The Pap smear (or Pap test) is a test done on your cervix. The cervix is the opening to the uterus or womb. The doctor or nurse uses a swab, a small brush or small wooden stick to get a sample of cells from your cervix. The sample is sent to a lab where it is looked at under a microscope. If some cells look different form normal cells, it is called an “abnormal Pap smear.”
- Pap smear or pelvic exam?
- Take charge!
- When do I need a Pap smear?
- When preparing for a Pap smear, it is best to:
- What do my Pap Smear results mean?
- What causes an abnormal Pap smear?
- What is HPV?
- What happens if I have an abnormal Pap smear?
- What is colposcopy?
- What did the biopsy show?
- What is treatment?
- What should I do now?
- Pap Test
- What is a Pap test?
- Why might I need a Pap test?
- What are the risks for a Pap test?
- How do I get ready for a Pap test?
- What happens during a Pap test?
- What happens after a Pap test?
- Abnormal Pap Smear
- What does an abnormal pap smear mean?
- What could cause an abnormal pap smear result?
- What is the treatment for an abnormal Pap smear?
- What check-ups are necessary after treatment?
- What if I have an abnormal pap smear during pregnancy?
- Abnormal Pap Smears And HPV
- My Pap Test Was Abnormal: Now What?
- What Happens After an Abnormal Pap Test?
- Treatment Options After an Abnormal Pap Test
- My Pap Smear Was Abnormal. Should I Be Worried?
- Abnormal Pap Test
- Topic Overview
- Are Abnormal Pap Results Common? Everything You Need To Know About Getting An Abnormal Pap Smear Result
- What Exactly Is A Pap Smear Checking For?
- So … What Does An Abnormal Pap Smear Mean?
- What Causes An Abnormal Pap Result?
- Human Papillomavirus (HPV)
- Other Sexually Transmitted Infections
- Vaginal Inflammation
- What Happens After You Get An Abnormal Pap Result?
- How To Get Rid Of Precancerous Cells
- The Bottom Line
- What Does It Mean to Have an Abnormal Pap Smear–and What Should You Do Next?
- Abnormal Pap test? What to know about cervical dysplasia
- Abnormal Pap Smears
- What is a Cervical Screening Test?
- How is cervical cancer screened in Australia?
- What is the difference between the conventional Pap Smear and the Cervical Screening Test?
- What if I have abnormal Cervical Screening Test results?
- What is HPV (Human Papilloma Virus)?
- How are HPV and cervical cancer related?
- How is HPV treated?
- Further Information
- Related posts:
Pap smear or pelvic exam?
A Pap smear is not the same as a pelvic exam. During the pelvic exam, the doctor or nurse looks at and feels the other organs around your cervix to make sure their shape and size is normal. A Pap smear is usually part of a pelvic exam. If you’re not sure whether your pelvic exam includes a Pap smear, ask your doctor or nurse.
Unless your doctor tells you otherwise, it is important to get a Pap smear once a year. If your result is abnormal, follow your doctor’s or nurse’s advice for what to do next. This gives you the best chance to stay healthy and prevent serious problems.
When do I need a Pap smear?
You should have a Pap smear once a year as soon as you start having sex. After three or more normal yearly Paps, some doctors may recommend Paps every two or three years, but it is still important to have a pelvic exam every year. Even women who have passed the change of life (menopause), have had their tubes tied or have had a hysterectomy need a Pap smear regularly as recommended by their doctor or nurse.
When preparing for a Pap smear, it is best to:
- Not use vaginal creams, foams, gels, douches or tampons 48 hours (two days) before your Pap smear. These products could cause an abnormal result.
- Not have sex 48 hours (two days) before your Pap smear. Sex can irritate the skin of the cervix or cause discharge (fluids) that can lead to an abnormal result.
What do my Pap Smear results mean?
This is good. You won’t need another Pap smear for 1 to 2 years.
The slide cannot be read. Causes include douching, bleeding, infections, or not enough cells on the slide. The Pap smear must be repeated in 2-3 months.
The Pap showed infection, irritation, or normal cell repair. Have another Pap smear.
There are minor changes in the cells. Since we don’t know what these changes mean, another Pap smear should be done in 3 to 6 months. If your Pap smears show atypia repeatedly, then colposcopy is usually done.
- LOW GRADE CHANGES
There maybe a wart virus infection (HPV). In one in six women, the Pap smear will get worse. You should have another Pap smear in 3 months to check. If found twice, then colposcopy is done. Some health care providers do colposcopy the first time.
- HIGH GRADE CHANGES
The cells of the cervix may progress toward cancer, but they are not cancer yet. Less than half of the women with tests like this will progress to cancer. Colposcopy should be done within the next few weeks. Waiting up to 1-3 months is okay because it is not an emergency.
What causes an abnormal Pap smear?
- Human papillomavirus (HPV) causes cell changes that are true abnormal Pap smears.
- Mild infection, irritation from yeast or tampons, or trauma from sexual intercourse also cause cell changes, but these changes often go away on their own or can be easily treated.
- The person reading the Pap smear may see some normal cells as abnormal. (This is not a true abnormal Pap smear, but it will require you to have the test again.)
What is HPV?
HPV is a very common virus. It is passed from the skin of one person to another during sex. There are many types of HPV Some types cause genital warts-bumps on the skin around the penis, vagina or anus-that you can see. A few types of HPV can slowly lead to cancer of the cervix if they are not treated. Most commonly these types do not cause warts or bumps on a woman’s pubic area or penis that you can feel. This is why getting a Pap smear once a year is so important to your health. Most women who have HPV do not develop cancer, but some do. The good news is that cervical cancer can be prevented if the abnormal cell changes that can lead to cervical cancer are found and treated early.
What happens if I have an abnormal Pap smear?
If your Pap smear shows abnormal cell changes, your doctor or nurse may:
- Repeat a Pap smear every four to six months to recheck your cervix
- Test your cervix for HPV a sexually transmitted disease
- Look at your cervix with a special lens called a colposcope
- Take a sample of tissue, called a biopsy, from the cervix
Whether the plan is for a follow-up Pap smear, an HPV test, a colposcopy or a biopsy, keep your appointment. Make sure you understand the next step and why your doctor or nurse chose it. Don’t be afraid to ask questions. You can use the form on the next page to write down your questions and to make a note of your next appointment.
What is colposcopy?
Colposcopy is looking at the cervix with a special microscope. If abnormal cells are seen, the health care provider will take a sample of the cells (biopsy). The cells are sent to a lab for examination.
What did the biopsy show?
- If biopsy shows the cells are normal, another Pap smear and sometimes another colposcopy are done just to make sure.
- If biopsy shows mild changes (warts, HPV, mild dysplasia, CIN I ), most health care providers do not treat. Treatment will not cure wart virus.
- If biopsy shows high grade changes (moderate to severe dysplasia, CIN II or 111), treatment should be done.
- If biopsy shows cancer, a cone or other surgery should be done.
- If colposcopydoes not give a diagnosis and the Pap smear shows high grade changes, a conization may be done.
What is treatment?
Discuss alternative treatments with your health care provider and follow through with treatment chosen:
- Cryocautery – freezing the surface of the cervix. The abnormal cells peel off and new healthy cells grow back. During cryocautery, you may have mild cramps. Afterwards, you will have a messy discharge and spotting. A risk includes abnormal cells remaining even after the cryocautery. This is the lowest cost treatment.
- LEEP / LLETZ – cutting off the surface of the cervix with an electric wire. This requires a local anesthetic. New healthy cells grow back. During LEEP/LLETZ, you may have some pain and smell burning tissue. Afterwards you will have some spotting and discharge. Risks include bleeding, cutting too deep into the cervix, and some abnormal cells remaining afterwards. This is a moderate cost treatment.
- Laser Vaporization – burns off the surface of the cervix with a carbon dioxide laser. This requires a local anesthetic. New healthy cells grow back. During laser vaporization, you may have some pain. Afterwards you will have spotting and discharge. Risks include bleeding, abnormal cells remaining afterwards, scar tissue in the cervix, and spreading wart virus in the smoke. This is a high cost treatment.
- Cone – cutting a cone-shaped area of the cervix to remove abnormal cells inside and on the surface of the cervix. It can be used to treat early cancer. This requires an anesthetic Afterwards, you will have some spotting. Risks include bleeding, scar tissue in the cervix, menstrual cramps, infertility, and future miscarriage. This is a high cost treatment.
- Hysterectomy – Removal of the uterus should be done only for cancer, not for dysplasia. During hysterectomy, you will be hospitalized and have an anesthetic. You will no longer have periods or be able to have children. Risks include death from anesthesia complications, early menopause if ovaries also removed. Osteoporosis and coronary artery disease are also increased. This is highest cost treatment.
What should I do now?
- Do not smoke. Smoking doubles the chance of cancer of the cervix. Smoking also helps warts grow.
- Eat healthy foods including dark green leafy vegetables and red/orange/ yellow fruits and vegetables. Folic acid and beta-carotene in them help the cervix heal.
- You will need Pap smears every 3 to 4 months for a year.
- You will need a Pap smear every year for the rest of your life, even if you have a hysterectomy (because precancerous cells could develop at the top of the vagina).
Stop by or contact us to talk about scheduling a Yearly GYN exam/pap test.
What is a Pap test?
For a Pap test, your healthcare provider will collect and examine cells from your cervix. The cervix is the opening to the uterus. He or she will do this test to screen for cervical cancer and other problems.
It’s important to talk with your healthcare provider about when and how often you should have a Pap test. Experts base screening guidelines on your age and risk factors for cervical cancer .
American College of Obstetricians and Gynecologists (ACOG), guidelines include:
If you are at least age 21, you should start cervical cancer screening, even if you are not yet sexually active.
If you are younger than 30, you can likely be tested for cervical cancer every other year instead of yearly.
If you are older than 30 and have had 3 normal Pap tests in a row, you can be tested once every 3 years.
If you are at high risk for cervical cancer, you may need more screenings more often the guidelines suggest. Especially if you have a weak immune system or have been treated for abnormal cervical cells in the past.
If you are 65 to 70 years old and have had at least 3 normal Pap tests in a row and are not sexually active, and have had no abnormal Pap tests in the past, you may decide with your healthcare provider to stop cervical cancer screening.
If you’ve had both your uterus and cervix removed (total hysterectomy), you do not need cervical cancer screening unless you’ve had past surgery for cervical cancer or pre-cancer.
Why might I need a Pap test?
A Pap test, along with a pelvic exam, is an important part of your routine healthcare. It can help find abnormal cells that can lead to cancer. Your healthcare provider can find most cancers of the cervix early if you have regular Pap tests and pelvic exams. Cancer of the cervix is more likely to be successfully treated if it is found early.
The Pap test is useful for finding cancerous cells, and other cervical and vaginal problems such as precancerous cells and inflammation.
Your healthcare provider may use a Pap test to diagnose the following conditions:
Your healthcare provider may do a test for the human papilloma virus (HPV) at the same time as a Pap test. Infection with HPV is the most important risk factor for cervical cancer in women over age 30.
Your healthcare provider may have other reasons to recommend a Pap test.
What are the risks for a Pap test?
Tell your healthcare provider if you are allergic to or sensitive to latex.
Tell your healthcare provider if you are pregnant or think you might be.
There may be other risks based on your condition. Be sure to discuss any concerns with your healthcare provider before the procedure.
Certain things may interfere with a Pap test including:
Use of things, such as vaginal creams, jellies, medicines, or spermicidal foams, for 2 to 3 days before the Pap test, as these substances may alter the pH of the cells or hide abnormal cells
Douching for 2 to 3 days before a Pap test as douching can wash away surface cells
Sex within 24 hours before the test may cause inflammation of the tissue
Certain medicines, such as tetracycline
How do I get ready for a Pap test?
Your healthcare provider will explain the procedure and you can ask questions.
Tell your healthcare provider if you are sensitive to or are allergic to any medicines, latex, or tape.
Generally, you do not need to do anything to prepare for this test.
Tell your healthcare provider of all medicines (prescription and over-the-counter) and herbal supplements that you are taking.
Tell your healthcare provider when you had your last period, and what type of birth control or hormone therapy, if any, you are using.
Tell your healthcare provider if you have a history of bleeding disorders or if you are taking any blood-thinning medicines (anticoagulants), aspirin, or other medicines that affect blood clotting.
Tell your healthcare provider if you are pregnant or think you could be.
Do not use vaginal medicines, spermicidal foams, creams, or jellies, or douche for 2 to 3 days before the test or for the time set by your health care provider. Avoid sex within 24 hours before the test.
You will be asked to empty your bladder before the procedure.
Follow any other instructions your provider gives you to get ready.
What happens during a Pap test?
Procedures may vary based on your condition and your healthcare provider’s practices.
Generally, a Pap test follows this process:
You will be asked to undress from the waist down and put on or cover up with a hospital gown.
You will lie on an exam table, with your feet in stirrups.
Your healthcare provider will insert an instrument called a speculum into your vagina. This will spread the walls of the vagina apart to show the cervix.
Your healthcare provider will use a small brush, swab or spatula to gently remove cells from the cervix and back of the vagina. He or she will place the cells in a vial of liquid or smear the cells on a glass microscope slide.
If you need an HPV test, your provider will take a sample of cells for this test as well.
If you have symptoms of a vaginal infection, your provider may take a sample of vaginal for testing.
Most often, your healthcare provider will do a pelvic exam after the Pap test.
Your provider will send the specimen to a lab for further study.
What happens after a Pap test?
You may rest for a few minutes after the procedure before going home. Scraping the cervix may cause a small amount of bleeding. You may want to wear a sanitary pad for any spotting that may occur.
Tell your healthcare provider if you have any of the following:
Foul-smelling drainage from your vagina
Fever or chills
Severe abdominal pain
Pap test results usually take a few days. Ask your healthcare provider how you will be hear back about the results.
Your healthcare provider may give you other instructions after the procedure, based on your situation.
OK, most of us probably don’t think about our ob/gyns when having sex. But, it turns out, maybe you should—at least, if that sex is unprotected and you have a doctor’s appointment coming up.
“Semen can interfere with any swabs taken for evaluation,” explains Jessica Shepherd, M.D., an assistant professor of clinical obstetrics and gynecology and director of Minimally Invasive Gynecology at The University of Illinois College of Medicine at Chicago
Jonathan Schaffir, M.D., an ob/gyn at The Ohio State University Wexner Medical Center, agrees, pointing out that the discharge you tend to have after unprotected sex can also be mistaken for something wrong and lead your doctor to think there’s a problem when there really is none.
Brett Worly, M.D., an ob-gyn at The Ohio State University Wexner Medical Center, says semen can even interfere with Pap test results, giving you an abnormal reading when everything is actually OK. (He also points out that douching, tampon use, and vaginal cream or medicine can also throw things out of whack when used within two days of a Pap test.)
“Although most Pap tests are now done with a liquid medium that ‘washes’ cells and makes them easier to see, it is still possible for sperm cells to be present that make the cervical cells harder to see,” Schaffir explains. Using a condom doesn’t necessarily make things better, he says: “Even if a condom is used, the recent friction can cause inflammatory changes in vaginal and cervical cells that might be interpreted as an abnormal or ‘atypical’ Pap smear.”
Doctors typically recommend that you avoid having unprotected sex up to 48 hours before a Pap test, but board-certified ob/gyn Pari Ghodsi, M.D., says you’re perfectly fine to have sex with a condom beforehand if you’re not getting a Pap at this visit. (If you’re not sure, call your doctor’s office in advance.)
Of course, things happen and it’s completely understandable that you might forget and have sex within the 48-hour window. If it happens, don’t panic—but please tell your doctor! “I would not cancel an appointment just because of recent sexual activity,” says Schaffir. “But letting the doctor know (particularly if she is collecting a swab) would be helpful so the result can be interpreted correctly.” Plus, you’ll potentially save yourself the hassle and stress of dealing with inaccurate abnormal results.
Shepherd says you shouldn’t feel weird about speaking up. “There’s no harm in being honest,” she says. “Your doctor will appreciate it.”
Abnormal Pap Smear
Women are encouraged to start getting yearly Pap smears at the age of 21 or within 3 years of becoming sexually active. Pap smears are not diagnostic tests, but they are screening tools used to find any abnormal cells or dysplasia in the cervix.
When women are faithful in having regular Pap smears, they increase their chances for early detection and treatment of any potential problems.
What does an abnormal pap smear mean?
Being alarmed or worried is a completely normal reaction when told your Pap smear is abnormal. An abnormal Pap smear may indicate that you have an infection or abnormal cells called dysplasia. It’s important to remember that abnormal Pap smear results do not mean you have cancer.
These results just show that further testing should be done to verify whether or not there is a problem.
What could cause an abnormal pap smear result?
An abnormal Pap smear may indicate any of the following:
- An infection or an inflammation
- Recent sexual activity
- HPV (Human Papilloma Virus) This is also called genital warts (up to 60% of women may carry this virus on their cervix, genital area, or skin and are completely unaware of it).
- Dysplasia (abnormal cells that can be pre-cancerous)
What is the treatment for an abnormal Pap smear?
A positive result indicates the presence of abnormal cells, also called an abnormal Pap. Remember that this is a test, not a diagnosis. A positive result does not prove that you have cancer or even dysplasia (a pre-cancerous condition).
However, it usually means you should have further evaluation, such as another Pap smear, a colposcopy (using a microscope to look into the cervix) or a biopsy (removing a small amount of tissue from the cervix). Your doctor will discuss the results with you.
One in ten Pap smears will indicate some abnormality, though most are not serious. Further testing will be required to determine if you have an infection, inflammation, a yeast infection, trichomoniasis, herpes or the Human Papilloma Virus (HPV).
HPV is the main risk factor for cervical cancer, but most women who receive treatment for abnormal cells caused by HPV, do not develop cervical cancer.
In 2003, the FDA approved a screening test that can be done in conjunction with a Pap smear to determine if you have the HPV virus. The HPV DNA test can detect high-risk types of HPV before any abnormal cells can be detected on the cervix. This screening is recommended for women over the age of 30, who are at an increased risk of an HPV infection turning into pre-cancerous cells.
Some Pap smears indicate an unsatisfactory sample because of recent sexual activity or use of vaginal creams and douches. Regardless of the reason, an abnormal Pap will require another Pap smear in a few months.
If the abnormal cells are persisting, you may need further treatment, which may include the following:
- A colposcopy is an examination in which a speculum is inserted into the vagina, and the cervix is painted with a vinegar solution which makes any abnormal areas stand out. When an abnormal area is located, a sample (biopsy) of the area may be taken for accurate diagnosis by a pathologist.
- Cryosurgery, or freezing of the abnormal cells, is usually performed next. Cone biopsy is a procedure in which a triangle of cervical tissue is removed including the abnormal cells; this is either performed in a doctor’s office or as an outpatient procedure. Bleeding and watery discharge are common after this treatment.
- The LEEP procedure is similar to a cone biopsy, but a loop-shaped instrument is used to remove the abnormal area. Bleeding and discharge may also occur.
What check-ups are necessary after treatment?
Check-ups following treatment are necessary to make sure all the abnormal cells are gone and the cervix has healed. Early detection is the key to minimize the risk of cancer developing. After treatment, women will be advised by their health care providers as to how often they will need to have routine Pap smears.
What if I have an abnormal pap smear during pregnancy?
It is safe to have a Pap smear during pregnancy. If your Pap smear results are abnormal, a colposcopy could be performed during your pregnancy. However, further treatment will probably be delayed until after your baby is born.
Frequently, the birth of your baby will wash away any abnormal cervical cells. Having an abnormal Pap smear does not pose a risk to your baby.
Last Updated: 08/2015
Compiled using the following sources:
Danforth’s Obstetrics and Gynecology Ninth Ed. Scott, James R,et al, Ch.53
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Abnormal Pap Smears And HPV
DOES HPV CAUSE CERVICAL CANCER?
Most women with HPV and/or abnormal Pap smear results do not get cervical cancer. Researchers now believe that almost all cervical cancer is caused by HPV 16 and HPV 18. Cervical cancer is diagnosed in 12,900 women in the United States each year and 4,400 women die of cervical cancer in the U.S. each year. There are currently 140 million women and girls living in the United States. The majority of women who are diagnosed with cervical cancer are over the age of 30 and have not had access to healthcare or regular Pap smears.
The medical community now views cervical cancer as a preventable cancer because Pap smears can detect abnormal cell changes in the cervix long before they become cancerous. Also not all types of HPV cause the cell changes that can lead to cancer of the cervix. The HPV test, which is now available, can tell generally what types of HPV you have. Results of the HPV test do not specify exactly what type you have but do distinguish between the high risk types of HPV and low risk types. Both the low risk types and the high risk types of HPV can cause abnormal cell changes in the cervix and abnormal Pap smear results. Researchers now know that 90% of Pap smears with results that are classified as LSIL and 70% of Pap smears that are HSIL will become normal once your body’s defense system has cleared the HPV virus. 7 8 The types of HPV which cause the genital warts you can see are not the high risk types that can lead to cervical cancer.
WHAT ARE MY OPTIONS FOR FOLLOW-UP OF AN ABNORMAL PAP SMEAR?
If your pap smear is mildly abnormal (ASCUS or LSIL) you can choose to repeat the Pap smear in 6 months or have a colposcopy.
If the Pap smear is HSIL the recommendation is for you to have a colposcopy. A colposcope allows your healthcare provider to view the cells on your cervix more closely (it’s like looking under a microscope) and possibly take samples of abnormal cells for further evaluation by a laboratory. This is called a biopsy.
You may also choose to have a test for HPV. This test will tell you if you have the high or low risk types of HPV. The HPV test is helpful if the results indicate that you have the low risk types of HPV because you will know that there is little chance that the cell changes found on your Pap smear will get worse. If the HPV test comes back with results that indicate the high risk types of HPV it is helpful because you may choose to get close follow-up.
Remember both high risk and low risk types of HPV can go away within 24 months.
8 ACOG Announces New Pap Smear and Cancer Screening Guidelines
On Friday, November 20, 2009, the American College of Obstetricians and Gynecologists announced that women should have their first cancer screening at age 21 and can be rescreened less frequently than previously recommended.
My Pap Test Was Abnormal: Now What?
“The good news is that we can actually prevent people from getting cancer because these cellular changes happen over several years. With a Pap test, we can treat abnormal cells before they progress to cancer,” says Jenell Coleman, M.D., M.P.H., medical director of the Women’s Health Center, Johns Hopkins Outpatient Center and co-director of the Johns Hopkins Colposcopy Clinic.
The American College of Obstetricians and Gynecologists (ACOG) recommends the following:
- Women ages 21 to 29 should get a Pap test every three years
- Women ages 30 to 65 should have a Pap test combined with an HPV test every five years.
- Some women with certain conditions may need more frequent testing, including women with a history of cervical cancer, HIV/AIDS or a weakened immune system.
What Happens After an Abnormal Pap Test?
If your Pap test results are abnormal, your doctor may recommend a colposcopy. If you’re told that you need a colposcopy, don’t panic, says Coleman.
“Women come to me saying, ‘Oh, my gosh. I could have cancer!’ But most women do not have cancer when they come in for a colposcopy. I’ve done hundreds of colposcopies, and I’ve diagnosed less than a handful of cervical cancers,” she adds.
The routine is similar to a Pap smear. But this time, your doctor will use a magnifying lens to look at your cervix in order to see abnormal cells. This is done by swiping the area with acetic acid, which turns abnormal areas white. At Johns Hopkins, doctors also use a digital colposcopy system called DYSIS to further pinpoint the exact location of changing cells. This makes diagnosis even more precise.
Once abnormal cells are identified, your doctor performs a biopsy, taking a small amount of tissue for testing. You’ll feel a pinch, nothing more. Then, your cells are off to the lab for analysis. You might experience some mild cramping after colposcopy, but that’s it. “Most women tell me, ‘That wasn’t as bad as I thought!’” says Coleman.
Treatment Options After an Abnormal Pap Test
When your colposcopy is complete and your biopsy results are finalized, your doctor will explain the changes in your tissue sample. Sometimes, those changes are low-grade. This means you can watch and wait. Low-grade cervical changes are unlikely to become cervical cancer. If the changes are moderate- to high-grade, your doctor will evaluate more options. These changes create a higher risk of cervical cancer.
If there are moderate to severe changes in your cervix, your doctor may want to remove the cervical tissue. Typically, your doctor will use the Loop Electrosurgical Excision Procedure (LEEP), or perform a cold knife cone biopsy as a minor surgical procedure.
Be sure to always bring up any questions you may about you Pap test with your gynecologist.
My Pap Smear Was Abnormal. Should I Be Worried?
A Pap smear, a test that screens for cervical cancer, may not be the most dignified medical test for a woman—even peeing on a stick to see if you’re pregnant pales in comparison to lying on an exam table, stripped from the waist down, with your feet up in stirrups. But it’s an important one. According to the Centers for Disease Control and Prevention (CDC), around 12,000 women in the US develop cervical cancer each year, and about 4,000 women die from it. Because cervical cancer often has no symptoms until it becomes advanced, getting screened early is critical.
Pap smear results are usually described as “normal” (no changes in cervical cells), “unclear” (cervical cells might be abnormal) or “abnormal” (cell changes found). The good news: Relatively few Pap smear results are abnormal. “It’s actually not that common,” explains Glenn Bigsby, DO, a gynecologic oncologist at Presbyterian/St. Luke’s Medical Center and Pediatrix Obstetrix Medical Group of Colorado in Littleton. “Probably about 10 to 15 percent of patients in general will have an abnormal Pap smear during their lifetime.”
Still, getting an abnormal result can be scary. If your test is abnormal, don’t panic: It doesn’t always mean you have cancer. Here’s what could be behind your Pap results:
- HPV. The biggest risk factor for an abnormal Pap smear is HPV, a sexually transmitted infection that can lead to cervical cancer, says Dr. Bigsby. Getting the HPV vaccine—which experts recommend for all girls and boys ages 9 through 26—can “significantly decrease your risk of getting HPV, and/or an abnormal Pap smear,” Bigsby explains.
- Infection. Sometimes an ordinary yeast infection will throw off a Pap test result. “The test is not designed to diagnose infections,” says Bigsby. “They’re just sometimes found at the time of the Pap smear.” If a yeast infection shows up, your doctor will be able to determine proper treatment.
- Menopause. Women in menopause may have abnormal Pap results caused by vaginal dryness or thinning of the walls of the vagina or cervix. These changes are triggered by the loss of estrogen during menopause and are not related to HPV or cancer.
If your Pap results are abnormal—or even unclear—your doctor may order one or more of these tests:
- Repeat Pap. Sometimes a Pap smear shows irregular cells called atypical squamous cells of undetermined significance, or ASC-US. Often these cells are simply caused by inflammation, and they’ll soon return to normal on their own. “We’ll repeat those Pap smears in a short amount of time, just to be sure,” Bigsby says.
- HPV test. This test can be done either as part of regular screening, or if your Pap shows irregular cells. “Typically we don’t do HPV testing on a regular basis until you’re over the age of around 25 to 30,” Bigsby says. The test looks for pieces of HPV DNA within cervical cells, and the cells are collected the same way as the Pap—in fact, they may be done with the same sample.
- Colposcopy. “A colposcopy is a more directed diagnosis of precancerous cells,” says Bigsby. The procedure takes 10 to 20 minutes in your doctor’s office. Just like a regular pelvic exam, you’ll lie on an exam table with your legs up so the doctor can position a speculum in your vagina to hold it open and create a clear view of your cervix, which your doctor will examine with the help of a special magnifying lens. He or she may swipe a solution on your cervix to highlight suspicious cells, which could cause some stinging or tingling.
- Biopsy. There are several types of cervical biopsies, but all involve taking a sample of tissue to check for signs of developing cancer. The test usually doesn’t hurt, although you may feel some pressure or cramping. The biopsy can confirm a cancer diagnosis. If the doctor is able to get all the cancerous or pre-cancerous cells at once, you may not need further treatment.
Related Video: How Frequently Should I Get a Pap Smear?
Medically reviewed in August 2018.
Abnormal Pap Test
What is an abnormal Pap test?
When your doctor says that your Pap test, or Pap smear, was abnormal, it means that the test found some cells on your cervix that do not look normal.
A Pap test may be done as part of a woman’s routine physical exam, because it’s the best way to prevent cervical cancer. But having an abnormal test result doesn’t mean you have cancer. In fact, the chances that you have cancer are very small.
What causes an abnormal Pap test?
Most of the time, the abnormal cell changes are caused by certain types of human papillomavirus, or HPV. HPV is a sexually transmitted infection.
Usually these cell changes go away on their own. But certain types of HPV have been linked to cervical cancer. That’s why regular Pap tests are so important.
Sometimes the changed cells are due to other types of infection, such as those caused by bacteria or yeast. These infections can be treated.
In women who have been through menopause, a Pap test may find cell changes that are just the result of getting older.
What increases your risk for an abnormal Pap test?
Certain sexual behaviors, like having sex without condoms and having more than one sex partner (or having a sex partner who has other partners), can increase your risk for getting HPV. And HPV raises your risk for having an abnormal pap test.
HPV can stay in your body for many years without your knowing it. So even if you now have just one partner and practice safer sex, you could still have an abnormal Pap test if you were exposed to HPV in the past.
Smoking or having an impaired immune system also raises your chances of having cell changes in your cervix.
Do abnormal cell changes cause symptoms?
The cell changes themselves don’t cause symptoms. HPV, which causes most abnormal Pap tests, usually doesn’t cause symptoms either.
If a different sexually transmitted infection is the cause of your abnormal test, you may have symptoms such as:
- A discharge from the vagina that isn’t normal for you, such as a change in the amount, color, odor, or texture.
- Pain, burning, or itching in your pelvic or genital area when you urinate or have sex.
- Sores, lumps, blisters, rashes, or warts on or around your genitals.
What will you need to do if you have an abnormal Pap test?
You may need more tests to find out if you have an infection or to find out how severe the cell changes are. For example, you may need:
- Colposcopy, a test to look at the vagina and cervix through a lighted magnifying tool.
- An HPV test. Like a Pap test, an HPV test is done on a sample of cells taken from the cervix.
- Another Pap test in about 6 to 12 months.
A colposcopy is usually done before any treatment is given. During a colposcopy, the doctor also takes a small sample of tissue from the cervix so that it can be looked at under a microscope. This is called a biopsy.
Treatment, if any, will depend on whether your abnormal cell changes are mild, moderate, or severe. In moderate to severe cases, you may have treatment to destroy or remove the abnormal cells.
Are Abnormal Pap Results Common? Everything You Need To Know About Getting An Abnormal Pap Smear Result
We at Bustle love giving you tips for how to tap into your sexual potential and troubleshoot when things aren’t going your way in the bedroom. But what about finding solutions to those stressful sexual health situations that inevitably crop up when you’re getting down? Emma Kaywin, a Brooklyn-based sexual health writer and activist, is here to calm your nerves and answer your questions. This week’s topic: what it means to get an abnormal pap smear result.
Q: I went to my gynecologist for my regular pap smear the other day, and I just got a call from the nurse saying I should come in for a follow-up because my pap came back abnormal . What does that mean?! What’s wrong with me? I’m freaking out that I’m really sick or something.
A: The word “abnormal” is definitely an intense one, particularly when it comes from a doctor; but know it is definitely not a death sentence, and is actually pretty common.
Getting an abnormal pap is extremely common — studies have found that anywhere from two to six percent of people with cervixes get them at least once in their lives. Extrapolating that for the United States population (which boasts approximately 161 million cervixes!), that’s between approximately 3.7 and 9.6 million people who got the same result as you in this country alone. Now contrast those huge numbers with these: around 12,900 people are diagnosed with cervical cancer annually, and only 4,100 die from it annually. This number used to be way larger and was in fact one of the most common cancers Americans with cervixes died from, but because of Pap smears, that number has gone down by over 50 percent!
So let’s take a collective deep breath and learn exactly what it means to get news of an abnormal pap smear.
What Exactly Is A Pap Smear Checking For?
First, let’s clarify what a Pap smear or Pap test is: it’s there to check out whether you have cancer in your cervix, and it is totally routine. Pap smears are usually paired with regular annual gynecological check-up activities. This means that when you get one, your doctor will insert a speculum all up into your parts (hopefully warning you first and doing it gently). If you’re getting a Pap smear during your exam, at this point, the doctor will snag some cells off your cervix with a spatula or soft brush. Luckily, this generally doesn’t hurt, although some people find it uncomfortable.
If, while checking out these cells from your most intimate interior, the doctor finds something that looks not right, you’ll get a call that your Pap has come back “abnormal”.
So … What Does An Abnormal Pap Smear Mean?
What gynecologists are looking for with the Pap test is indication of precancerous cells. This would be cells that are “abnormal,” in the sense that they are not dying at the end of their usual life span or are dividing unusually.
This may sound scary to you. Let’s be real, anything associated with the word “cancer,” even if it has “pre-” in front of it, is going to sound at least a little terrifying, and no one likes their tenderest of bits to be called abnormal. But here’s the thing: early detection saves lives. The earlier you can catch these cells, the earlier you can get rid of them or even just have your doctor keep a loose eye on them.
Cervical cancer is a slow roll of a disease that takes years to grow into a beast that can harm you. For this reason, it’s recommended that you get tested every two to three years starting when you turn 21.
What Causes An Abnormal Pap Result?
There are a few things that can cause the cells in your cervix to go all wonky.
Human Papillomavirus (HPV)
Most abnormal Pap results are caused by the sexually transmitted infection (STI) HPV. HPV is the most common STI in the United States. Around 79 million Americans have it, and around 14 million more get infected each year. In fact, it’s so common that almost every sexually active human will get at least one strain of HPV at some point.
The good news is that, of the over 100 different strains, only a couple are known to cause cancer, and there are varying risks within those strains. More good news is that, in a majority of cases, your body will clear an HPV infection, which means it will get rid of it. In fact, the average life of an HPV infection is between four and 20 months, and most people clear it within two years. HPV progresses to pre-cancer in the pretty rare instance when your body doesn’t clear a high-risk strain for a long time, leading the normal infected cells to turn abnormal. It generally takes 10 to 15 years for your cells to become abnormal and then transition into cancer cells because of HPV.
The bad news is that it’s hard to protect yourself from HPV — if you’re having sex, that is. Since it’s transmitted through skin contact (as opposed to semen or vaginal fluids, like the majority of STIs), condoms don’t protect you completely. However, research shows that they do help, with one study finding that young women whose partners used condoms were 73 percent less likely to get infected. Of course, this is why getting the HPV vaccine is so important.
Other Sexually Transmitted Infections
Other STIs can cause your cervical cells to become inflamed, making them look abnormal. Chlamydia or gonorrhea are both very common in these cases.
Chlamydia is the most commonly reported STI, with nearly one and a half million cases reported annually. Young women are particularly affected, with around seven percent of sexually active young women infected. Gonorrhea is the second most commonly reported STI, with over 300,000 cases reported annually. Luckily, these STIs are treatable with antibiotics, so if this is the reason why you have an abnormal Pap, hit those pills! And you can protect yourself from them in the future by using condoms.
Yeast infections and bacterial vaginosis are other causes of cervical inflammation that can be read as an abnormal pap. These challenges take place when your vagina is too basic (it’s a delicate balance all up in there!). This causes your natural defenses to be weakened, and allows bacteria to grow in amounts that it shouldn’t. Symptoms of these include itching and irregular discharge (the ever-disgusting “cottage cheese-like” description).
You can treat yourself for a yeast infection using over-the-counter creams or home remedies like yogurt and garlic, apple cider vinegar, or boric acid suppositories. You can also ask your doctor for a one-day antibiotic to kick it fast. Bacterial vaginosis can go away on its own, but if it doesn’t, talk to your doctor to get it taken care of.
Finally, research has found that smoking is correlated with a higher chance of ending up with abnormal cervical cells. Research has found that if you smoke tobacco, your chances of getting cervical cancer goes up two to four times. Of course, smoking is related to a ton of different cancers — cervical cancer is just one of them.
What Happens After You Get An Abnormal Pap Result?
Depending on how abnormal the cells are, your doctor may need to check you out more. This usually takes the form of a colposcopy, which is when your doctor looks at your cervix using a magnifying glass made for vaginas. If s/he discovers something all up in there, s/he can take a biopsy, a teeny sample of cervical tissue, which can be tested by a lab for precancer.
How To Get Rid Of Precancerous Cells
If you do have precancerous cells, your doctor will vanquish them! This can happen through laser therapy, also called laser ablation, which is when the abnormal cells are burned away with a laser, (because we’re in the future). Luckily, you get a local anaesthetic during this, so it doesn’t hurt … although you may smell burning. Another way to get rid of unwanted cervical cells is through cryotherapy, which is freezing off the cells with a cold probe. While you won’t feel the freezing taking place, you may get cramps during and for a bit after. With both of these procedures, once the abnormal cells are gone, normal cells can grow back in their place.
More intense procedures involve removing the whole area — not just the specific cells. Options include diathermy , which uses an electric current to snip the cervical tissue that has the abnormal cells; large loop excision of the transformation zone (or LLETZ for shorter), which is basically the same as diathermy in that it cuts away the abnormal area using a loop of wire and an electric current; cone biopsy , which is when a cone-shaped area of your cervix is surgically removed; and in rare cases (basically once you’re in menopause or certain that you’re done making babies) hysterectomy , which is where your entire womb is taken out.
These are clearly way more invasive, but the advantage is that the removed piece can be checked out by the lab, versus in laser therapy or cryotherapy where they are destroyed.
The Bottom Line
Getting an abnormal Pap is most definitely not the end of the world, and it is more common than the name implies. If you get one, it means that you might want to get tested for STIs and you will definitely be asked to come back sooner than your usual two to three years to get another smear. These extra trips to the doctor may seem like hassles, but in actuality, you’re protecting your future self.
Images: d Uthman/flickr, Giphy
What Does It Mean to Have an Abnormal Pap Smear–and What Should You Do Next?
A bit uncomfortable and sometimes a little awkward, sure. But luckily, most Pap test results come back normal, meaning you can heave a sigh of relief and schedule your next exam years down the road.
However, some 2% to 5% of women who have a Pap test–named after the originator of the exam, George Papanicolaou–will have an abnormal result, says Adi Davidov, MD, director of gynecology and robotic surgery at Staten Island University Hospital. If you’re one of those women, you’re probably more than a little nervous about what “abnormal” really means. Here’s what you need to know.
RELATED: 9 Cervical Cancer Symptoms Every Woman Needs to Know
What can cause an abnormal Pap smear?
For starters, abnormal cells on Pap test results do not necessarily mean you have cancer. “There can be many different reasons why a Pap smear may be abnormal,” says Nazia Munir, MD, a family physician at Henry Ford Health System in Detroit. “The most common is the human papillomavirus.”
Human papillomavirus (HPV) is responsible for almost all cases of cervical cancer. But testing positive for the virus does not mean you actually have cancer. Around 90% of the time, the virus, which is sexually transmitted, clears on its own, leaving no evidence in its wake. “A lot of times patients have HPV and are completely asymptomatic,” Dr. Munir says. Some may have mild symptoms but still recover completely, Dr. Davidov adds.
When HPV does lead to pre-cancerous or cancerous changes in cervical cells, those abnormally growing cells will be categorized as mild, moderate, or severe, says Leslie McCloskey, MD, associate professor of obstetrics, gynecology, and women’s health at Saint Louis University, and your doctor will help you determine the best course of treatment.
What else can cause an abnormal pap smear besides HPV? Other sexually transmitted infections may be to blame, including chlamydia, gonorrhea or, in very rare cases, herpes. Yeast infections can also cause changes in cervical cells. All of these can be treated.
In rare instances, even inflammation–perhaps from having sex recently–can lead to an abnormal Pap test result.
Later in life, menopause can produce changes in cervical cells too. “When there’s not that much estrogen, cells can look funny and mimic precancerous conditions,” says Dr. Davidov.
RELATED: 17 Things You Should Know About HPV
What should you do if you’ve had an abnormal Pap smear?
A Pap test can tell you something might be wrong–but it can’t tell you what the problem is. If your Pap results come back abnormal, your doctor will want to follow up to find out what, if anything, is going on.
If you haven’t had one already, your doctor may order a second test, one which looks for HPV DNA. This will tell you if HPV is a likely cause of the abnormal results. It can even tell you if you have one of the specific strains (often HPV 16 or 18) that cause cervical cancer, though it won’t say if you have the disease.
The next step is a colposcopy, which is when a doctor looks closely at the cervix with a microscope-like device called a colposcope. A diluted vinegar solution is often applied to the cervix to temporarily change the color of any abnormal areas, making them easier for your doctor to see.
Not every abnormal Pap test warrants a colposcopy, especially in younger women, Dr. McCloskey says. “Their risk of having is so low, on occasion we may just elect to repeat a Pap test in six months or a year,” she says, to see if the results are still abnormal.
If anything looks more than mildly wrong in a colposcopy, doctors will do a biopsy, which is the removal of a small sample of tissue or cells to test further in the lab. A biopsy will tell you specifically if you have cancer or precancerous changes. “If the biopsy result confirms that there is a precancerous condition, the patient usually requires treatment that removes the precancerous condition,” says Dr. Davidov.
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In general, women under 30 should get a Pap test every three years starting at age 21. From 30 on, women should get a Pap plus an HPV test every five years. (That remains true whether or not you’ve been vaccinated against HPV. The vaccines don’t protect against all strains of HPV.) If you happen to be pregnant when it’s time for your Pap smear, the test can still be done as usual. Doctors can even follow up on abnormal Pap results with a colposcopy if needed.
Every year, nearly 13,000 women are diagnosed with cervical cancer and around 4,000 die from the disease. But most are preventable, says Dr. McCloskey, “if patients come for Paps and for the appropriate follow-up.”
Abnormal Pap test? What to know about cervical dysplasia
So, you’ve been through the discomfort and awkwardness of your Pap test, and you’ve gotten the unexpected call from your doctor: Your Pap test was abnormal. Now what?
We recently spoke with Kathleen Schmeler, M.D., co-leader of MD Anderson’s HPV-Related Cancers Moon Shot™, to find out what you should know. Here’s what she had to say.
What does it mean when my doctor says I have an abnormal Pap test?
An abnormal Pap test result means there are cells on your cervix that don’t look normal under a microscope. This fairly common condition is known as cervical dysplasia, or pre-invasive cervical disease.
Does my abnormal Pap test mean I’m going to have cervical cancer?
An abnormal Pap test doesn’t mean you have cancer or that you’ll have cancer in the future. In most cases, women with an abnormal Pap test don’t end up developing cervical cancer. But some do have pre-cancer, which is very treatable.
What causes an abnormal Pap test?
Abnormal cell changes in the cervix are often caused by the human papillomavirus (HPV). Usually, HPV infections clear up on their own. But some HPV strains can cause high-grade dysplasia and several types of cancer, including cervical cancer.
Sometimes, abnormal cells are caused by a yeast infection or a bacterial infection, both of which are very treatable. Or, if you’ve already been through menopause, these cell changes may be the result of age.
A weakened immune system and HIV can also make you more likely to have an abnormal Pap test.
But most women with abnormal Pap test results are perfectly healthy.
What’s the difference between low-grade and high-grade cervical dysplasia?
Low-grade cervical dysplasia typically goes away on its own. But if you have high-grade cervical dysplasia, the cells are more abnormal and need to be treated because they can turn into cancer.
What do I need to do now that I have an abnormal Pap test?
When we see a woman who’s had an abnormal Pap test at MD Anderson’s Colposcopy Clinic, we typically do a pelvic exam with a colposcopy and cervical biopsies. A colposcopy is a procedure where a doctor closely examines your cervix with a special instrument called a colposcope.
If you’re diagnosed with high-grade dysplasia, the doctor may need to do a loop electrosurgical excision procedure (LEEP). This procedure removes abnormal cells from the cervix using a wire loop heated by an electrical current.
What kind of doctor do I need to see?
Make sure you see a gynecologist or gynecologic oncologist who’s done a lot of colposcopies. This is the best way to ensure you receive the correct diagnosis and treatment the first time.
What happens during a colposcopy?
During a colposcopy, we put acetic acid on the cervix so that it’s easier to see the abnormal areas with a colposcope. It can be performed in the clinic and doesn’t require anesthesia. If we see anything abnormal during the colposcopy, we’ll biopsy those areas.
It typically takes about a week to get the biopsy results.
What if my biopsy results are abnormal?
If we see significant cell changes, we’ll remove the abnormal tissue. Usually, we’ll do this in the clinic using a LEEP.
But if we’re concerned a patient may have cancer, we do a cone biopsy in the operating room. This is a more extensive biopsy in which a cone-shaped wedge of abnormal tissue is removed from higher up in the cervical canal. Because that area is harder to get to, this procedure requires general anesthesia.
What kind of follow-up care will I need after my colposcopy?
If the cervical dysplasia is low-grade or normal, you’ll need to see your doctor in a year. If it’s high-grade, you’ll have an appointment much sooner — just four weeks after your LEEP — and then have a follow-up appointment in a year, depending on the results.
Of course, if you notice any changes in your body before your next appointment, see your doctor sooner.
Anything else you want women to know about abnormal Pap test results?
Make sure you get follow-up care when you find out your Pap test is abnormal. That way, your doctor can monitor you and come up with a treatment plan to make sure the abnormal cells don’t turn into cancer. And, if these cells do turn into cancer, your doctor can catch the cancer early, when it’s most treatable.
MD Anderson’s Colposcopy Clinic offers diagnosis and treatment for cervical dysplasia. Request an appointment online or by calling 1-877-632-6789.
Abnormal Pap Smears
What is a Cervical Screening Test?
Cervical Screening Test is a simple procedure to check the health of your cervix and screen for pre-cancerous and cancerous changes to your cervix. Having regular Cervical Screening Test every 5 years is the most effective way to protect against cervical cancer. It is performed in exactly the same way as pap smear, but the sample taken is tested differently. It has replaced pap smear as a tool to screen for cervical cancer.
How is cervical cancer screened in Australia?
As of 1 December 2017, cervical cancer is screened in Australian women aged between 25 and 75 through a 5 yearly HPV screening (Human Papilloma Virus – also commonly known as wart virus). This replaces the previous 2 yearly pap smear screening program. The process of obtaining a swab from the cervix using a vaginal speculum is still the same as previously.
The Pap test used to look for cell changes in the cervix, whereas the new Cervical Screening Test looks for HPV which can lead to cell changes in the cervix.
What is the difference between the conventional Pap Smear and the Cervical Screening Test?
The way the sample is taken is exactly the same. An instrument called speculum is gently inserted into the vagina to visualise the cervix. A swab is taken from the cervix and sent away for testing in a pathology laboratory. The cells of the cervix were examined in conventional pap smear, while the presence of HPV is checked in Cervical Screening Test. This is a step ahead of the cells examination, as cell changes occur almost invariably due to presence of HPV.
What if I have abnormal Cervical Screening Test results?
Most Cervical Screening Tests are performed by GPs. If HPV (wart virus) is detected, the result is considered abnormal. The sample is then sent for testing for presence of abnormal cervical cells. This may be normal, low grade or high grade dysplasia (pre-cancerous).
If the result is abnormal, your GP should contact you with the result and organise further follow-up. Depending on the abnormality, this may be a repeat test or a referral to a gynaecologist for a colposcopy. If you have been recommended to see a gynaecologist and wish to see Dr Kuswanto for a colposcopy, please call (03) 9115 9338 to make an appointment.
It is important to know that most of these abnormal results does not mean cancer, but more likely to be pre-cancerous.
What is HPV (Human Papilloma Virus)?
Human papilloma Virus (HPV) is a common virus that is spread by genital skin-to-skin contact during sexual activity. It is so common that many people have it at some point in their lives and never know it as there are usually no symptoms.
There are many types of HPV and your body’s immune system will naturally clear most types within one to two years.
If your body does not clear a HPV infection, it can cause cells in your cervix to change, which in rare cases can develop into cervical cancer. It usually takes up to 10 to 15 years for HPV to develop into cervical cancer.
Cervical cancer is preventable with regular cervical screening. The Cervical Screening Test is more accurate at detecting HPV. By detecting a HPV infection early, it allows your doctor to monitor the infection and intervene if there are any changes to cells in your cervix.
How is HPV treated?
There is no treatment for HPV. In most cases the immune system will clear HPV from the body naturally over time. Most people with a HPV infection have no symptoms and will never know they have it.
If your body does not clear a HPV infection, it can cause changes to cells in your cervix, which in rare cases can develop into cervical cancer. If HPV and cervical cell changes are found on your Cervical Screening Test, your doctor will advise you about further testing and treatment.
Some types of HPV can cause genital warts and your doctor can suggest treatment options. Kent sees his private patients in Epworth Freemasons in East Melbourne. He also consults in Box Hill and Werribee.
Please click here for Dr Kuswanto’s presentation to GP on the New National Cervical Screening Program.
to RANZCOG Patient Information on Cervical Screening in Australia.