Dealing with a Diagnosis
Understanding how some reproductive conditions affect your chances of conceiving
Another scary-sounding diagnosis is dysplasia of the cervix. This is also likely to be turned up at an annual gynecological exam, a preconception exam, or if you are being evaluated for infertility. Cervical dysplasia is the presence of abnormal cells on the cervix, most commonly caused by exposure to the human papillovirus (HPV). HPV exposure comes from sexual contact, but development of dysplasia may come years or even decades after exposure. HPV is also the cause of the more commonly known “genital warts,” but you can have dysplasia without any evident warts.
Cervical dysplasia is serious business, as evidenced by its often being called “pre-cancerous.” That will get your attention. Beth M. Iovinelli, RN, BSN, IBCLC, says, “Cancer can develop in the cervix when abnormal cells grow at a rapid rate—when normal cells come into contact with cancer-causing agents. In the case of cervical cancer, HPV is often the agent.” There is now a “cervical cancer vaccine,” actually a vaccine against HPV, recommended for girls starting at age 11.
If you have cervical dysplasia, your doctor may do a loop electrical excision procedure, or LEEP, which will remove the lesion completely as well as provide a specimen to allow for thorough diagnosis. This makes it a superior procedure to freezing or applying a laser to the spot on the cervix. Unfortunately, all such destructive procedures carry a small risk of incompetent cervix with a subsequent pregnancy, says Dr. DiLeo. “Tell your doctor you’re planning a pregnancy soon, so he or she will take special care to do the LEEP as shallow as possible,” he advises those planning to conceive.
The cervix should heal from the LEEP in about four weeks, and in another month will be back to normal. But, “partner with your doctor on when to attempt pregnancy,” says Dr. DiLeo, “since he or she will provide the continuity of care from your dysplasia and its elimination to your pregnancy.”
It is the job of the cervix to stay shut and keep a pregnancy safely in the uterus until it is time to deliver. According to Dr. Jarrett, “In some individuals, the cervix just does not form quite properly, and in others it malfunctions as a result of prior surgery or manipulation.” An incompetent cervix usually starts dilating fairly painlessly in the second trimester of pregnancy, and can lead to miscarriage or premature delivery. When it is discovered in time, mothers are put on bed rest.
Since the cervix rarely shows sign of “incompetence” before pregnancy, it is very hard to diagnose preconceptually. According to a University of Illinois Medical Center fact sheet, if a woman has no history of an incompetent cervix, it usually cannot be prevented. After the diagnosis is made, treatment is available for future pregnancies.
It can be treated with procedure called cerclage, in which the cervix is stitched shut. This is usually done about 14 weeks into the pregnancy. The procedure is done through the vagina and the cerclage can be removed before delivery (or left in place if delivery is by Cesarean section).
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