Managing Abnormal Pap Results and CIN1 After Conization: A Patient's Guide

Cervical intraepithelial neoplasia (CIN)

Hello Dr.
Tsao, I would like to ask you about my situation.
In January of this year, I had an abnormal Pap smear and tested positive for HPV, which was classified as CIN1.
My gynecologist performed a cone biopsy in February, but after three months, in May, my Pap smear still showed abnormalities.
The doctor has suggested either undergoing electrosurgery or regular follow-up.
I am currently postmenopausal and feeling uncertain about how to decide.
Thank you.

Yu, 50~59 year old female. Ask Date: 2020/05/28

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, please follow the doctor's instructions.
Wishing you good health.

Reply Date: 2020/05/28

More Info

Managing abnormal Pap results and cervical intraepithelial neoplasia (CIN) can be a complex and concerning process for patients. In your case, you have been diagnosed with CIN1 following an abnormal Pap smear and HPV positivity, and you underwent a conization procedure in February. However, your follow-up Pap smear in May still showed abnormal results, leading to a recommendation for either electrosurgical treatment or continued monitoring.

Understanding CIN1 and Its Management
CIN1 is classified as a low-grade squamous intraepithelial lesion (LSIL), which indicates that there are mild changes in the cervical cells. This condition is often associated with transient HPV infections, which the immune system can typically clear on its own. In many cases, CIN1 does not progress to more severe lesions, and active treatment may not be necessary. Instead, regular monitoring is often recommended.

Follow-Up After Conization
After a conization procedure, which involves removing a cone-shaped section of the cervix to treat abnormal cells, it is expected that follow-up Pap smears will be performed to ensure that the abnormal cells have been adequately addressed. The fact that your follow-up Pap smear still shows abnormal results can be concerning, but it is essential to understand the context:
1. Healing Process: After conization, the cervix undergoes a healing process, and it is not uncommon for the first follow-up Pap smear to show some abnormalities. This can be due to residual changes or inflammation rather than persistent disease.

2. HPV Status: Since HPV is a significant factor in the development of cervical lesions, understanding your HPV status is crucial. If your HPV test remains positive, it may warrant closer monitoring or additional treatment.

3. Electrosurgical Treatment: Your doctor has suggested electrosurgical treatment, which can be an option if there is concern about persistent abnormal cells. This procedure can help remove any remaining abnormal tissue and reduce the risk of progression to higher-grade lesions.

4. Regular Monitoring: If you choose to pursue regular monitoring, it typically involves Pap smears every six months to a year, depending on your doctor's recommendations. This approach allows for close observation of any changes in your cervical health.

Decision-Making Considerations
Given that you are now post-menopausal, this may influence your decision-making process. Hormonal changes can affect cervical health, and it is essential to discuss how these factors may impact your treatment options with your healthcare provider.

1. Consultation with Specialists: If you are uncertain about the best course of action, consider seeking a second opinion from a gynecologic oncologist or a specialist in cervical health. They can provide additional insights into your specific situation and help you weigh the risks and benefits of further treatment versus monitoring.

2. Personal Comfort and Anxiety: Consider your comfort level with the options presented. If the idea of ongoing monitoring causes significant anxiety, you may prefer to pursue treatment to alleviate those concerns.

3. Long-Term Health: Discuss with your doctor the long-term implications of both options. Understanding the potential outcomes of continued monitoring versus treatment can help you make a more informed decision.

Conclusion
In summary, managing abnormal Pap results and CIN1 after conization involves careful consideration of your individual circumstances, including your HPV status, the results of your follow-up tests, and your personal preferences. Regular monitoring is often sufficient for CIN1, but if there are persistent abnormalities, further treatment may be warranted. Open communication with your healthcare provider is crucial in navigating this process and ensuring that you feel confident in your chosen path forward.

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