Dysplasia of the cervix

Cervical dysplasia is a clear change in the number and morphological structure of cells in individual sectors of the mucous membrane of the cervix uteri. This condition of the epithelium is considered dangerous due to a high risk of oncology, but with timely diagnosis and treatment, the pathology is reversible. Cervical cancer is the third most common among women. According to WHO statistics, dysplasia of the cervix as a precancerous pathology is diagnosed annually in more than 40 million women. In modern gynecological practice, dysplasia of the cervix as a diagnosis is replaced by the definition - CIN (Cervical intraepithelial neoplasia), or cervical intraepithelial neoplasia.

[1]

Causes of the cervical dysplasia

Causes of cervical dysplasia according to the latest WHO data in 90% of cases are associated with a viral infection. Most often, it is HPV - a human papilloma virus, the DNA of this virus is detected in almost every study, regardless of the severity of cervical dysplasia. However, etiologically, CIN can be provoked by other factors, including the following diseases, conditions and circumstances:

1. Papillomavirus (HPV)
2. HSV-2 (HSV2) - herpes simplex virus, type 2
3. Cytomegalovirus (CMV) is a cytomegalovirus
4. Gardinella, anaerobic bacterial infection (Gardnerella vaginalis)
5. Vaginal Candidiasis (Candida spp)
6. Urogenital infection - mycoplasmosis (Mycoplasma hominis)
7. Chlamydia (Chlamydia trachomatis)
8. Long-term use of hormonal contraceptives
9. Random sex, promiscuity in choosing sexual partners
10. The onset of sexual activity until sexual maturity is reached (12-14 years)
11. Genetic oncofactor in history
12. Immunodeficiency, including HIV
13. Chemotherapy
14. Alimentary pathologies associated with malnutrition, micronutrient deficiencies and essential vitamins
15. Frequent delivery or on the contrary, abortion
16. Harmful habits - smoking, alcohol dependence
17. Asocial way of life, insufficient level of observance of elementary hygiene

It should be noted that dysplasia of the cervix is most often associated with STDs - diseases that are sexually transmitted, leading among them HumanPapillomavirus - papillomavirus. This is the most common cause of precancerous diseases in women, so it should be considered in more detail.

HPV on the risk of development of oncology is divided into the following categories:

• Genital warts, warts, non-cancerous nature
• Low oncogenic risk (oncogenic serotype of 14 species)
• High risk of oncology

The danger of such etiological factors is the asymptomatic course of the disease. The onset of a developing pathology without regular gynecological examinations is almost impossible to notice by oneself. From the start of infection to the stage of an explicit oncology process, it can take more than 10 years. Infection threatens many women, but most of all it affects those who are in the category of risk. These are ladies who lead a sexually free lifestyle, as well as those who do not use contraception when changing their sexual partners. In addition, the risk of infection with HPV and women, negligently related to any inflammatory process in the genitourinary sphere. A small percentage of infections occur in cases of traumatic damage to the cervix during the interruption of pregnancy.

An interesting version of the causes contributing to the development of cervical dysplasia, put forward an American gynecologist Polikar. "The theory of weeds" explains CIN in this way:

• Epithelial cover of the cervix is a kind of soil
• In the "soil" can get viruses, bacteria, provoking changes in tissue cells
• In order for the "seeds" to start growing and provoking pathology, they need certain conditions
• Conditions for pathological growth of "seeds" - heat, moist environment, dirt, light
• The role of conditions for the development of pathology growth is played by such factors:
  • immunodeficiency
  • deficiency of vitamins and lack of microelements
  • refusal to comply with hygienic rules
  • bad habits
  • genetic factor

The hypothesis of a doctor from the University of California has not yet been rejected, but is not accepted as an axiom, but clinical observations indicate a certain certainty of the "theory of weeds". In the clinic, doctors were treated for women who had cervical dysplasia. In 45% of them, after quitting smoking, getting normal vitaminized food and immunomodulators, the indications of PAP tests and histological scrapings improved.25% of patients were finally healed of HPV after a year.

[2], [3], [4], [5]

Pathogenesis

Cervical dysplasia is pathogenetically most often associated with infection with Human Papillomavirus, human papillomavirus. In the practice of oncogynecologists, it is customary to consider two types of development of a viral infection:

1. The first stage - the DNA of the papilloma virus is already in the cell, but does not penetrate into its chromosome (episomal state). This variant of infection is considered to be reversible and well curable in terms of treatment
2. The second stage, when the papillomavirus DNA is already in the cell's genome. This variant of infection can be called the first step to the development of pathological transformation of cells. This leads to the induction of the production of a specific estrogen (16α-ONEL1) with an aggressive form of development that has a carcinogenic effect. To form a tumor process, these are ideal conditions.

In general, the pathogenesis of cervical dysplasia is associated with the transformation of the cellular structure of the tissue. Epithelial tissue of the neck has certain properties:

• The structure (4 layers)
• Norms of cell nucleus sizes
• Cell Contact Mode

Also epithelial tissue can be different in structure depending on localization. Endocervix is inside the uterus, it is a glandular tissue (single-rowed cylindrical epithelium). The outer layer of the epithelium (vaginal) is a flat epithelium having many layers (MPE). The layers of multilayer epithelium are divided into the following types:

• Initial, sprout (basal, low-grade cells)
• A layer that is capable of actively dividing, multiplying, is a parabasal
• Intermediate, spiny layer of differentiated cells with pronounced cytoplasm. This is the protective layer of the epithelium
• A layer that is capable of sloughing is superficial. This layer is subject to cornification

Pathogenetically, dysplasia of the cervix is most often associated with a violation of the structure of the basal and parabasal layers (hyperplasia). Changes affect such processes:

• Fission of nuclei, their sizes, contours
• Cells are poorly differentiated
• The normal stratification of the epithelium

Pathology can develop for years until the integrity of the basal membrane is violated, which in turn leads to cervical cancer (invasive form).

Currently, thanks to programs of regular screening (gynecological examination), most women have the opportunity to stop the development of atypical cells in the early stages. Cervical dysplasia of mild, moderate form is successfully treated and is not life threatening disease. Severe dysplasia is most often associated with the refusal of patients at risk to comply with the rules of preventive examination and adequate therapy.

[6], [7], [8], [9], [10], [11],

Symptoms of the cervical dysplasia

Symptoms of CIN are characterized by their "secrecy". Dysplasia of the cervix is dangerous in that it occurs without obvious, marked clinical manifestations. In time to see the clinical picture without examination, especially in the early stages of the disease, is practically not possible. Absolutely asymptomatic pathology develops in 10-15% of women, the rest of the patients can stop the process due to regular examinations at the treating gynecologist.

It should be noted that CIN rarely occurs as an independent disease, it is usually associated with bacterial, viral infections:

• HPV
• Colpit
• Chlamydia
• Herpetic infection
• Cervicitis
• Leukoplakia
• Adnexitis
• Candidiasis

Symptoms of cervical dysplasia may not be the true causes of the actual CIN process, the signs are usually due to concomitant diseases and can be as follows:

• Itching in the vagina
• Burning sensation
• Discharge, atypical for a healthy state, including blood
• Pain during sexual intercourse
• Drawing pains in the lower abdomen
• Visible warts, papillomas

Cervical dysplasia is not an oncological disease, but due to the implicit clinical picture it is considered quite dangerous, prone to progression, and in severe form it can lead to cervical cancer (cervical cancer). Therefore, the main way to detect asymptomatic changes in the epithelial cover of the cervix in a timely manner is examination and diagnosis.

[12], [13], [14]

First signs

The latent course of CIN is a characteristic clinic for all types of cervical dysplasia.

The first signs that a disease can manifest are rather related to the presence of signs of associated pathologies, or initially provoking factors.

Most often, dysplasia of the cervix is etiologically conditioned by infection with HPV.

According to statistics, every ninth inhabitant of the planet is the bearer of one of 100 varieties of human papillomavirus. Many types of HPV pass independently in view of the activity of the immune system, some of them are prone to recurrence and can manifest themselves as follows:

• Warts in the genital area (they are identified on examination by a gynecologist)
• Pointed condylomas - visible formations with uneven edges in the vagina, in the anus. Internal condylomas are visible only on examination in the doctor's office
• Periodic megacine bleeding after intercourse, especially in the middle of the monthly cycle
• Discharges uncharacteristic in color, odor, consistency
• Irregular monthly cycle

The first signs may be absent, it all depends on the type of HPV, the protective properties of the immune system. This is a serious threat, since dysplasia of the cervix can proceed as a process for many years. The erased clinic of CIN as a risk factor can only be prevented through surveys and screening. For all women after 18 years old, doctors recommend visiting a gynecologist and undergo a diagnosis - both clinical and instrumental, laboratory.

[15]

Allocations for cervical dysplasia

Allocations that could indicate dysplasia of the cervix are most often detected when viewed on a gynecological chair or when taking material for cytology. A certain amount of mucous fluid may be released from the cervical canal. Its properties, characteristics are not due to the actual CIN, but rather concomitant, attached infections, more often bacterial or viral. Also, excretions in cervical dysplasia are associated with erosive processes. A little more about specific signs of discharge:

• The abundant, white color and thick consistency of the discharge acquire the appearance of flakes, have a characteristic smell. These are signs of colpitis, which can accompany cervical dysplasia
• Scanty, with an admixture of blood or pus excretion can serve as a signal of erosive processes, especially if they appear after sexual intercourse
• Allocations accompanied by itching, pain, and burning are a sign of a viral, bacterial infection more often associated with STDs (sexually transmitted diseases)
• Allocations, the number of which increases in the second half of the cycle, with acute itching, burning - a symptom of genital herpes. He, in turn, is a factor provoking cervical dysplasia
• Bloody discharge, abundant or meager, is a dangerous sign. CIN in the third stage is characterized not so much by pain sensations as by the properties of the secreted fluid from the vagina.

In order to determine the cause of the secretions, in any case, one inspection is not enough, bacteriological seeding, cytology and other laboratory tests are required. If you pass all the stages of diagnostics in time, the process can be stopped at the initial stage and the pathological transformations in the cervical epithelial cells can not develop.

[16], [17],

Pain in cervical dysplasia

Pain in cervical intraepithelial neoplasia is a menacing symptom, which can mean that cervical dysplasia is already moving to grade III. CIN of the first two stages is considered a background disease and does not apply to oncoprocesses. As a rule, dysplasia proceeds without tangible clinical signs, there may be minor symptoms (discharge, itching), characteristic of concomitant diseases.

In what cases can there be pain in cervical dysplasia?

1. All inflammatory processes associated with pelvic organs - PID:
   • Endomiometritis in acute form - pain accompanied by fever, chills
   • Oophoritis unilateral or bilateral is often infectious in nature (mycosis, Candida, all that is associated with STDs). Inflammation in the ovaries gives pain in the lower abdomen, often with secretions
   • Endometritis in the acute phase - pain in the lower abdomen
   • Myometritis - pain, bloating, temperature
   • Salpingitis is manifested by pain symptoms at the end of the menstrual cycle
   • Adnexitis in the subacute or acute course of the process is accompanied by severe pain

PID - inflammations associated with pelvic organs are etiologically conditioned by infections, viruses, bacterial damage. This "base" is considered favorable for the development of cervical dysplasia as a consequence of a neglected disease.

1. Dysplasia of the cervix, passing into the third degree, when changes are affected by two thirds of the epithelial layers. The pain symptom lasts a long time, drawing character, often with secretions (blood, odor, atypical consistency). Pain can appear even without a stress factor, at rest, rarely is sharp, acute. In such cases, a preliminary diagnosis is made - the cervical cancer, requiring specificity (localization of the process, degree of injury)

Most often, pain with CIN is a clinical manifestation of factors that provoke dysplasia. These include, first of all, viral infections (HPV) and virtually the whole range of diseases transmitted through sexual contact (STDs).

Stages

Modern practitioners use the new classification that WHO developed. Cervical dysplasia is defined as CIN of three degrees depending on the severity of the process:

1. Changes in the cellular structure are insignificant. This is a mild degree of dysplasia or CIN I. Diagnosis needs to be clarified through laboratory tests and screening.
2. The cellular structure of the epithelium is subject to a pronounced transformation. This is dysplasia of the cervix in the middle degree of severity of the process or CIN II.
3. A typical picture for CIN III is visible pathological changes in two-thirds of the epithelial layers. Morphology and function of cells are clearly violated, this stage is diagnosed as severe (CIN of severe degree). It may not yet be cancer, but the diagnosis is defined as the boundary between carcinoma in situ and a neglected form of oncology.

Dysplasia of the cervix should not be confused with another nosology - erosion. According to the ICD 10 classification, erosion is a defect of the epithelial cover, fixed in the XIV class under code N 86. The terminological definition of "cervical dysplasia" was adopted back in 1953, then at the First Congress of Exfoliative Cytology in 1965 this term was approved .After 10 years in 1975, another international forum was held (II Congress on pathological changes in the cervix uteri).

It was decided to refer to dysplasia of the cervix Cervical Intraepithelial Neoplasia (CIN). Or CIN. Cervical intraepithelial neoplasia as a diagnosis was divided into 3 degrees:

• 1 degree - easy.
• 2 degree - moderate.
• 3 degree - severe, carcinoma in situ was added (initial, preinvasive stage).

In the generally accepted classification of ICD 10, the diagnosis of cervical dysplasia is recorded in this way:

1. Class XIV, code N87

• N87.0 - cervical dysplasia is weakly expressed, CIN of the first degree.
• N87.1 - moderately expressed dysplasia of the cervix, cervical intraepithelial neoplasia (CIN) of the second degree.
• N87.2 - pronounced dysplasia of the cervix of the uterus (CIN without additional specification), not elsewhere classified. This code excludes the CIN III degree.
• N87.9 - CIN - cervical dysplasia, unspecified.

Carcinoma in the initial stage (in situ) is denoted by the code D06 or as cervical intraepithelial neoplasia (CIN) of the third degree.

[18], [19]

Complications and consequences

The consequences of CIN are directly related to the diagnosed stage of the disease. In general, most women take care of their health and regularly consult a doctor for the purpose of preventive examinations. This greatly affects the risk of malignancy of dysplasia. According to statistics, 95% of the fair sex, who are under the supervision of a gynecologist, successfully cope with such ailment as dysplasia of the cervix.

[20], [21], [22],

Diagnostics of the cervical dysplasia

Dysplasia is a characteristic transformation of the cellular tissue of the cervical epithelium. Accordingly, the diagnosis is aimed at determining changes in the structure of endocervical cells.

Diagnosis of CIN (cervical dysplasia) is based on 7 signs that determine the morphology of the cellular structure:

1. How much the size of the nucleus of the cell increases
2. Changes in the shape of the kernel.
3. How the density of the color of the nucleus increases.
4. Polymorphism of the nucleus.
5. Characteristics of mitoses.
6. Presence of atypical mitoses.
7. Absence or definition of maturation.

[23], [24], [25],

Differential diagnosis

Dysplasia of the cervix requires careful examination and differential diagnosis is mandatory.

Differential diagnosis is necessary because the epithelial layer of the neck has a layered structure. In addition, the neck itself consists of a small layer of muscle tissue, it has connective tissue, blood vessels and lymph vessels, and even nerve endings. Such a complex structure of the cervix requires clarification if the doctor doubts the diagnosis, especially with dysplastic processes.

Dysplasia of the cervix, with what it can be confused?

Differential diagnosis should exclude such diseases:

• Cervical erosion during pregnancy, caused by the change of hormonal leadership and some shift of certain cell layers. For the process of bearing the fetus, such changes are considered the norm.
• Erosive processes, defects of epithelial tissue - true erosion. Trauma mucous can cause anything - tampons, alkaline agents, drug therapy, intrauterine contraception, instrumental procedures without proper training and qualification of the doctor. It happens that erosion occurs as an inevitable consequence of the planned surgical intervention. Under a microscope, lymphocytes, plasmocytes, and other cellular elements that indicate the onset of cell transformation can appear. However, in conjunction with other criteria of the survey, all this can rather eliminate dysplasia and confirm erosive damage.
• Cervicitis of infectious etiology. It is an inflammatory process in the epithelial cover of the cervix, which occurs quite often. The fact is that the epithelium is in principle very sensitive and subject to multiple factors. An infectious agent can provoke inflammation in the first two layers of tissue. Chlamydia, as a rule, act on cylindrical cells, gonococci also. Other infections can give rise to a pseudo-tumor process or ulceration. Differential diagnostics should clarify and divide nosologies, it is desirable to determine the type of causative agent of infectious inflammation.
• Diseases (STDs) transmitted with unprotected sex. Trichomoniasis gives a picture almost in all similar to dysplasia of the cervix.
• Venereal diseases (syphilis), Treponemapallidum gives a picture of epithelial damage, similar to dysplastic changes.
• Herpetic infections. The disease needs a specific type and type of herpes.
• Hyperplasia (proliferation by the type of polyps).
• Cervical polyps - type and type (fibrotic, inflammatory, pseudosarcoma, vascular and others).
• Leukoplakia.
• Residual fragments of the Wolff duct.
• Cervical atrophy due to low estrogen levels.
• Papilloma ploskletochnaya as a benign neoplasm.
• Hyperkeratosis.
• Endometriosis.
• Protozoal infections (amebiasis).
• Cervical dysplasia in most cases is provoked by HPV (papillomavirus), but it also requires specification by type, type.

Differential examination is a classic complex of procedures in gynecology:

• Collection of anamnesis and complaints of the patient.
• Inspection, including with the help of medical mirrors.
• Cytology.
• Colposcopy according to indications.
• The fence of the material for histology is a biopsy.
• Possible additional ultrasound transvaginal method, PCR analysis, general and detailed blood tests, urine.

[26], [27], [28]

Treatment of the cervical dysplasia

Treatment of dysplasia of the cervix begins after the woman passes all the stages of diagnosis. The factors that provoke dysplastic pathologies are diverse, so an accurate assessment of the pathogen-the virus, infection is not just important, but can sometimes save a patient's life. Cervical cancer in the representatives of the beautiful half of humanity still remains in the list of the most common oncological diseases. In time to detect it, stop at the initial stage is the main task of treating cervical dysplasia.

Treatment involves solving a very specific problem - to eliminate the cause that caused pathological changes in the cells of the epithelium. Most often, the transformation of cellular tissue is provoked by viruses, the first place among them is the human papillomavirus. In addition, the age-related hormonal changes, inflammatory diseases in chronic forms, coccal infections and many other reasons are not so easy to "surrender" their positions. A woman who has cervical dysplasia should be prepared for a fairly long period of treatment, which will really make her healthy.

Consider what methods are used in the treatment of endoservical dysplasia :

• Conservative (taking medication according to the course and regimen determined by the doctor).
• Surgical (local surgery, a full operation, depending on the stage of development of pathology).
• Additional methods of treatment (physiotherapy, phytotherapy).
• Non-traditional methods of treatment of cervical dysplasia, which are not confirmed clinically or statistically. Therefore, they will be considered below only as a survey description.

In general, therapy can be designated in this way:

1. Elimination of the cause of the disease and mandatory removal of the dysplasia sector:

• Cauterization of the site (laser therapy).
• Cryodestruction.
• Electrocoagulation method.
• Drug-induced long-term therapy (immunomodulators, vitamin therapy).
• Surgical treatment (conization) or removal of the damaged area with a radio-knife.

Tactical and strategic planning for the treatment of cervical dysplasia directly depends on the severity of the pathology.

1. The first degree of severity is the medicamentous therapy that activates and supports the immune system. Often dysplasia after treatment is neutralized, especially this is typical after the elimination of the pathogen - HPV.

Therapy plan:

• Continuous observation of the patient from one year to two after the diagnosis is clarified.
• Regular screening of the epithelium condition (cytology).
• Immunomodulators, the intake of important trace elements - selenium, folic acid, B vitamins, vitamins E, A, C.
• Parallel treatment of concomitant pathologies of the genitourinary sphere.
• Treatment of dysplasia damaged areas of the cervix with chemical coagulation substances (vagotil).
• Recommendations for healthy eating and lifestyle.
• The choice of adaptive means of contraception, excluding hormonal drugs.
• Observation of the endocrinologist.

2. The second degree of severity :

• Methods of cauterization.
• Methods of cryotherapy (cryodestruction).
• Laser treatment.
• Treatment by radio wave therapy.
• Conization (excision of the affected area of epithelial tissue).

Treatment with surgical methods for cervical dysplasia is performed on the second day after the end of the monthly cycle in order to prevent pathological proliferation of the endometrium. Also these days it is easier to heal small wounds after surgery.

3. The third degree of severity is a serious diagnosis. Treatment is determined jointly with the oncologist.

A short review of the treatment methods with their advantages and disadvantages:

1. Cauterization.

• The advantage is availability, both in technology and in value.
• Disadvantage - technologically there is no possibility to control the quality of cauterization, the depth of penetration of the electro-loops.

2. Cryomethod (destruction by means of ultra-low temperatures):

• After the procedure, there is no deep scarring, the method is suitable for young, nulliparous women.
• Lack - complications, temporary, but uncomfortable, in the form of copious discharge after the procedure. It should also be taken into account that after cryopreservation the patient should give up sexual intercourse for 1.5-2 months.

3. Laser treatment:

• The specific "evaporation" of the affected area of the epithelium practically leaves no traces, there are no scars, the procedure is very precise.
• The nearby sectors of the cervix can be laser-affected and burned.

4. Radio wave therapy:

• The method is considered to be less traumatic, accurate, painless. After radio wave treatment, rehabilitation or regime restrictions are not needed. Relapses practically do not occur.
• The disadvantage is the high commercial cost of the procedure.

5. Conification:

• Do not consider any advantage or disadvantage of any specific criterion for conical excision of tissue. In all cases of scalpel application, wounds will remain, the method is traumatic, however in modern practice gynecologists conduct conization with a laser. Laser excision is much more effective, does not cause prolonged bleeding. Conication as a cervical dysplasia treatment is prescribed only if necessary and impossible to apply a more gentle method.

In general, the treatment of cervical dysplasia is conditionally divided into several stages:

• General - drugs for normalizing the state of epithelial tissue (orthomolecular therapy) - the necessary vitamins (beta-carotene, B vitamins, ascorbic acid, folic acid, oligomeric proatocyanidins, PUFA - polyunsaturated fatty acids, selenium, enzyme therapy. Diet.
• Drug treatment - immunomodulators and cytokines for the neutralization of viruses, infectious agents.
• Local therapy is chemical moxibustion (coagulation).
• Treatment with the help of a surgical operation.
• Phytotherapy

Medications

Dysplasia of the cervix in most cases is successfully treated, provided that diagnostic measures are carried out on time. Medications can be prescribed as an auxiliary stage of therapy, the basic treatment of CIN is considered methods of removing epithelial tissue, the area and the layer where the pathological process develops. Nevertheless, conservative treatment with the help of medications is also included in the complex of therapeutic measures. First of all, drugs are needed to neutralize the activity of the most common pathogen of dysplastic changes - HPV. In addition, an important criterion for the choice of drugs can be the age of the woman and her desire to maintain the ability to procreate.

The drugs used in CIN therapy are aimed at the following tasks:

• Anti-inflammatory drugs (etiotropic therapy). The treatment scheme is chosen depending on the etiology and stage of the disease.
• Medicines from the category of hormonal drugs to restore the normal activity of the endocrine system.
• Immunomodulators.
• Preparations, drugs that help to normalize the microbiocenosis (microflora) of the vagina.

Thus, drugs that can be prescribed at the stage of conservative treatment are all kinds of immunomodulators, carefully selected complex of vitamins and microelements. The leading role of gynecologists is given to folic acid, a group of vitamins - A, E, C, selenium.

In more detail about what medicines can be prescribed for cervical dysplasia:

Drugs that stimulate the immune system	Interferon-alpha 2 Isoprinosine Prodigiosan	Activates the production of immune cells that can withstand viral infection. Protect cells from penetration of bacteria, viruses Strengthens all protective functions of the body as a whole
Vitamin preparations, microelements	Folic acid Retinol (vitamin A) Vitamins C, E Selenium	Folic acid is prescribed as a means to counteract the destruction of epithelial tissue cells. Vitamin A helps the cells of the epithelium to undergo the division process in normal mode. Vitamin E works as a powerful antioxidant. Vitamin C is a classic remedy that strengthens the body's defense. Selenium also acts as an antioxidant, and helps cells of endocervical tissue to regenerate and recover after coning, cauterization and other therapeutic manipulations.

Similar treatment regimens for cervical dysplasia are used in almost all countries that consider themselves to be developed. Gynecologists try to avoid serious surgical interventions for as long as possible in the diagnosis of CIN, however, drugs are not always able to have an effective effect on the pathological process of cell degeneration. Therefore, in 65-70% of cases, it is necessary to remove the site of the cervical tissue, and then to prescribe a supporting medication course.

It should be noted that the doctor can also carry out antibacterial, antiviral therapy, as a rule, this happens already when dysplasia of the cervix passes into more severe stages. In general, drugs are not used as a separate treatment strategy for CIN.

Operative treatment of cervical dysplasia

Surgical treatment of cervical dysplasia is the most commonly used method. The choice of the treatment option for CIN depends on many factors - the patient's age, the stage of dysplasia, the concomitant pathologies, the size of the site of the damaged epithelium. Expectant treatment strategy is appropriate only when dysplasia of the cervix is diagnosed as mild, i.e. I stage of severity.

Modern surgical treatment includes several basic techniques:

• Excision and its variants: electrocoagulation by loop, radioexcision, diathermoelectric method of tissue removal, electroconjuration.
• Destruction of the atypical site of the epithelium with the help of cold action - cryoconization, cryodestruction.
• Vaporization by laser (as well as laser conization or moxibustion).
• Excision of the zone of atypical transformation of epithelial cells - knife conization.
• Removal of the cervix is an amputation.

Under what conditions is it expedient to conduct operative treatment of cervical dysplasia?

1. The best period for removing the pathologically altered epithelium is the follicular phase of the monthly cycle (phase I). At this time, after the procedure, tissue regeneration is improved due to the increased content of estrogens.
2. If the operation is carried out urgently, it is necessary to find out the level of the chorionic gonadotrophin in a person (hCG) to exclude a possible pregnancy. This is especially important when the operation is scheduled for the second phase of the menstrual cycle.
3. Surgery is inevitable when dysplasia of the cervix is diagnosed in stage III. In this way, it is possible to minimize the risk of malignancy - the development of oncology
4. In the case of detection of HPV (papillomavirus), the laser method of removal of transformed cells or diathermocoagulation is most effective.

More details about the methods of operative treatment CIN:

• Destruction. As a rule, gynecologists use the cold method - cryodestruction with the help of cryogen (liquid nitrogen). This technology was first tested in 1971 and since then its effectiveness has been confirmed clinically and statistically by almost all doctors of the world. Cryomethode is used on the 7-10 day of the monthly cycle, it does not require specific preparation. However, there are some contraindications to its use:
  1. infectious diseases in acute stage.
  2. pronounced areas of scar tissue in the cervix.
  3. Acute inflammatory process in the vagina.
  4. dysplasia of the cervix, passing into the III stage.
  5. chronic endometriosis.
  6. The tumor process in the ovaries.
  7. implicitly expressed boundaries of the pathologically altered part of the cervix.
  8. pregnancy.
  9. the start of menstruation.

After cryodestruction, many patients note bloody, fairly abundant discharge, which is considered an acceptable norm for a certain post-operation period. The effectiveness of the method is close to 95%, depending on the preliminary diagnosis and individual characteristics of the patient. Relapse is possible in cases of an incorrectly defined stage of cervical dysplasia.

• Diathermocoagulation is one of the most common methods of surgical treatment of cervical dysplasia. In fact, this method of cauterization with the help of two versions of electrodes - large and small (in the form of a loop). The current is supplied point-wise and in low voltage, which allows a fairly accurate procedure. Nuance of the technique - there is no possibility to regulate the depth of cauterization, but with complex detailed diagnosis this problem is surmountable. Complications - scars, necrotic tissue, possible development of endometriosis. According to statistics, about 12% of patients can fall into the category of those who suffer from such consequences.
• Laser evaporation and laser conization. Vaporization has been known to gynecologists since the 80s of the last century, the method was very popular, but it still remains quite expensive. Radiation, CO ₂ method is the targeted destruction of atypical cells. The technology is effective, practically bloodless, but, like other operational methods, has its side effects:
  • it is possible to burn nearby tissue sites.
  • absence of possibility to conduct a histology after operation.
  • need for complete immobilization of the patient (immobility with the help of general anesthesia).
  • risk of pain after the procedure.
• Radio wave method gynecologists use as an alternative to other techniques. The technology has not yet been officially approved by the global medical community, as there are not enough clinical and statistical data. As well as ultrasound treatment, RVT (radio wave therapy) has been little studied in the field of complications and effectiveness
• Conization of the cervical site with a scalpel (knife conization). Despite the emergence of more modern techniques, scalpel conization remains one of the most common ways of treating CIN. Gynecologists excise a site of atypical cells with a cold-knife method, while simultaneously taking tissue for biopsy. Complications and disadvantages of technology - possible bleeding, risk of traumatization of surrounding tissues, prolonged regeneration.
• The removal of the cervix or its site (amputation) is performed strictly according to indications, when cervical dysplasia is diagnosed as pronounced (stage III). The operation takes place under stationary conditions, general anesthesia is shown. Such a radical method is necessary to minimize the risk of developing cervical cancer (cervical cancer).

Sex with cervical dysplasia

Dysplasia of the cervix is not a contraindication for intimate relationships. Sex with dysplasia of the cervix is possible, but there are certain conditions and rules.

Abstinence is indicated after surgery (surgical treatment of cervical dysplasia):

• Cauterization by laser (or radio wave method).
• All kinds of conization (cryodestruction, using a laser or electro-loops).
• Removal of the site or the entire cervix (amputation).

Why should I limit sex?

1. 1-2 months after cauterization, epithelial tissue is restored, it takes time to regenerate. During this period, the woman needs special conditions - special nutrition, day regimen, and you should not use vaginal tampons. Term abstinence is determined by the option of the technique, the patient's condition and the stage on which cervical dysplasia is located.
2. Excision of the cervix is a rather serious procedure. After it, you need to exclude intimate relationships for at least 4-5 weeks. Konisation is considered a more serious surgical intervention compared to vaporization or moxibustion, so the rejection of sex can last up to two months.
3. The removal (amputation) of the cervix requires at least a 2-month withdrawal from sexual contacts. Term abstinence is established individually, but one should remember the serious health consequences in case of violation of the abstinence regime.

The reasons for excluding sex after surgery are understandable:

• The wound surface is very vulnerable, including for infections. In addition, sexual contact significantly slows the process of tissue regeneration.
• Intimate life at a time when, after surgical treatment, discharge with blood is possible, is questionable as such.
• Sexual contact after surgery may further injure the cervical epithelium and provoke a relapse of dysplasia.
• There is a risk of re-infection with infectious agents if the partner has not been treated with a woman.
• Sex in the postoperative period can cause damage to the healing zone, it threatens to bleed.
• For a woman, intimate relationships after removal of the damaged cervical region are very painful and bring discomfort.

If dysplasia of the cervix is treated in a conservative way, sex with a partner is not prohibited, but it will be necessary to consult a treating gynecologist. It is not recommended to enter into relations with unfamiliar partners, of course, excluded from frequent shifts. Also, a woman needs to be as attentive to her own health as possible, especially if atypical discharge or pain sensations appear after sexual intercourse. This may be the first signal of an accelerating pathological process.

Tanning with cervical dysplasia

Sunburn and gynecological disease are incompatible. Cervical dysplasia is considered a precancerous disease. Not being a verdict, nevertheless, such a diagnosis presupposes prevention and protection measures

One of the factors that provoke cancer, including cervical cancer (cervical cancer), can be excessive tanning. Dysplasia in the initial stage is successfully treated, but solar rays, solarium can provoke its development. This is due to the fact that viruses, bacteria, infectious agents, which are often the cause of CIN, respond well to heat, it is for them an almost ideal environment. In addition, a long stay on the beach not so much will give the skin a beautiful shade, how much will reduce the protective functions of the body, not to mention the sun or thermal shock. Weakening of the immune system is the right way to start the development of infections and related pathologies. UV-rays are useful only at a certain time, in a normal dose and only for absolutely healthy people. Their excess has a negative effect on the cellular structure, and dysplasia of the cervix is just an atypical division of the epithelial cells. In addition, ultraviolet can penetrate deep enough into the layers of the skin and activate the "sleeping" oncoprocesses, provoke a genetic malfunction.

Tanning with dysplasia of the cervix can take place only if the attending physician has given him permission and specifically painted the regime of sunbathing. This rule also applies to visits to the solarium. Even with a CIN of an easy, initial stage, you should not experiment and risk your own health. Remember that statistically, cervical cancer ranks third among all the most common oncological pathologies in women. The sun will wait, you can sunbathe when the disease is left behind. This time comes, as a rule, 12-16 months after successful treatment and regular examination by a doctor.

Prevention

Cervical dysplasia is a serious diagnosis, the condition of epithelial tissue is threateningly seeking oncopathology. Therefore, prevention should be comprehensive and regular. Cervical cancer as one of the risks of CIN development starts with pre-tuberculosis of gynecological diseases. One of the most effective methods of prevention in this area is systematic screening. Back in 2004, the international community of gynecologists approved a resolution on a total screening survey of all women, starting from the age of 20-25. Inspections are recommended to be conducted at least once every 2 years until the climacteric period (50-55 years) is reached. Then, prophylactic screening is put every 3-5 years, although patients can go through it and more often at will.

The program of prophylaxis for cervical dysplasia makes it possible to determine in the early stages the patches of pathologically altered epithelium and take timely measures for their reduction. It is worth noting that screening is not a 100% way to prevent the development of HPV (papillomavirus), it can only be stopped by vaccination.

Vaccines are effective against all oncogenic infectious and viral agents, they are recommended to be administered to women in their reproductive years. These measures, combined with regular cytology, significantly reduce the incidence of cervical cancer and save thousands of lives in general.
Thus, the prevention of dysplasia of the cervix, more accurately, its transformation into the III stage, is the following:

• Timely appeal to the gynecologist, at least once a year.
• Complex sanation of any infectious or viral pathogen.
• A healthy diet and lifestyle in general. Refusal from destructive habits - smoking, alcohol abuse, promiscuous sexual relations.
• Observance of elementary rules of personal hygiene.
• The use of cotton underwear, the rejection of fashion experiments with synthetic thongs and other "delights", often leading to inflammatory processes.
• Contraception as a barrier to infection, especially with STDs (sexually transmitted diseases).
• Vaccination against papillomavirus.
• Regular screening of the status of the uterus, cervix and pelvic organs (PAP test, cytology, according to indications - biopsy).

Recommendations for the prevention of dysplastic pathology for women of different age categories:

1. The first preventive examination should take place no later than reaching the age of 20-21 (or in the first year after the debut of sexual relations).
2. If the PAP test is negative, a preventive visit to the gynecologist should be made at least once every 2 years.
3. If a woman older than 30 years PAP-test shows normal results, she still needs to show the doctor at least once every 3 years.
4. Ladies over 65-70 years can stop going to the gynecologist and examinations, if the cytology is normal. Prophylactic screening should be continued in the case of frequent positive PAP tests in the period up to 50-55 years.

In many developed countries, there are educational programs for the population, in which explanatory work is carried out on the threat of cancer and their prevention. However, neither programs nor orders at the government level can replace common sense and the desire to preserve one's own health. Therefore, the prevention of cervical cancer and dysplastic changes should be a matter of conscious and voluntary, every reasonable woman should understand the importance of preventive examinations and take them on schedule in order to avoid serious consequences.

[29], [30], [31], [32], [33],

Forecast

Cervical dysplasia is not a cancer, this diagnosis only indicates the risk of malignization of the pathological process. According to statistics, about 25-30% of patients who refused comprehensive treatment and regular examination fall into oncostatsnonar. There are other figures, more optimistic. 70-75% (sometimes more) with the help of diagnostics, carefully selected course of treatment, including radical methods, are completely cured and then only preventive examinations take place. Obviously, the overwhelming majority of women are still more attentive to their own health and successfully overcome the disease.

In order for the information to be more convincing, we will issue a prognosis of cervical dysplasia in this way:

• Each third patient, diagnosed with CIN, did not feel the symptoms of the disease. Dysplasia was detected accidentally during a routine examination with a doctor.
• Modern medicine is able to successfully combat cervical cancer (cervical cancer) under the condition of a timely revealed pathology of the epithelial cover of the cervix.
• Surgical treatment for diagnosis - cervical dysplasia is shown in 80-85% of cases.
• Relapses of dysplastic processes are possible in 10-15% of cases even after successful treatment. They are usually detected on preventive examinations 1.5-2 years after the operation.
• The return of the development of pathology can be explained by inaccurate excision of the site with atypical cells or in the case of persistence of papillomavirus.
• During pregnancy, stage I dysplasia can be neutralized by a powerful adjustment of the hormonal, immune and other systems of the woman.
• Cervical dysplasia does not interfere with natural delivery and is not a strict indication for caesarean section.
• With CIN at a moderate stage, the prognosis is more than favorable. Only 1% of patients continue treatment for the transformation of pathology in the II and III stages.
• 10-15% of women with dysplasia of the cervix in the II stage continue complex therapy because of the development of the process in the III stage (this occurs within 2-3 years).
• The transition of dysplasia to Stage III and to cervical cancer is observed in 25-30% of women who have not received treatment, in 10-12% of patients, undergoing a full course of therapeutic measures.
• More than 75-80% of women who have CIN at an early stage are fully recovered within 3-5 years.

Cervical dysplasia as an asymptomatic process, which is developing rather slowly, remains a difficult but surmountable task for gynecologists. This problem is especially successfully solved provided that the woman understands the severity of the disease and consciously undergoes timely preventive examinations, including a whole set of diagnostic tests. CIN is not an oncology, but still the first alarm signal about a threat. Risk is easier to prevent and neutralize at the very beginning of development.

[34], [35], [36]