HSIL stands for high grade cervical squamous intraepithelial lesion.  When a doctor says your test shows HSIL, she means that the cells are not normal-looking.  Instead of stacking nice and neat like a stone wall, they are sloppy and disordered under the microscope.  When they see that, it indicates that something is disturbing the tissue, and it may not be cancer.  It could be severe inflammation due to a sexually-transmitted disease other than HPV or something like that.

But we know that 20% of HSIL will progress to cancer.  How do you know if you might be one of those 20%?

You don't, so all women with this Pap smear result have to get examined by colposcopy and have some biopsies.  

Treatment for HSIL

I have to laugh whenever I read that the biopsies cause "minor discomfort."  Seriously, a man must have written that. I will tell you that I find them painful, but that doesn't stop me from going to the gynecologist. The biopsies are really quick, a very sharp pinch on your cervix that is milliseconds.  I think the anticipation is worse than the actual biopsy, like when you get a shot of novocaine at the dentist.  Yes, it hurts, but it doesn't hurt very long.  But then again, I've known people who refuse to go to the dentist also.  Really, folks, fear of pain is not a good reason!  I just sweat my way through it, knowing that it is a necessary thing to prevent something worse, like metastatic cancer and death.  

If the biopsy shows the same thing, then your doctor will probably recommend a LEEP to remove the tissue.  Sometimes they'll recommend a cone biopsy--either way, the goal is to remove the abnormal tissue before it gets worse and goes deeper.  Waiting is usually not recommended at this point.

Because that's how serious this can become if you don't get it checked out. There is no reason for a woman to die from cervical cancer because early screening is available.

In this case, it doesn't matter if your Pap test also shows HPV or not--HSIL alone is potentially serious enough that it usually needs to be treated.  With any other Pap test result, many doctors would just recheck in a few months as long as HPV was negative since, as we know, the cervical tissue will revert to normal in many cases.  HSIL is more worrisome, though.  It's not cancer, but it's getting close in the eyes of most doctors.  The good news is that this is superficial and easy to remove.  For a lot of women, this is the end of treatment and future Pap tests are normal.