Precancerous Cervical Lesions (CIN)

What it is

Precancerous cervical lesions, known as cervical intraepithelial neoplasia (CIN), are changes in the cells of the cervix caused by persistent HPV infection. They are not cancer, but if left unmonitored, some can progress to it over the years. They are classified as CIN 1 (low grade, which most often regresses on its own), and CIN 2 and CIN 3 (high grade, which usually need treatment). They are typically discovered through an abnormal Pap smear result and confirmed by colposcopy with biopsy. Low-grade lesions are followed with repeat testing; high-grade lesions are treated with LEEP (loop electrosurgical excision procedure), which removes the affected area and allows the tissue to be analyzed, or with other methods, such as laser. After treatment, follow-up with Pap smears and HPV testing is essential, and HPV vaccination is recommended.

Most common symptoms

• No symptoms in the vast majority of cases
• Abnormal Pap smear result
• Positive HPV test for high-risk types
• Bleeding after intercourse, in some cases
• Persistent discharge with no other identified cause
• Abnormal areas identified on colposcopy

Causes and risk factors

• Persistent HPV infection, mainly types 16 and 18
• Intercourse without a condom and multiple partners
• Smoking
• Low immunity, including HIV infection
• Not having periodic Pap smears
• Not being vaccinated against HPV

How it is diagnosed

Precancerous lesions are usually suspected because of an abnormal Pap smear result or a positive HPV test. From there, your gynecologist recommends colposcopy, an office exam that examines the cervix under magnification using solutions that highlight abnormal areas. When suspicious findings are seen, a biopsy is taken at the same time and sent for analysis, determining whether the lesion is low grade (CIN 1) or high grade (CIN 2 and 3). This classification guides management.

How we treat it at Femi Saúde

Management depends on the grade of the lesion, the patient's age and her reproductive plans. Low-grade lesions (CIN 1) usually regress on their own and are followed with Pap smear, HPV testing and colposcopy at defined intervals. High-grade lesions (CIN 2 and 3) generally require treatment, and Femi Saúde's gynecology team performs the loop electrosurgical excision procedure, LEEP (CAF), which removes the affected area and allows the tissue to be analyzed; in selected cases, CO₂ laser may be an alternative. After treatment, follow-up with Pap smear and HPV testing continues, and vaccination is recommended. The plan is individualized.

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