I have been dealing with atypical pap smears and high risk hpv for 7 months now. I had a colposcopy following the first atypical pap which was benign. Recently, I had a pap come back abnormal. I had a second colposcopy done this week and I suspect it will confirm some mildly abnormal changes. My doctor advised me that if the changes are in fact mild, we do not need to treat the dysplasia, only to monitor it. I am 25 years old and never been pregnant, altough I would like to become pregant in the near future. I am terrified of damage to my cervix which would prevent a pregnancy, but just as terrified of this disease progressing without treatment. Is my doctor right to hold off treatment? What are the risks of waiting? Are the risks for infertility significant after treatment? Last, will having lots of biopsies done damage my cervix at all?

Many women are diagnosed with high risk HPV on their Pap smears. Once the colposcopy is done, if the biopsies show normal cells, inflammatory atypia or low grade dysplasia (also called CIN I), then no treatment is necessary. It is strongly agreed upon that only moderate to severe dysplasias should be treated. 90% of mild dysplasias and inflammatory atypia will revert back to normal on their own with no treatment. Once the colposcopy is done, there is no need to repeat a Pap smear in less than one year even with high risk virus unless the patient is immunocompromised (ie: HIV + or receiving chemotherapeutic agents). Healthy women do not have rapid progression of disease from mild to moderate or severe dysplasias in this time period. If a Pap remains abnormal, there is no definitive agreement, but a colposcopy should be done roughly every 1 1/2 to 2 years to confirm that the dysplasia has not progressed. Paps and colposcopies more frequently than this, will only make the patient nervous and do not serve any purpose. Yearly surveillance is adequate. Moreover, most young women, especially those under 30 at time of diagnosis of HPV, will clear the virus from their systems with time and the DNA test used to diagnose the HPV will revert back to negative. Even women diagnosed with HPV should consider getting the HPV vaccine (Gardasil® by Merck) as it may still give them some protection against subtypes of HPV to which they may not have been exposed. The vaccine is approved for women age 9 to 26, but it can be given to older women if their doctors feel it is indicated. Biopsies of the cervix are generally superficial in depth and do not predispose to fertility nor pregnancy issues. However, over aggressive treatment or multiple procedures such as cryosurgery, laser ablations of the cervix, LEEP procedures and cone biopsies can occasionally be associated with fertility issues or cervical incompetence during pregnancy. It is important to remember that 50% of sexually active men and women have been exposed to HPV, but only 10% of women will end up needing treatment for their dysplasias and most will eventually clear the virus on their own.

Answered by Dr. Lynn Friedman, M.D.