Low-Grade Squamous Intraepithelial Lesion (LSIL)

Definition - What does Low-Grade Squamous Intraepithelial Lesion (LSIL) mean?

Low-grade squamous intraepithelial lesion or LSIL is a term used to describe a condition in which the cells of the cervix are slightly abnormal, as detected by a Pap test. Squamous cells are flat cells lining the cervix. LSIL is caused by a virus, called human papillomavirus (HPV), which is transmitted through sexual contact. LSIL is not a cancerous condition and usually goes away spontaneously, on its own. However, in about 19% of cases, LSIL can transform to a high-grade squamous intraepithelial lesion (HSIL), which can likely progress to cervical cancer, if not addressed at the right time. When detected on a cervical biopsy, LSIL is called a cervical intraepithelial neoplasia 1 (CIN 1). Although LSIL by itself does not affect fertility, the modes of treatment used for LSIL that progresses to high-grade disease may cause difficulty conceiving.

FertilitySmarts explains Low-Grade Squamous Intraepithelial Lesion (LSIL)

Factors that put a woman at significant risk of acquiring LSIL include:

  • Infection with high-risk HPV types like 16, 18, 31, or 33
  • Lack of sufficient protection, such as use of condoms
  • Lacking adequate immunity or having a poor diet
  • Conceiving before the age of 17 years

LSIL usually does not cause any symptoms and is discovered by a routine Pap smear.

After a Pap test shows LSIL, further evaluation depends upon age and the results of HPV test as follows:

1. In women aged 25 years or older:

  • Colposcopy is done if the HPV test is positive.
  • If HPV testing is negative, a Pap test and HPV test are repeated in about a year

2. In females aged 21 to 24, HPV testing is not routinely done, and another Pap test is done in about a year.

Some physicians may treat LSIL by a “watch and wait” approach. Others prefer a more aggressive approach by performing a detailed examination of the cervix, called colposcopy along with a biopsy. If the abnormality progresses, the doctor may employ procedures, such as loop electrosurgical excisional procedure (LEEP), cryosurgery, cone biopsy, or laser ablation to remove the abnormal cervical cells. These procedures tend to decrease the number of cervical glands that produce mucus. Since the cervical mucus facilitates the transit of sperm up into the genital tract, the ablative procedures on the cervix can interfere with the normal reproductive process. Moreover, these procedures can distort the structure of the cervix, which also serves as a barrier to reproduction.

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