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LSIL stands for low grade squamous intraepithelial lesion. It means there is mild dysplasia on your Pap smear, and that's not normal, but it's not necessarily cancer either. What happens next depends on a couple things.

One thing is your age. If you became sexually active in your 20s, and were exposed to HPV (which pretty much everybody is), then in your 30s, your Pap smear should be negative for HPV. The reason is that your body puts HPV into hibernation within 2 years in most people. If you are HPV positive, then the suspicion is that you have an older infection and there may be more going on than just dysplasia.

Another factor is how many abnormal Pap smears in a row you have had. If you had an abnormal Pap test a year ago, and the followup Pap smears since then have also been abnormal, it's time to dig a little deeper--literally. You need a colposcopy to see if something is going on.

The next step is a colposcopy and biopsy. A Pap smear is just a screening test for abnormalities, but a biopsy is an actual diagnostic test to see if there is more dysplasia or even cancer.

This was my scenario. My Pap smear showed LSIL or mild dysplasia plus HPV, and I was in my 30s. A biopsy showed moderate dysplasia, so I had to have a LEEP, which showed a microinvasive carcinoma.

Sometimes the LEEP shows only more dysplasia, but don't think that that means it was a waste of time. Moderate dysplasia can progress over time to cancer, so the tissue needs to be removed. And a LEEP or a cone biopsy is the only way to know for sure if you have cancer and not just dysplasia.

If you have only one Pap smear that shows LSIL, if it is also HPV-negative, waiting for a repeat Pap test is an option no matter how old you are. Most mild dysplasia becomes normal within a few months to a year, and there are many causes of dysplasia other than cancer. That's also true even if you're HPV-positive as long as you're under 30 years old.

But even a young woman who has repeat abnormal Pap smears should have a biopsy after a second or definitely after a third abnormal Pap test in a year.

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