I had my first abnormal pap a couple months ago. Since then, everything has gone down hill. I had a bad feeling to start off with. I was positive for a high risk type HPV. Then they did the colposcopy, he found a spot and decided to biopsy it. It came back as high grade something or other. And that I would have to have a LEEP done. Is there a difference between the high grade and CIN I,II,or II? Does this mean I have severe dysplasia? I know..probably stupid questions. I'm having the LEEP done today and I'm scared! Never had something like this done. Thanks in advance!

Hello, i myself have been dealing with all of this since january of this year. If they said you have high grade it probably is "CIN II or III" I was told by my doctor that moderate dysplasia is CIN II and severe dysplasia is CIN III or carcinoma in situ.. which is what I was most recently diagnosed with BEFORE this 2nd Leep that I had on Friday....so now i'm waiting to see what has happened in the 3 month "waiting" period. hoping for better results!!!
And these are not stupid questions :) It's all so confusing! But this forum seems to be very helpful and caring... Please let us all know how you make out today.
~Namaste~

Thank you! It IS all confusing. And the nurse that called me to set up the LEEP didn't really explain anything. The only thing I really remember is her saying "high grade" and that it NEEDS to be taken care of. She probably told me CIN somewhere along the line, but went so fast. My Dr. I'm sure will explain everything in detail today. I really like my Dr. but I thought I was only supposed to see him yearly. LOL I will let you know how it goes today. :-)

Sorry to hear about your troubles too. It sucks being a woman sometimes. My boyfriend just doesn't understand either. He's driving me nuts especially about the no sex part. Good luck, hope you get better results!

Hi Shellbel,

I was told I had an abnormal pap in April and was told very little to nothing about what it all meant. I was so worried and totally preoccupied by it all. The colo biopsy showed CNIII or high grade leison. Finally I met with a dr who explained everything. She is great. This board is great too--so ask away if you have any questions. I had a Fischer Cone Biopsy last week and just had my follow up appt which was all positive--clear margins, no spreading, and healing well. It is amazing how this can all weigh on you, but find comfort knowing that you are not alone.

hiya,

i am classed as high grade. my pap had suggested i was cinIII, buta recent leep showed cinII, however the doctors still class this as high grade here in the uk.

Hi there. Many (((HUGS))). I wish there was a way for us to communicate with the medical professionals to tell them about beside manners and providing us with more information. Sometimes I feel that there is collusion between the doctors to recommend LEEPs with no other information.

I just got back from my appt today. I have "high grade" dysplasia which is CIN II - III. That was all the explanation I got. He even said that he doesn't know why they talk about it in stages b/c it's all the same - either you have Low, or you have High. GREAT!! Now there is more conflicting news!

Well, I had the procedure, and it was not bad as I figured it would be. He didn't have to take alot out, so I have very little restrictions. No sex, or tampons for a week until I have my follow up. Other than that, he said I can do what I normally do. I will take it easy though. He did explain that I had CIN II but only one high grade lesion.

I just feel some bloating and occasional cramp, but other than that, I'm fine. Should I expect anything in the next week?

Thanks for all your info. :-)

He even said that he doesn't know why they talk about it in stages b/c it's all the same - either you have Low, or you have High. GREAT!! Now there is more conflicting news!

You know, I have wondered about this and it hasn't been clear to me either. Does it progress? Do different types of HPV cause different types of dysplasia (I believe people can have more than one type)? I have understood my situation to be that I have a high risk HPV strain which causes CNIII, which has a higher risk of turning into cancer than other types of HPV and dysplasia. But did I start with CNI? If it reoccurs will it always be CNIII?

Shellbel,

Glad the procedure wasn't too bad. Good luck with the healing and take it easy--be good to yourself!

You know, I have wondered about this and it hasn't been clear to me either. Does it progress? Do different types of HPV cause different types of dysplasia (I believe people can have more than one type)? I have understood my situation to be that I have a high risk HPV strain which causes CNIII, which has a higher risk of turning into cancer than other types of HPV and dysplasia. But did I start with CNI? If it reoccurs will it always be CNIII?
I have wondered this too Marie... if you find out the answer to that let me know! I think that's one i'm going to remember to ask the doctor when I go back for my 2 week checkup...

Hey guys!

In the states CIN I is classified as mild dysplasia, CIN II is moderate & CIN III is considered severe & can also be referred to as carcinoma in situ. They use high grade vs low grade as an additional way of classifying CIN. Low grade means less likely to progress to cancer & high grade means more likely to progress to cancer. Whether or not it continues to progress in severity largely depends on persistent infection with HPV. Since HPV varies drastically from person to person, and can go dormant or become active spontaneously within the same individual, noone can really say for certain or predict anyones outcome. All we can do is stay on top of our paps & be extra diligent if we are known to be infected with a high risk HPV strain. It is possible to be infected with more than one strain, and only certain strains have been linked to severe dysplasia.

Hope this helps at least a little bit....

Hi girls,

Regarding the advancement of dysplasia and HPV strain, I don't think that your cervix goes from normal/healthy to CIN III overnight. Even if you develop severe dysplasia rather quickly, it will have to go through the first two stages (mild then moderate) of dysplasia. I'm no scientist or doctor by any means, but the abnormal cells have to go through a series of changes before they reach the CIN III level.

The rate of dysplasia progressing depends on a myriad of factors, like Cyn said. Some HPV strains are more aggressive than others, causing dysplasia to progress more quickly than others. On top of that, each woman is different and her immune response to the infection will be different than another woman. So an older, more immune-compromised, smoking female with HPV 16 will probably developd dysplasia more quickly than a younger woman, non-smoker, with a strong immune system. Of course, even healthy young women develop severe dysplasia, so it's not always a cut-and-dry situation. I'm very healthy and rarely get sick but I developed CIN I-II after having HPV for 3 years. One of my good friends is VERY healthy, athletic, vegetarian, etc etc BUT she developed dysplasia too. If she's the picture of health, how did this happen?? I also have friends who are chain-smokers and are very sexually promiscuous, but have had no cervical problems whatsoever.

So sometimes when I think of it that way, HPV/dysplasia makes no sense to me. But then I also realize that most women I know who have HPV and dysplasia ALSO were involved in several long-term relationships where condoms were not used for long periods of time. Could this be the reason?

Sorry for the rant, but it just got me thinking that doctors should REALLY caution women who are about to start the pill, about HPV. I never heard of the virus until last year after having had abnormal paps for 3 years. I truly wish my doctor warned me about HPV before prescribing me with the birth control pill. Had I known, I don't think I would ever have stopped using condoms with my boyfriend. I know that condoms don't fully protect you against HPV, but I'm positive it does protect you to some degree and that a lot of us women on these boards probably got HPV when having sex without condoms.

Anyway, those are my thought! This is a interesting discussion though. I hope all you post-LEEP ladies are healing well and taking care of yourselves! Go enjoy the nice summer days. :)

With all due respect, CIN III lesion can develop without beginning as CIN I. In fact, one of the biggest misconceptions is that of progression. In fact most CIN 1 lesions are much different than CIN II and III. Not just in terms of the depth of the epithelium in which they presnt, but in the nuclear activity within the cell. CIN II/III are classified together for this reason. They usually do not begin as CIN I. While CIN I can progress, it the exception rather than the norm. What usually occurs is that a CIN II or III lesion existed before, but only the CIN I was found on biopsy.

Piperpilot,

So how come all the doctors tell us that dysplasia progresses? I think every doctor, nurse, specialist, etc, has talked about dysplasia in terms of progression and/or regression. The exact manner in which dysplasia and HPV work are quite mysterious to me (and a lot of us here), but I don't understand how it's a misconception when the medical professionals themselves are talking about dysplasia either progressing, regressing, or staying the same. I suppose I'm just trying to make sense of this all, especially since my diagnosis bridges low grade and high grade dysplasia (CIN I-II). If CIN I and CIN II are so markedly distinct, how come the pathologist couldn't determine from my one biopsy specimen whether I had CIN I or CIN II? I wish I could make more sense of it all!

LAGirl,

I believe that in our litigious society, and in keeping with the hypocratic oath to do no harm, the clinical side of medicine (doctors, nurses, etc) is much more inclined to play it safe. If you read the research journals you will see a much different tone regarding CIN 1, compared to CIN 2/3. Cin 1 is usually a heterogenous type lesion, meaning that it USUALLY shows a combination of more than one HPV genotype (many times of non-oncogenic strains) (if it were to be genotyped which is rarely done), CIN 2/3, or high-grade lesions are generally present as a result of a single high-risk HPV genotype, although they can present as also as heterogeneous lesions. A homogeneous lesion generally has more capacity to replicate for several reasons. The other main consideration is the moderately subjective nature of cytology and histology. Often times, cell samples and tissue samples are read differently depending upon the individual reading them, in addition to the gyn or clinician missing the worst part of the dysplasia when they take biospy. Additionally, so much is still not known about the morphology of dysplasia. There are many lifestyle factors that ultimately determine whether a specific patients immune system is capeable of staving off the dysplasia. So, taken in total, this suggests that the medical community and the general population are better served by propagating the idea that "all dysplasia is precancerous and is a progressive disease". If that statement were true, the FACT that most cases of dysplasia resolve or regress on their own, which I'm sure you have read time after time, would not be true, and statistically it is true.
It is not my contention that dysplasia cannot or does not progress. It can and it does, but the variables in determining who's lesions progress and who's do not may be more controllable by diet, excercise, hormone balance, etc. (a.k.a, naturolistic factors). As far as a diagnosis of CIN I-II, I would want to know more: is this more than one lesion? Have your PAPS also indicated I and II? Since the primary definition here deals with depth of dysplasia in the epithelium, (lower 1/3-mild, up to 2/3-moderate and full depth-severe) you may have cells right at the 1/3 depth, or maybe just less than 2/3--so how does the histologist call that biopsy? Probably CIN I-2.

LAGirl,
A homogeneous lesion generally has more capacity to replicate for several reasons.
The other reason is the subjective nature of cytology and histology. Often times, cell samples and tissue samples are read differently depending upon the individual reading them, in addition to the gyn or clinician missing the worst part of the dysplasia when they take biospy.

Additionally, so much is still not known about the morphology of dysplasia. There are many lifestyle factors that ultimately determine whether a specific patients immune system is capeable of staving off the dysplasia. .

I didn't know these much details on the different nature of the cells CIN I and those CIN II/III, but have heard/read that they are treated differently. That would actually explain the presence of CINII/III before any CIN I was ever detected.

I am still surprised with the over-agreesive approach that doctors take on this matter. It might be fear of error or fear of being sued, but to think of how slowly usually (statistically) the dysplasia progresses and the agressive approach the doctor take, it is like they're considering that you will have cancer within the next 3 weeks if you dont follow their advices.

I completely agree that ALL doctors are highly subjective when it comes to deciding treatment. Lifestyle is something that is highly considered whn deciding so. Especially, the ability to follow up properly on dysplasia.

Hi piperpilot,

Wow that's very informative, thank you for sharing that knowledge with us! Regarding my particular case, my CIN I-II diagnosis this past May is in regards to only one cervical biopsy, so that's why I was confused as to how come it bridged low to high grade lesion, if it's only one spot. I have high risk HPV and have been having ONLY ASCUS paps for the past 3 years and the past 2 biopsies during those years were benign. My paps never came back LSIL or HSIL, but merely ASCUS. That's why I was a bit shocked when my last biopsy came back showing dysplasia. I'm not sure if I had a new high risk strain from when I tested positive last year or the same strain FINALLY morphed into a dysplastic change. Ugh I wish I studied science now to understand how this works better!

Either way, I agree 100% with Furtiva. But then again, we are like-minded in that we're both pursuing naturopathic health regimens before going the LEEP-route.

And Furtiva, the over-aggressive protocol the docs use now is so frustrating! When I got my biopsy results in May, my primary doc gave me a referral to see a gyno -- she said it'd take a few months to schedule a referral appointment. In my freaked out mind (this was before I knew how dysplasia worked), I asked her if that was too long to wait. She reassured me that waiting a few months wouldn't be dangerous regarding my condition because dysplasia is SO slow to progress, if it does at all! So I felt reassured.

So when I finally see the gyno (still a physician resident at my University which equals limited experience...the doctor was not much older than me!), she tells me that we're going to treat my CIN II (not CIN I-II, but JUST CIN II) with a LEEP. I told her I'd only gone in to see her for a CONSULT, not treatment, but she PUSHED and PUSHED that day for me to get a LEEP, saying it's better not to wait a few months but rather I should do it that very day.

I stood my ground and said no, I'd like a second opinion. She confidently told me that the other docs would agree with her treatment recommendation and you know what? All the other docs gave different recommendations!

At first I was scared and thought, "Oh my god. The dysplasia is growing and if I wait to get this LEEP I will have cancer in 3 months!!!" But I soon realized her scare tactics were really to cover her, and the university's, ***. This was confirmed when the university gyno clinic called me 2 days later and asked when I was getting a LEEP done. I said I was not getting one done as of yet. The nurse on the phone asked me to verbally repeat to her that this was *my* choice to refuse treatment despite my doctor's recommendation that I get a LEEP done.

I knew then and there that this was ALL about avoiding malpractice suits and they didn't care a lick about my health. It's really sad! And my boyfriend is a physician's assistant so he knows first-hand that this is all cover your a** medicine since people sue left and right for everything in the US-- it's quite aggravating!

Anyway sorry to vent-- but this is why I am reluctant to blindly adhere to my doc's treatment plan and believe boosting our immune systems is the only way to get to the root of this problem: HPV.

Hey girl! I totally understand what you are going thru. I am waiting on my biopy results and then going to make a decision based on that.