As part of the dysplasia consultation, cytological and HPV smears are taken if indicated in order to rule out an infection with human papillomaviruses or to identify the high-risk types in the event of an infection.

An HPV vaccination against currently 9 HPV types (low and high risk) can reduce the lifetime risk of condyloma acuminata and HPV-induced carcinomas in men and women, so that this vaccination is recommended by the STIKO (Standing Committee on Vaccination) for boys and girls (from the age of 9) before their first sexual contact. The costs are covered by statutory health insurance up to the age of 17.

Colposcopy (magnifying examination) is a gynecological examination procedure in which the gynecologist examines the cervix or vulva with a magnifying lens (7.5 to 30x), the colposcope. Colposcopy plays an important role in the early detection of cancer, e.g. cervical carcinoma. Colposcopy is an integral part of the assessment of dysplasia and the basis for determining further treatment.

During a colposcopy, defects in the superficial epithelium of the cervix, inflammation of the cervix (cervicitis), cervical polyps, bleeding and cervical tears or cervical anomalies can be detected. In the case of findings that are not clearly harmless, a smear cytology or a tissue sample is usually taken. Tissue samples taken from the cervix are not painful, but an anaesthetic is applied to the external genitalia beforehand.

The colposcope is also used as a surgical microscope - e.g. for laser operations. For important documentation, photos and video films can be taken via the colposcope, which is very important for follow-up examinations and discussions.

• Vinegar test diagnostics - the classic procedure

In order to diagnose a dysplastic cell change or to make a clinical assessment with regard to grading, a 3 - 5% vinegar solution and, if necessary, an iodide solution are also used. Due to altered metabolic processes in the dysplastic cells, the use of the above-mentioned solutions results in special changes that can be visualized and assessed under colposcopic view.

• Fluorescence diagnostics with ALA derivatives, spectroscopy - a modern procedure

Fluorescence diagnostics is a modern diagnostic procedure that utilizes the emission of light signals from tissues. This fluorescence can be caused, for example, by the application of exogenous 5-aminolevulinic acid (5-ALA), which is metabolized intracellularly to the photosensitizer protoporphyrin IX, which then emits a fluorescent signal after excitation by light of a suitable wavelength. Dysplastic tissue has a higher concentration than normal tissue, so that the conspicuous areas are marked by the reddish porphyrin fluorescence.
In gynecology, fluorescence diagnostic methods are being researched and used primarily in the areas of cervical dysplasia, ovarian cancer and endometriosis.

• Sampling - Appropriate samples can be taken for further diagnosis and histological classification of the severity.

Sampling in the cervical area is hardly or not at all painful, so that no anesthesia is necessary. The same applies to tissue samples taken from the vagina. If a sample is taken from the vulva, a local anesthetic is administered beforehand.

ALL SAMPLES ARE TAKEN IN CONSULTATION WITH AND WITH THE CONSENT OF THE PATIENT.

Depending on the histological and cytological findings, in conjunction with the patient's HPV status, we recommend follow-up checks in our dysplasia consultation hour or further care by the resident gynecologist.

If surgical treatment is necessary, patients will be informed of this by the physician in charge and the procedure will be discussed in advance. As a rule, these are outpatient procedures.

Cervical cancer develops slowly, over a period of years. In most cases, this is caused by chronic infections with papilloma viruses. Mild tissue changes (CIN 1) can develop into moderate (CIN 2) to severe tissue changes (CIN 3/CIS) in the long term. In the case of mild and moderate changes, it may be possible to wait until spontaneous healing occurs. However, this is increasingly rare with more severe changes.

Changes classified as CIN 3 in particular are more likely to develop into precancerous lesions. If malignantly altered cells have already penetrated into the deep tissue layers, this is cervical cancer.

Treatment of precancerous lesions

In our dysplasia unit, we have modern procedures at our disposal for the treatment of precancerous stages in order to treat the tissue as gently as possible, e.g. sclerosing the diseased tissue with a laser(CO2 laser) or excision with an electric snare(loop conization, so-called LEEP). Both can be performed under general or local anesthesia. These are usually outpatient procedures.

CIN

• Loop conization
• CO2 laser

VAIN / VIN

• CO2 laser
• excision
• (Skinning) vulvectomy
• Partial / total colpectomy (with reconstructive surgery, Davidoff sheath, etc.)
• Imiquimod, a drug from the group of antivirals, which is used to treat genital warts(condylomata acuminata), among other things. Imiquimod is marketed worldwide under the trade name Aldara®.

As a rule, close follow-up care is recommended initially to monitor minor changes, but also after treatment of cell changes in the genitals. We are happy to carry out this follow-up examination in consultation with your gynecologist.