Womens Health

Cervix and Pap Smear Problems


Frederick R. Jelovsek MD

Can't get pregnant after dysplasia treatment

I am a 24 year old female that has had cervical dysplasia; I had surgery to remove the affected cells. What I want to know is I have a son 4 years old and wish to have another any time now. I have been off the Pill for a year and nothing has happened. Is the cervical dysplasia the cause for not getting pregnant? I have been clean on my Paps for a year and a half now? If this is not what's wrong, how can I get pregnant!!!

Treatments to the cervix for cervical dysplasia, such as conization by cold knife, LEEP (loop electrical excision procedure), laser or cryosurgery (freezing), can negatively affect the ability to get pregnant. The cervical mucous glands play a role in fertility and they are often destroyed or impaired by these procedures. The dysplasia itself, altho it sounds as if you are cured, shouldn't cause infertility. After a year of trying to get pregnant unsuccessfully, it is recommended that you see a physician for diagnosis of secondary infertility.


Can this be fixed with treatments, or any other way?

Yes. If you have a cervical factor causing infertility such as the glands destroyed by past cryotherapy, you may need artificial insemination in which your husband's sperm is injected directly into the uterus around the time of your ovulation.

How does cervical dysplasia form?

We don't know for sure. Many doctors suspect that viruses play a role and stimulate cervical cells to have more nuclear activity. If left alone over many years, that nuclear activity may turn into malignant invasive growth if it progresses.

Did I get dysplasia from being on the pill too long?

No. The pill doesn't cause it. There is an increased incidence of dysplasia in women on the pill, but most people think that since women on the pill use less barrier contraception such as condoms, they are more exposed to sexually transmitted viruses if having sexual relations with different men over the years. It is this lack of using barrier contraception that makes women on pills more likely to get dysplasia, i.e., more exposure to agents that could cause dysplasia. If they did a study of women who used both pills and condoms it would probably show the same incidence of dysplasia as women using condoms alone.

There is nothing like this in my family history, no cancer either. I want to have more children but if it can't be fixed I want to stop trying to get my hopes up.

This can be fixed. At the current time you should see an infertility specialist.

Is cryotherapy overkill for cervical dysplasia?

My ob/gyn has recommended cryotherapy for cervical dysplasia, which has developed over the last year (paps were fine til now). My family physician said the abnormal cells which are interfering with my pap are likely to go away on their own over time. I'm hoping to conceive in a year or so and have heard that cryo can affect fertility. Is cryotherapy overkill at this point - ie. just in order to get a clear result on a pap?

I assume you had a cervical biopsy that showed dysplasia. The Pap is only a screening test and what is actually on the cervix can be more abnormal (more severe) than the PAP smear suggests or less abnormal or the same. But all treatment is based on what the colposcopically directed biopsy shows. Usually there are 3 grades of dysplasia: mild, moderate and severe/cis.

To answer your question, as to whether cryotherapy is overkill, it depends on the grade of the dysplasia. If the biopsy is a low grade squamous intraepithelial lesion consistent with mild dysplasia, then cryotherapy isn't really needed at this point. Most of those lesions (over 2/3) will regress to normal on their own over time. It just needs to be followed with every 3 months Paps, but if it progresses (Pap worse and subsequent biopsy worse) then some treatment would be indicated. I'm not sure that cryotherapy is the best treatment, however, if you want to get pregnant in th near future. If you had a good colposcopically directed biopsy in which the physician was confident that the worst appearing area was biopsied and it returned as moderate dysplasia, I would put off treatment with cryo until after you get pregnant. Just follow-up each 3 months with the doctor to see that it doesn't get worse.

If you have severe dysplasia on biopsy, I would recommend treatment before trying to get pregnant. I don't think you should take the chance that it could get worse during the time you are trying to get pregnant and then waiting for delivery.

Squamous Metaplasia

What is Squamous Metaplasia?

Cells that are repairing-- new growth. This is the body's normal method of healing irritation or inflamed cells.

Is it the same as Human Papilloma Virus?

No. Metaplasia in a normal healing function, HPV is an infectious process that makes changes in cells.

Atypical squamous cells of undetermined significance (ASCUS)

I had a pap done and the report stated it was abnormal it stated: Atypical squamous cells of undetermined significance. Favor reactive and/or inflammatory process. Endocervical cells present. I once read in my doctor's recent note that something stated suggestive of human papilloma virus? I'm confused and afraid. Is either of these conditions dangerous?

No. It states that the cellular changes seen are thought to be mostly a response to some cervical inflammation or irritation, however, some of the inflammation may be due to the human papilloma virus (HPV). HPV usually goes away on its own after a year or two as your body develops immunity to the virus. There are some strains of the virus that are thought to be more aggressive and if left for a long time, may promote more severe changes called dysplasia and even cancer. That is why the Pap changes need to keep being checked, to make sure they don't get worse over time.

If a colposcopy is done, is a biopsy necessary or can the doctor tell if there is something wrong without doing a biopsy?

Atypical squamous cells of undetermined significance (ASCUS) is usually treated by just repeating the Pap smear in 3-6 months. Colposcopy is usually not done unless there are 2 or 3 ASCUS reports in a row. Colposcopy only allows the doctor to see which area of the cervix is giving the abnormal cells so a biopsy can be directed to the worst area. The biopsy is the "gold standard". Most of the time it needs to be done although sometimes if you've had previous biopsies that are consistent with colposcopic visualization and that visualization has not worsened, a biopsy can be avoided.

How soon should a colposcopy be done and if it shows okay does there need to be a follow up in less than 1 year because I only go to the gyn once a year for my pap test?

In our office, ASCUS smears are repeated every four months. Some physicians repeat them at every 6 months. If the Pap worsens, or persists too many times then a colposcopy is done. So yes, you will have to be seen more often than just once per year.

ASCUS Paps over and under age 50

Recently I heard that there is a higher incidence of ASCUS Pap smears progressing to dysplasia in women over age 50. Do you have information for woman under 50 with the same condition?

I have been experiencing ASCUS on and off for last 5 years and don't seem to be cured. Dr. told me that it is more worrisome for younger woman with this condition because it could develop to cervix cancer.

Is there cure for ASCUS or even for dysplasia?

Yes. Most of the time (70-85%) ASCUS Pap smears revert to normal on their own over time.

Women under age 50 have a higher progression of ASCUS pap smears to dysplasia than do menopausal women, but the rates vary considerably depending upon the population studied and the accuracy of the laboratory used. One study has noted that ASCUS Paps over the age of 50 had a lower incidence of progressing to dysplasia - 13% vs 30%. Most studies, however, will quote a lower rate of progression to dysplasia for younger women than 30%.

The point is that it is quite rare for the lesion to progress all the way to an invasive cancer as long as repeat Pap smears are monitored. Pap smears that show only ASCUS can be followed for a long time. Since your Pap has not worsened in 5 years, that is a fairly good sign it is not going to progress at all.

On the other hand, 5 years is a very long time to worry about this and undergo the hassle of frequently repeated Pap smears. It might be time to ask your physician to treat the cervix with some method to get it to produce normal cells and a normal Pap smear. ASCUS changes and even dysplasia are curable by destroying the cervical surface cells by freezing, cautery, LEEP, laser and any procedure that destroys the abnormal cells and stimulates the body's normal cells to repair the damaged ones.

Unsatisfactory Pap smear

My pap smear came back unsatisfactory. They said it had too much blood and inflammation. What could be the cause? The nurse said maybe the doctor scraped me when he took the sample. I have to go back in 6 weeks for another one.

There are a number of reasons why a PAP smear may be read as unsatisfactory. These include a thick normal vaginal secretion, but more commonly cervical or vaginal infection will give you inflammation. Also some of the endocervical cells may not have been collected on the slide. Rarely a menstrual period may result in too many blood cells and not enough epithelial cells to assess. Anything that obscures the cytologist being able to see enough of the expected cells will result in a report of unsatisfactory. This is not an abnormal report, just a pain in the bottom because it should be repeated.

And yes, the doctor did scrape your cervix as that is what he/she needs to do to obtain the sample. Keep in mind, however that the "scraping" is just to pick up cells that have already been sloughed off of the cervical surface. It is NOT a scraping that removes a layer of growing cells on the cervix.



Differential Diagnosis of

Abnormal Paps, cervical and vaginal discharge

Related Educational Articles

HGSIL - High Grade Intraepithelial Lesions of the Cervix on Pap Smear
What is a Microscopic Cancer of the Uterus?
Abnomal Pap Smear with Atypical Squamous Cell Changes - ASCUS
Carcinoma In situ of the Cervix and What to Expect
HPV Type Associated with Cancer
Bacterial Vaginal Infections in Pregnancy
Do You Need a Pap After a Hysterectomy?
Signs and Symptoms of Vulvovaginal Candidiasis
Natural Progression of an Abnormal Pap
Irritant Vulvitis Often Misdiagnosed as Yeast
Atypical Glandular Cells of Unknown Significance (AGCUS)
Papillomavirus Testing of Abnormal Pap Smears
Painful Intercourse Due to Vulvar Vestibulitis
STDs in Adolescents
Yeast Vaginitis - Treat the Symptoms or Diagnose by Culture?
PAP Smear Diagnosis of Endometrial Cancer
PAP Smear Recommendations




Login to comment

Post a comment

I had a pap smear done 6 months after the birth of my baby the pap smear came abnormal so my doctor told me I needed a colposcopy and the diagnosis was : squamous atypia suggestive but not diagnostic for hpv, chronic cervicitis and squamous metaplasia. What does this mean? Would I be able to get pregnant again?
13 years ago