About the cervix. Note to Housewives. As a Preface

Since only knowledge can overcome this fear and horror that is generated in the minds of patients by a large part of our doctors, here is the most detailed description of what can happen to the cervix, and how to treat it all.

1. from the age of 21 to 65, take a cytological smear from the cervix once every three years, preferably if it is liquid Cytology, this method is more accurate.
2. Do not worry in response to any conclusions about the cervix during its examination by a doctor (erosion, cysts, deformity, etc.) until the results of tests are received.
3. Colposcopy is best performed after receiving the results of Cytology, if there are deviations in it. Colposcopy data can only be interpreted in conjunction with Cytology data, and Cytology data are of great importance.
4. a cervical Biopsy is performed only if the presence of dysplasia is confirmed by Cytology and colposcopy, but not before or after these results are obtained.
5. HPV Analysis is performed only after receiving a result about the presence of dysplasia in the cytological smear. The purpose of this analysis is not to prescribe treatment for HPV (this virus is not treated), but to decide on further tactics: observation or treatment. The analysis should only be quantitative (the result is a number, not “positive”), the analysis performed using the” Digene test ” system or the reverse hybrization method is considered reliable, and other tests may have less confidence.
6. HPV Vaccination does not treat HPV, but prevents infection with oncogenic types of the virus. If the vaccination was made, this does not exclude the need to also take a cytological smear. Vaccination is best done before the start of sexual life, it is recommended to perform it in the period from 9 to 26 years.
7. erosion of the cervix is cauterized only in two cases: if there is a bloody discharge after sexual intercourse or excessive mucous discharge that affects the quality of life. Moxibustion does not affect the ability to get pregnant and give birth.
8. Leukoplakia of the cervix is a precancerous condition. You do not need to delete it if there are no changes according to the Cytology data.
9. there Are two classifications of changes in the cervix: dysplasia -1, -2, -3 and LSIL, HSIL; they are used in parallel, the second is more modern. There is a separate abbreviation ASC-US. All other words in the conclusion of Cytology reflect variants of the norm. NILM is generally a description of the norm.
10. The reduction of ASC-US is not associated with cancer. This, in fact, means that there are small changes in the cells, but we need to clarify. Most often, an HPV test and/or colposcopy is performed. In the vast majority of cases, everything is normal.
11. The conclusion of the cytological smear should be drawn up correctly: a description of the picture, a conclusion indicating the class according to the classification of Papanicolaou. Classes 1 and 2 are the norm. Starting from the 3rd grade, clarifications are required. If the conclusion is not drawn up correctly, it should not be completely trusted and it is better to repeat the analysis.

When detecting mild cervical dysplasia at the age of 30 years, more often resort to observation, and after 30 years, the approach is more radical.

12. the Need for treatment of cervical dysplasia by a small surgical operation is determined by age, the severity of dysplasia, the presence of HPV and the amount of this virus, as well as the results of additional tests. Most often, surgical treatment is used closer to 30 years and later, since it is known that before this age, changes in the cervix can pass independently, that is, they resort to wait-and-see tactics, but there are exceptions.
13. when communicating with the doctor who suggested surgery on the cervix, keep in mind the formula: your age (before 30 years or after), Cytology data (preferably liquid), the presence of HPV, its amount, the conclusion of colposcopy and the result of a biopsy. Until there are all the elements that prove the presence of dysplasia and its severity, you should not give consent, look for a second opinion.
14. the most important “protective document” from the doctor’s active actions is the result of a cytological smear (better liquid Cytology). Remember: if the Cytology revealed no cervical dysplasia, normal picture colposcopy please leave me alone (exception: ASC-US – asked to be tested for HPV and will tell you when to alter Cytology; pattern of inflammation – ask to make a smear on flora). All the other suggestions from doctors and the cancer intimidation go unheeded.

Cervical canal polyps are usually benign, but they must be removed.

15. No cysts on the cervix should be removed, no matter how you are convinced of this. They are not dangerous and do not interfere with anything. Scarring of the cervix in most cases does not require correction and does not affect the onset of pregnancy and gestation; get a few opinions before agreeing to surgery. Cervical canal polyps are in the vast majority of cases benign, but they should be removed.

CONCLUSION

If even after reading all of the above, you still have questions and nothing is clear, below is a detailed algorithm of actions depending on your age.

1. You are less than 21 years old – you do not need to perform any cervical examinations, and you do not need to take an HPV test either. If, however, you have been tested and identified HPV oncogenic types, mild dysplasia (LSIL) or cervical erosion and offer treatment, we refuse and just wait until you are 21 years old.
2. If you are between 21 and 29 years of age, it is necessary to make the analysis of liquid-based Cytology cervical. If the result is NILM, i.e. the norm, repeat the analysis in three years. If ASCUS is detected, make a smear on the flora. If a violation of the flora is detected, treat it and repeat the liquid Cytology in 6-8 weeks, adding colposcopy. If LSIL is detected, perform a quantitative analysis for HPV, p16ink protein, and colposcopy. In the absence of p16ink protein, repeat liquid Cytology after one year, even if HPV is positive. A positive test for HPV oncogenic types requires an annual cytological examination, and not once every three years. If there are suspicious areas during colposcopy (dense white epithelium, rough mosaic or punctuation, atypical vessels), a targeted biopsy may be performed. With a positive result of the HSIL liquid Cytology analysis, a targeted cervical biopsy is performed to clarify the diagnosis and decide on the treatment method. We are not talking about medication, which does not exist, but about a small surgical intervention: conization or excision of the cervix. This is a non-dangerous procedure that practically does not affect your reproductive system and the ability to get pregnant and carry out pregnancy.

No cervical examinations should be performed before the age of 21.

3. if you are over 30 years old, the cytological examination of cervical cells is always supplemented with an analysis for HPV oncogenic types. With a normal smear (NILM) and no HPV, you should take a smear once every 3 years. If the smear is normal, but there is HPV-colposcopy, if suspicious areas are detected-a targeted biopsy. If everything is normal-a cytological smear 1 time a year, this is due to the presence of HPV in the body. If LSIL is detected, it is mandatory to perform a colposcopy, a targeted biopsy to confirm the diagnosis and then make a decision about treatment. In this situation, laser vaporization of the cervix is acceptable. If HSIL is detected, a biopsy is performed to confirm the diagnosis. Treatment – conization or excision of the cervix.

At the age of 30, if HPV is negative, a smear test is required once every three years.

4. Please note: no medication (allokin-alpha, isoprinosine, Panavir, genferon, etc.) is used even when HPV is detected, as it is ineffective. Treatment of cervical lesions is aimed only at removing or destroying the affected tissue of the cervix, when there are the indications described above.
5. Leukoplakia of the cervix itself is not a precancerous condition. In leukoplakia, there may be the same changes that occur in other cells of the neck. When detecting leukoplakia, a targeted biopsy of the cervix is sufficient to determine whether there are atypical cells in this formation. If it is a simple leukoplakia, it is not necessary to remove it.
6. recently, in America and Europe, it has been proposed to replace routine cytological examination of cervical cells with analysis for oncogenic HPV types. The bottom line is that cervical cancer is always caused by oncogenic types of HPV, that is, if you do not have these types of virus in the analysis, then you can not have any changes in the cervix that could lead to cancer, so you do not need to do Cytology. If HPV is detected, only in this case it is worth taking a smear. Thus developed a special high-sensitive test system for self-taking samples from the vagina, we can only send material to the laboratory and wait for the result. If the test is positive, go to the clinic to collect a cytological smear, if it is negative, live in peace and repeat the analysis in a year. This approach is more aimed at optimizing the passage of cervical screening and saves women from having to climb on a chair and take a smear. I fully agree with this approach and support it, but I believe that it is too early to introduce it in our country. This is due to the idea of many gynecologists that HPV should be treated, and it is almost impossible to convince them, since HPV treatment is included in all standards of gynecological care and is preached by many leading gynecological institutions. It is important to understand that if you are diagnosed with HPV oncogenic type, this does not mean that you will ever develop changes in the cervix. This is just an excuse to do a cytological smear, which in the vast majority of cases will be normal. But I am very afraid that this will not end in our country. Even if there is a normal smear, the patient will still be afraid of the horrors of the risk of cervical cancer and will begin to conduct completely unnecessary HPV treatment. If you now understand that the presence of oncogenic types of HPV does not require treatment, you can replace the cytological smear with an HPV test, but be sure to use a quantitative analysis of the Digest test or the reverse hybridization method, since only these methods have a reliable result. At the time of writing, tests for self-collection of material for analysis in our country have not yet been registered.

If you decide to replace the cytological smear with an HPV test, be sure to use a quantitative analysis of the Digest test.No cervical examinations should be performed before the age of 21.

3. if you are over 30 years old, the cytological examination of cervical cells is always supplemented with an analysis for HPV oncogenic types. With a normal smear (NILM) and no HPV, you should take a smear once every 3 years. If the smear is normal, but there is HPV-colposcopy, if suspicious areas are detected-a targeted biopsy. If everything is normal-a cytological smear 1 time a year, this is due to the presence of HPV in the body. If LSIL is detected, it is mandatory to perform a colposcopy, a targeted biopsy to confirm the diagnosis and then make a decision about treatment. In this situation, laser vaporization of the cervix is acceptable. If HSIL is detected, a biopsy is performed to confirm the diagnosis. Treatment – conization or excision of the cervix.

At the age of 30, if HPV is negative, a smear test is required once every three years.

4. Please note: no medication (allokin-alpha, isoprinosine, Panavir, genferon, etc.) is used even when HPV is detected, as it is ineffective. Treatment of cervical lesions is aimed only at removing or destroying the affected tissue of the cervix, when there are the indications described above.
5. Leukoplakia of the cervix itself is not a precancerous condition. In leukoplakia, there may be the same changes that occur in other cells of the neck. When detecting leukoplakia, a targeted biopsy of the cervix is sufficient to determine whether there are atypical cells in this formation. If it is a simple leukoplakia, it is not necessary to remove it.
6. recently, in America and Europe, it has been proposed to replace routine cytological examination of cervical cells with analysis for oncogenic HPV types. The bottom line is that cervical cancer is always caused by oncogenic types of HPV, that is, if you do not have these types of virus in the analysis, then you can not have any changes in the cervix that could lead to cancer, so you do not need to do Cytology. If HPV is detected, only in this case it is worth taking a smear. Thus developed a special high-sensitive test system for self-taking samples from the vagina, we can only send material to the laboratory and wait for the result. If the test is positive, go to the clinic to collect a cytological smear, if it is negative, live in peace and repeat the analysis in a year. This approach is more aimed at optimizing the passage of cervical screening and saves women from having to climb on a chair and take a smear. I fully agree with this approach and support it, but I believe that it is too early to introduce it in our country. This is due to the idea of many gynecologists that HPV should be treated, and it is almost impossible to convince them, since HPV treatment is included in all standards of gynecological care and is preached by many leading gynecological institutions. It is important to understand that if you are diagnosed with HPV oncogenic type, this does not mean that you will ever develop changes in the cervix. This is just an excuse to do a cytological smear, which in the vast majority of cases will be normal. But I am very afraid that this will not end in our country. Even if there is a normal smear, the patient will still be afraid of the horrors of the risk of cervical cancer and will begin to conduct completely unnecessary HPV treatment. If you now understand that the presence of oncogenic types of HPV does not require treatment, you can replace the cytological smear with an HPV test, but be sure to use a quantitative analysis of the Digest test or the reverse hybridization method, since only these methods have a reliable result. At the time of writing, tests for self-collection of material for analysis in our country have not yet been registered.

Most gynecologists in Russia still believe that HPV should be treated. This misconception is a test of the competence of specialists.

If you decide to replace the cytological smear with an HPV test, be sure to use a quantitative analysis of the Digest test.