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Sarah, a 33-year-old woman who postponed pregnancy in her 20s has now been trying to get pregnant for several years. Her husband had a son during a prior marriage. She presents to her gynaecologist for work-up of her infertility. Relevant history includes menarche at age 12; four lifetime sexual partners; cyclic menses regularly every 30 days; no birth control for 2 years; no pelvic examination in 5 years. Sarah reports no intravenous drug use.
Vaginal examination findings include a friable, vascular lesion on the anterior uterine cervix, a cervical smear diagnosis of high-grade squamous intraepithelial lesion, a human papillomavirus (HPV) assay positive for high-risk HPV serotypes, and a cervical biopsy diagnosis of severe dysplasia (CIN III).
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