a doctor discussing an abnormal pap smear

My Pap Smear Was Abnormal. Now What?

A Pap smear is a simple screening test for cervical cancer. The United States Preventative Services Task Force recommends all women between the ages of 21 and 65 undergo a Pap smear every three years. During a Pap smear, the gynecologist collects a sample of cells from the cervix by gently rubbing a brush over the cervix. The sample is sent to a laboratory and the cells are examined for abnormalities.

Understanding Your Abnormal Pap Smear

A positive, or abnormal, result on a Pap smear doesn't necessarily mean you have cervical cancer. The most common result is either a finding called "atypical squamous cells of uncertain significance" (ASCUS), or a low-grade squamous intraepithelial lesion (LSIL). If your Pap result indicates ASCUS, the next step is to perform a test for human papillomavirus (HPV) infection. Usually this test can be performed on the same sample that was submitted for the original Pap smear. Women with ASCUS who test negative for any high-risk types of HPV can simply return to their normal lives and resume normal Pap smear testing every three years. Women with LSIL, and women with ASCUS who are positive for high-risk types of HPV should return in 12 months for another Pap smear. 

The reasoning behind these recommendations is based on the fact that cervical cancer is caused by infection with high-risk types of HPV. If you aren't infected with a high-risk type of HPV, your chance of developing cervical cancer is practically nil. If you are infected with a high-risk type of HPV, in most cases the body's immune system simply clears the infection out and nothing further happens. The return visit in a year will be used to confirm that the infection has been cleared and the cervix has healed. If it doesn't heal on its own, you'll probably need to undergo a colposcopy test, see below. 

Causes for Greater Concern

If your Pap smear identifies a high-grade squamous intraepithelial lesion (HSIL) or atypical glandular cells, these rare findings are of slightly greater concern. Most commonly your gynecologist will suggest performing a colposcopy test. In a colposcopy test a special magnifying instrument is used to allow the gynecologist to examine the cervix closely for abnormalities. Sometimes the doctor will take small tissue samples during the test. 

If the results of the colposcopy test suggest that the abnormal cells need to be removed, the doctor will discuss your options with you. Most commonly a loop electrosurgical excision procedure (LEEP) or cryotherapy procedure can be performed to quickly and easily remove the cells via the vagina. There is no incision and only a local anesthetic is used. The procedure only takes about ten minutes. Afterwards there may be some cramping and discharge. 

Removing abnormal cells from the cervix prevents cervical cancer from forming. Women who develop cervical cancer are almost always women who have not had regular Pap smears. Don't be afraid to go for a Pap smear; it can save your life.

Last Updated: February 05, 2016