Cervical Dysplasia (CIN)

Dr. Wei-Wei Wee-Stekly

Senior Consultant Obstetrician & Gynaecologist

MBBS (London), MRCOG (United Kingdom), MMed (O&G) (Singapore), FAMS (Singapore), FRCOG (United Kingdom)

Being told you have an abnormal Pap smear or a condition called cervical dysplasia can feel alarming. However, it’s important to understand that cervical dysplasia is not cancer — and in many cases, it can be treated effectively before it ever becomes serious.

Cervical dysplasia, also known as Cervical Intraepithelial Neoplasia (CIN), is a condition where abnormal cells are found on the surface of the cervix. These changes are usually discovered through routine screening (Pap smears or HPV tests) and may resolve on their own or require treatment, depending on the severity.

What Is Cervical Dysplasia (CIN)?

Cervical dysplasia refers to the abnormal growth of cells on the cervix — the lower part of the uterus that connects to the vagina. These changes are not cancer, but they can be a precursor to cervical cancer if left untreated over time.

Cervical dysplasia is graded based on how abnormal the cells are and how deeply they affect the cervical tissue:

• CIN 1 (Mild Dysplasia): Low-grade changes affecting only the surface layer of cells. Often resolves on its own.
• CIN 2 (Moderate Dysplasia): Cells are more abnormal and affect deeper layers.
• CIN 3 (Severe Dysplasia): Significant abnormalities involving most or all of the cervical lining. This is considered a high-risk precancerous condition.

The purpose of regular cervical screening is to detect these changes early — when they can be easily treated to prevent progression to cervical cancer.

What Causes Cervical Dysplasia?

The main cause of cervical dysplasia is persistent infection with certain types of the human papillomavirus (HPV) — a common sexually transmitted virus. While most HPV infections clear on their own, some high-risk strains (especially HPV 16 and 18) can cause abnormal cell changes over time.

Other risk factors that may contribute to the development of cervical dysplasia include:

• Early onset of sexual activity
• Multiple sexual partners
• Smoking
• Weakened immune system (e.g., from HIV or immunosuppressive medications)
• Long-term use of oral contraceptives
• A history of sexually transmitted infections (STIs)

HPV is extremely common — most sexually active people will be exposed at some point. The presence of HPV doesn’t mean you’ll develop cervical dysplasia, but regular screening is essential to catch changes early.

Are There Symptoms of Cervical Dysplasia?

Cervical dysplasia usually does not cause any symptoms, which is why regular Pap smears and HPV tests are so important.

In rare cases, if dysplasia progresses to an advanced stage or becomes cervical cancer, symptoms may include:

• Abnormal vaginal bleeding (after sex, between periods, or after menopause)
• Unusual vaginal discharge
• Pelvic pain or pain during intercourse

However, in the pre-cancerous stages, most women feel completely normal, further underscoring the importance of routine screening.

How Is Cervical Dysplasia Diagnosed?

Cervical dysplasia is typically discovered through routine cervical cancer screening. Diagnostic steps may include:

1. Pap Smear (Cytology)

A sample of cervical cells is collected to look for abnormal changes.

2. HPV Testing

Used alongside or after a Pap smear to check for high-risk HPV strains that may cause cervical changes.

3. Colposcopy

If abnormalities are found, a colposcopy (a magnified visual examination of the cervix) may be recommended. The doctor may apply a special solution and use a lighted scope to examine the cervix more closely.

4. Cervical Biopsy

If needed, small tissue samples may be taken during the colposcopy to confirm the grade of dysplasia (CIN 1, 2, or 3).

Early and accurate diagnosis is essential to determine the appropriate follow-up or treatment.

When Should You See a Gynaecologist About Cervical Dysplasia?

You should seek medical care or follow-up if:

• You’ve been told your Pap smear is abnormal
• You test positive for high-risk HPV
• You’ve been diagnosed with CIN and need guidance on treatment options
• You experience unusual bleeding, discharge, or pelvic discomfort

Cervical dysplasia is treatable, especially when caught early, but timely care and monitoring are essential.

How Is Cervical Dysplasia Treated?

Treatment depends on the grade of CIN, age, desire for future pregnancy, and other individual factors.

CIN 1 (Mild Dysplasia)

• Often resolves on its own, especially in younger women.
• Monitoring with repeat Pap smears and/or HPV tests every 6–12 months is common.
• Treatment may not be necessary unless it persists or progresses.

CIN 2 and CIN 3 (Moderate to Severe Dysplasia)

• These higher-grade lesions carry a greater risk of progressing to cervical cancer and are usually treated.

Treatment options include:

• LEEP (Loop Electrosurgical Excision Procedure): Uses a thin, electrically charged wire to remove abnormal tissue.
• Cold Knife Cone Biopsy: A small, cone-shaped section of the cervix is removed for more advanced or persistent cases.
• Cryotherapy: Freezing abnormal cells to destroy them (less commonly used).
• Laser Therapy: Vaporises abnormal cells with a focused laser beam.

These treatments are typically done as outpatient procedures, and most women recover quickly. Regular follow-up is important to ensure the abnormal cells do not return.

Can Cervical Dysplasia Affect Fertility or Pregnancy?

In most cases, cervical dysplasia and its treatments do not affect fertility. However, some treatments that remove cervical tissue (such as LEEP or cone biopsy) may slightly increase the risk of preterm birth or cervical insufficiency in future pregnancies.

If you plan to conceive or are currently pregnant, be sure to discuss your options with your gynaecologist. In some cases, treatment may be delayed until after delivery, especially if the dysplasia is low grade.