Women with CIN 2 or CIN 3 should undergo a diagnostic excisional procedure, usually in an office setting. If there is any evidence that the cervical dysplasia extends into the cervical canal, cryotherapy is generally not recommended. Although excisional procedures are relatively simple procedures for providers with proper training, patients often feel significant anxiety over a diagnosis of CIN and the procedure used to treat the condition.
59
The general public lacks basic knowledge about HPV,
60,62 which may contribute to the anxiety women feel when they test positive for HPV or have abnormal cytology.
63,65 In their study of women in the United Kingdom, Maissi et al
63 assessed the state of anxiety, distress, and concern and quality of life 6 months after HPV testing in women with mildly abnormal Pap screening tests. They compared these women with a group with normal Pap test results and a group with abnormal Pap test results who did not undergo HPV testing.
63 They found that at 6 months, levels of concern remained high in all women who had an abnormal Pap test result and were highest among the women not tested for HPV. Some predictors of concern across all women with an abnormal Pap test result were fear of the development of cancer, being HPV positive, or not knowing their HPV status (ie, not tested).
63 Also in this study, the authors found that women who were either HPV positive or not tested for HPV perceived their risks of the development of cervical cancer as significantly higher than women with normal Pap test results and women who tested negative for HPV. Thus, appropriate counseling messages for women are needed, particularly as HPV testing becomes more widely marketed and available.