past 3 years, however, after her pap earlier this month, she was told that further testing was necessary. She had a colposcopy done last Tuesday and we are now waiting for the results. She was told last week that she has the most virulent type of HPV - that is, the type most likely to cause cancer. I know that in most cases, HPV infections in young women resolve on their own within two years of the initial infection. It has been 3 years for my child and she still has not beaten back the virus. The doctor told her that that may be because of stress and that possibly after graduation her immune system will vanquish the HPV. My poor D is terrified that she will be diagnosed with cervical cancer. She has not had a normal pap in the 3 years since the rape. I’ve been placed in the position of trying to help her push her fears to the back of her mind and remain relatively calm until her test results come back. (My husband has been having murderous thoughts again. My D was the victim of date rape. Her attacker was the boy who took her to her H.S. senior prom!) I appreciate reading the positive stories from those of you who have had cervical dysplasia and/or cervical cancer. I may be calling on you for advice.</p>
<p>To those of you who have teenage Ds, please have them vaccinated! Gardasil became available shortly before my child was diagnosed with HPV. I planned to have her get the series of vaccinations during her freshman year of college. My D informed me in September of that year that her doctor said she was not a candidate for the vaccination because she was already infected. (She did not tell me about the rape at that time.) I asked D to find out if it would not still be a good idea to get the vaccination since it protects against 4 types of HPV and she had only been infected by one. D rather angrily told me that the doctor said it was pointless. I have brought up the subject several times over the past 3 years and gotten the same reaction each time. (Of course, I now know why!) I have read recently in several different sources that doctors are now recommending that even women who have been diagnosed with HPV be vaccinated. I did convince my D to talk with the doctor about it last week and she (the doctor) agrees that my D should receive the vaccination. I have read that the medical community is now considering recommending that even women over the age of 40 be vaccinated. Women over age 40 are the group at highest risk of developing cervical cancer from an HPV infection. It will be interesting to see if in the next couple of years Gardasil becomes recommended for all women.</p>
<p>Do any of you know if males who are infected with HPV eventually rid the virus from their bodies and become incapable of transmitting it to their partners? I have to confess that it disturbs me greatly that the disgusting boy who raped and infected my D may be infecting other young women.</p>