Treatment Options and Outlook
Standard treatment for CIN is removal of the
abnormal cells with follow-up pelvic exam, Pap
test, and other pathologic tests. The procedures for
removal include
- LEEP, an office procedure in which the gyneco-
logic surgeon inserts a wire loop through the
VAGINAto the cervix and removes slices of tissue
by sending a mild electrical current through the
wire loop; LEEP is the standard treatment for
CIN2 and some CIN3 - conization, also called excisional conization or
cone biopsy, in which the gynecologic surgeon
removes larger areas of tissue with instruments
inserted through the vagina; the woman usu-
ally undergoes general ANESTHESIA, and the pro-
cedure is performed in an operating room
These treatments usually cure the CIN, though
doctors recommend regular follow-up Pap tests,
colposcopy, and other laboratory tests for up to
five years after the initial treatment.
Risk Factors and Preventive Measures
The strongest risk for CIN is INFECTIONwith HUMAN
PAPILLOMAVIRUS (HPV). CIN is more common in
women who smoke and in women who have
HIV/AIDS. A Pap test can detect CIN in its early, eas-
ily treatable stages. Preventive measures include
safer sex methods (such as abstinence, condom
use, or mutually monogamous sexual relation-
ships) to prevent HPV infection. In 2006 the first
vaccine to prevent HPV infection in women
became available. The vaccine protects against
infection with HPV types 6, 11, 16, and 18, the
types associated with genital warts and cervical
cancer. Health experts recommend HPV vaccina-
tion for girls beginning at age 12, though women
to age 26 can receive the vaccine.
See also CANCER TREATMENT OPTIONS AND DECI-
SIONS; CELL STRUCTURE AND FUNCTION; SURGERY BENEFIT
AND RISK ASSESSMENT.
cervix The neck of the UTERUS, a thick cuff of
muscular tissue about one inch in length that
joins the VAGINAto the uterus. A narrow channel
through the cervix, the cervical canal, allows
menstrual material to leave and SPERMto enter the
uterus. The opening of the cervix within the
uterus is the internal os; the opening of the cervix
within the vagina is the external os. The cervix
has the ability to thin and dilate to permit CHILD-
BIRTH.HEALTH CONDITIONS THAT MAY AFFECT THE CERVIX
CERVICAL CANCER cervical DYSPLASIA
cervical erosion CERVICAL INTRAEPITHELIAL
cervical polyps NEOPLASIA(CIN)
CHLAMYDIA INFECTION GONORRHEA
HUMAN PAPILLOMAVIRUS(HPV) incompetent cervix during
infection PREGNANCY
traumaFor further discussion of the cervix within the
context of the structures and functions of repro-
duction and sexuality, please see the overview sec-
tion “The Reproductive System.”
See also COLPOSCOPY; DILATION AND CURETTAGE
(D&C); FALLOPIAN TUBES; GENITAL TRAUMA; HYSTEREC-
TOMY; OVARIES; PAP TEST; PELVIC EXAMINATION.cesarean section Surgical CHILDBIRTH. In
cesarean (spelled caesarean in countries other
than the United States) section, the obstetrician
makes an incision through the abdominal wall
and the wall of the UTERUSto extract the FETUS.
Doctors in the United States perform cesarean sec-
tion, also called c-section, to deliver 90 percent of
breech presentations (fetus is bottom down rather
than head down in the uterus) and about 25 per-
cent of pregnancies overall. Most cesarean sections
are unplanned though nonemergency, performed
because of the mother’s health status, the size of
the baby, or the failure of labor to progress. Emer-
gency cesarean section may be necessary when
the fetus is in distress.
Though some women feel disappointed or even
dismayed to need cesarean delivery, the outcome
of healthy baby and healthy mother is the over-
arching objective. A woman who feels rushed into
surgical delivery should discuss alternatives with
her obstetrician. Ideally the woman and the obste-
trician have had discussions during the course of
PRENATAL CARE about the circumstances under
which the obstetrician may recommend cesarean
section and are in agreement about them.cesarean section 259