Objective: To determine the factors associated with the increased risk of developing high-grade squamousintraepithelial lesions (HSIL) of the uterine cervix in women younger than 30 years compared with those aged ≥ 30years who also had HSIL. Methods: Patients with HSIL who underwent loop electrosurgical excision procedure (LEEP)between January 2006 and July 2017 at Chiang Mai University Hospital were retrospectively reviewed. We analyzedthe factors associated with the development of HSIL by comparing two age groups between women aged < 30 yearsand those aged ≥ 30 years. The factors analyzed included the well-recognized risk factors for cervical cancer, i.e. ageat sexual debut, number of sexual partners, use of oral contraceptive (OC) pills, smoking history, sexually transmitteddiseases and HIV status. Univariate and multivariate logistic regressions were used to assess factors associated withthe increased risk of developing HSIL in women younger than 30 years compared with those aged ≥ 30 years. Results:During the study period, there were 345 patients with HSIL, 30 were < 30 years (case group) and 315 aged ≥ 30 years(control group). By multivariate analyses , early sexual debut(OR, 2.86; 95% CI, 1.01-8.13; P=0.047), multiple sexualpartners (OR, 2.94; 95% CI, 1.23-7.02; P=0.015), history of genital warts (OR, 20.46; 95% CI, 2.27-183.72; P=0.007)and history of smoking (OR, 2.95; 95% CI, 1.10-7.93; P=0.032) were significantly associated with the developmentof HSIL in women younger than 30 years when compared with those aged ≥ 30 years. The OC use, HIV status andunderlying diseases were not significantly different in both groups. Conclusion: Early age at sexual debut, multiplesexual partners, history of genital warts and smoking are significant risk factors for developing HSIL in women youngerthan 30 years. Cervical cancer screening should be considered in young women with such factors.

Background: Adenocarcinoma in situ (AIS) of the uterine cervix is a preinvasive lesion of the invasiveadenocarcinoma. We analyzed the cervical screening results leading to detecting the AIS lesions including the coexistenceof AIS lesions with high-grade squamous intra-epithelial lesions (HSIL) and invasive carcinoma. Methods:Women who were diagnosed and received treatment for AIS at Chiang Mai University Hospital between January 1,2007 and August 31, 2016 were retrospectively reviewed. The inclusion criteria were the women who had pathologicaldiagnosis of AIS obtained from cervical punch biopsy or excisional cone biopsy with either loop electrosurgical excisionprocedure (LEEP) or cold-knife conization (CKC). The patient characteristics, diagnostic work-up and treatment detailswere reviewed, including the cervical screening results prior to the diagnosis of cervical AIS, pathologic results ofexcisional cone biopsy and hysterectomy specimens. Results: During the study period, 75 women with AIS pathologyundergoing excisional cone biopsy with either LEEP (n=62) or CKC (n=13) were identified. The abnormal cytologicscreening leading to detection of AIS was the squamous cell abnormality accounting for 57.3%. Abnormal glandularcytology accounted for 37.3%. The most common abnormal cervical screening results was HSIL cytology (n = 25)followed by AIS cytology (n = 13). Normal cytology was noted in 4 women in whom 3 were positive for HPV 18and 1 had AIS on the endocervical polyp. AIS coexisted with HSIL and invasive carcinoma were detected in conebiopsy specimens in 21 (28%) and 29 (38.7%) patients, respectively. Conclusion: The majority of cervical screeningresults leading to detection of cervical AIS was the squamous cell abnormality accounting for 57.3% in which, HSILcytology was the most common. Abnormal glandular cytology accounted for only 37.3%. Diagnostic cone excision isrecommended if AIS lesion is noted in cervical biopsy specimen since nearly 40% have coexisting invasive lesions.

Background and Objective: To investigate the efficacy of listening to music on pain reduction during colposcopy-directed cervical biopsy (CDB). Materials and Methods: From June 2020 to November 2021, 240 women undergoing CDB were enrolled. The participants were randomized into three groups: Group 1, colposcopic examination while wearing headphones and listening to music; Group 2, colposcopy while wearing headphones but not listening to music; Group 3 (control group), colposcopy while neither listening to music nor wearing headphones. All participating women completed a 10 cm visual analog scale for subjective pain at three time points: baseline, immediately after cervical biopsy, and 15 min after the procedure. The primary endpoint was the biopsy pain score. Result: Of the 240 women, a sample size of 80 was randomly assigned per group. The clinical–pathological and procedure-related characteristics of the participants in all groups were similar. The mean baseline pain score between each group was not significantly different (2.83 in the music group, 2.54 in group 2, and 2.94 in the control group, p = 0.47). There were no significant differences between each group in terms of mean biopsy pain score (4.21 in the music group, 4.24 in group 2, and 4.30 in the control group, p = 0.98). The differences in changes between the baseline pain score and the biopsy pain score were not statistically significant (1.39 in the music group, 1.70 in group 2, and 1.36 in the control group, p = 0.69). In the multiple comparison analysis, the differences in changes between the biopsy pain score and the baseline pain score between each group were also not statistically significant. There were no complications with the intervention observed. Conclusion: This study demonstrated that there was no beneficial effect of listening to music on pain reduction during colposcopy-directed cervical biopsies.

Objectives: The objective of this study was to evaluate the efficacy of lidocaine spray in reducing the pain during colposcopy-directed cervical biopsy (CDB). Methods: From December 2017 to February 2019, 312 women undergoing CDBs were enrolled. The participants were randomized to three groups: group 1 (lidocaine spray), in which lidocaine spray was applied thoroughly to the cervix; group 2 (placebo), in which normal saline was applied thoroughly to the cervix; and group 3 (control), in which no anesthetic agent was applied to the cervix. Each woman completed a 10 cm visual analog scale to classify the subjective pain experience at three time points: baseline, immediately after biopsy, and 10 min after the procedure. The primary outcome of this study was the biopsy pain score. Results: The 312 enrolled women were randomly assigned to the three groups, amounting to 104 women per group. The clinical and pathological characteristics of the participants in all groups were comparable. The baseline, the biopsy, and the post-procedure pain scores were comparable among the three groups. There was a significant increase in the pain score from baseline to biopsy and from baseline to post-procedure in each group. The pain-score changes from baseline to biopsy in the lidocaine spray group significantly decreased when compared with the normal saline group (<0.001), and tended to decrease, though not significantly (p = 0.06), when compared with the control group. No complication with the intervention was observed. Conclusions: The application of lidocaine spray to the cervix has the benefit of reducing the pain associated with CDBs by a small amount. However, the intervention is safe and may be considered in nulliparous and/or overly anxious women undergoing the procedure.