Cervical Cytological Changes Associated with Prolonged Sexual Exposure due to Early Marriage in Rural India

Abstract

Introduction: There is likelihood of development of premalignant changes in the cervix in the teenagers due to early sexual activity. This assumes importance under rural conditions in India where majority of marriage of girls are performed at young age below 20 years. Aim: The present cytological study was carried out in the three cohorts of rural girls- adolescents (16-20 years), young adult girls (21-25 years) and adult women (26-30 years) to see the effect of early increasing sexual exposure. Materials and Methods: The study cases were derived from the cervical cancer screening which is in progress in the rural population of Lucknow, Uttar Pradesh, India. Of the 1185 study cases, 97 were adolescents, 338 young adult girls and remaining 750 were adult women. Results: The Atypical Squamous Cell Changes of Unknown Significance (ASCUS) were found higher in the adolescents than in young adult girls and adult women while Squamous Intraepithelial Lesions of cervix (SIL) rate was almost equal in the three cohorts. Follow-up revealed progression of ASCUS to Low grade SIL (LSIL) almost equal in the three groups while the persistence of SIL was higher in the young adult girls and adult women. The gynaecological symptoms especially vaginal discharge was more common in the last two groups than in adolescents but the SIL rate was higher with all symptoms in the adolescents. The cervical lesions were more common in the young girls and adult women and SIL rate was higher with different cervical lesions. The majority of adolescents were nulliparous with high SIL rate while in the young adult girls and adult women, the SIL incidence showed rising trend with increasing parity. Conclusion: The study highlights the importance of cytological screening of all the rural young girls and adult women specially who reveal cervical lesions or are symptomatic. This will yield large number of pre-cancerous cases, timely treatment of which will check the progression of SIL to malignancy

Keywords

• adult women
• cytological screening
• rural adolescents
• teenagers