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.

Women are encouraged to start getting yearly Pap smears at the age of 21 or within 3 years of becoming sexually active. 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?

An abnormal Pap smear may indicate any of the following:

  • An infection or an inflammation
  • Herpes
  • Trichomoniasis
  • 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?

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.

Here are some terms your doctor might use and what your next course of action might be:

  • Atypical squamous cells of undetermined significance (ASCUS). Squamous cells are thin and flat and grow on the surface of a healthy cervix. In the case of ASCUS, the Pap smear reveals slightly abnormal squamous cells, but the changes don’t clearly suggest that precancerous cells are present.With the liquid-based test, your doctor can reanalyze the sample to check for the presence of viruses known to promote the development of cancer, such as some types of human papillomavirus (HPV).

    If no high-risk viruses are present, the abnormal cells found as a result of the test aren’t of great concern. If worrisome viruses are present, you’ll need further testing.

  • Squamous intraepithelial lesion. This term is used to indicate that the cells collected from the Pap smear may be precancerous.If the changes are low grade, it means the size, shape and other characteristics of the cells suggest that if a precancerous lesion is present, it’s likely to be years away from becoming a cancer.

    If the changes are high grade, there’s a greater chance that the lesion may develop into cancer much sooner. Additional diagnostic testing is necessary.

  • Atypical glandular cells. Glandular cells produce mucus and grow in the opening of your cervix and within your uterus. Atypical glandular cells may appear to be slightly abnormal, but it’s unclear whether they’re cancerous.Further testing is needed to determine the source of the abnormal cells and their significance.
  • Squamous cell cancer or adenocarcinoma cells. This result means the cells collected for the Pap smear appear so abnormal that the pathologist is almost certain a cancer is present.”Squamous cell cancer” refers to cancers arising in the flat surface cells of the vagina or cervix. “Adenocarcinoma” refers to cancers arising in glandular cells. If such cells are found, your doctor will recommend prompt evaluation.

If the abnormal cells persis, 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. You doctor will use a special magnifying instrument (colposcope) to examine the tissues of the cervix, vagina and vulva. 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.

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Compiled using the following sources:
Danforth’s Obstetrics and Gynecology Ninth Ed. Scott, James R,et al, Ch.53

Mayo Clinic: Tests, Procedures