Signs and Symptoms
Cervical dysplasia does not have any specific signs or symptoms, though it can cause abnormal bleeding, spotting, or watery vaginal discharge. Menstrual bleeding can be abnormally heavy, and unusual bleeding may occur at other times, typically after intercourse. Advanced cervical cancer may cause pelvic pain, difficulty with urination, and leg swelling. Cervical cancer may spread to nearby organs or circulatory vessels, affecting their function (ACOG 2014; Zanotti 2014).
HPV Vaccination – Prevention of Cervical Dysplasia and Cervical Cancer
HPV vaccination confers a high degree of protection against cervical dysplasia and cervical cancer, and is a leading method of prevention. Males and females up to age 26 can be protected by receiving an HPV vaccination, and girls and boys as young as nine years of age are eligible for these vaccines (Xu 2005; Ferris 2014). Three HPV vaccines are approved by the US Food and Drug Administration (FDA): Cervarix, Gardasil, and Gardasil 9. The vaccinations are given in three injections over the course of six months (CDC 2011; Gardasil 2014a; Gardasil 2014b).
Cervarix protects against HPV types 16 and 18, which cause about 70% of cervical cancers (Goldie 2008; Cervarix 2012). Gardasil, known as Silgard in Europe, prevents infection from four HPV types: HPV 16 and 18, as well as HPV 6 and 11, which cause about 75% of cases of cervical cancer (Gardasil 2014c; McCormack 2014). In late 2014, the FDA approved Gardasil 9, which protects against nine HPV types: 6, 11, 16, 18, 31, 33, 45, 52, and 58. The five additional HPV types against which Gardasil 9 offers protection—31, 33, 45, 52, and 58—are not prevented by previously approved HPV vaccines. Gardasil 9 will protect against roughly 90% of cervical cancer cases (Simon 2015; FDA 2014; Joura 2015). HPV vaccination can also offer protection against anal, oropharyngeal, vulvar, vaginal, and penile cancers (NCI 2011b).
The vaccines work best when given before there is any contact with the HPV types against which they are meant to protect. Nevertheless, vaccination has been reported to be effective among women who are already sexually active. In 235 young women who were almost all (97%) sexually active before either receiving the complete set of HPV vaccinations, or being partially vaccinated, cervical cellular abnormalities were 65% less frequent in women who had received at least one HPV vaccination (Brogly 2014).
Some parents may be opposed to HPV vaccination for their children because they feel the vaccine would encourage risky sexual behavior (Soper 2006; Perkins 2010). However, a survey of 1243 females aged 15–24 years found that vaccination did not increase the likelihood of risky sexual behavior, and, in fact, vaccinated individuals were more likely to use condoms (Liddon 2012).