Can my daughter undergo LEEP for her cervical dysplasia?

Question

Hello doctor,

My 19-year-old daughter was diagnosed with cervical dysplasia after an abnormal Pap smear. The HPV (human papillomavirus) test was positive for high-risk types 16 and 18. Colposcopy showed CIN 2 (cervical intraepithelial neoplasm), and the biopsy confirmed moderate dysplasia. The gynecologist recommends the LEEP (loop electrosurgical excision procedure) procedure, but she is scared about the effects on fertility. She has been sexually active with one partner for two years. The family has no history of cervical cancer.

What are the treatment options for cervical dysplasia in young women?
Will LEEP affect her ability to carry pregnancies?
Can the immune system clear HPV naturally?

Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I have gone through your query and understand your concern.

Colposcopy offers an accurate way to diagnose cervical intraepithelial neoplasia (CIN) and to differentiate high-grade lesions from low-grade abnormalities. The positive predictive value (PPV) of a colposcopic diagnosis is dependent on the prevalence of the disease in the referred population; the highest prevalence is found in individuals referred with a high-grade cytology result, the lowest in individuals referred with persistent hrHPV (human papillomavirus) and negative cytology.

PPV is defined as the proportion of individuals with an adequate colposcopic examination and a colposcopic impression (CI) of a high-grade lesion who have high-grade CIN (including cervical glandular intraepithelial neoplasia (CGIN) or worse) confirmed by histological examination (directed biopsy or tissue excised at first visit (see and treat)).

The PPV should be at least 75 percent for a CI of a high-grade lesion (CIN2 or worse) for individuals referred with high-grade cytology, and at least 35 percent for all other referrals

Local ablative techniques: All individuals must have an established histological diagnosis within three months of having ablative treatment.
Cryocautery: Cryocautery should only be used for low-grade CIN. A double freeze technique must be used.
Excision: Removal of the specimen. When excision is used, at least 80 percent of cases should have the specimen removed as a single sample. Removing the transformation zone in multiple fragments can increase the difficulties encountered in histopathological assessment. Furthermore, if microinvasive disease is present, it may be impossible to allocate a sub-stage or define completeness of excision in fragmented excisional specimens.

Complications of treatment during pregnancy.
1. Preterm premature rupture of membranes.
2. Preterm labor.
3. Miscarriages.
  
  I hope I have answered your question.
  
  Let me know if I can assist you further.
  
  Thank you.