No one wants to receive a call from their gyno explaining that they had an abnormal Pap smear. For starters, “abnormal” doesn’t only carry a pretty negative connotation, but it’s also unspecific! Abnormal how? And what comes next after abnormal Pap smear results? There’s basically zero detail there. When you combine that with the fact that Pap smears are used to screen for cervical cancer, your mind might naturally—and scarily—jump to the conclusion that you’re dealing with a serious health issue. But the truth is that abnormal Pap smear results are, in most cases, not actually anything to worry about. Here’s why.
What is a Pap smear, again?
If you know the gist of how a Pap smear works but aren’t sure about the nitty-gritty, this is what you need to know.
A Pap smear involves a doctor swabbing your cervix to collect samples that can later be examined for any changes in cervical cells that could be precancerous. (Your cervix is the lower end of the uterus that serves as a passageway into the vagina.) You’ll lie down on an exam table while a doctor uses a speculum to hold open the walls of your vagina and make the swabbing part easier, the American College of Obstetricians and Gynecologists (ACOG) explains. After swabbing your cervix with a tool like a brush, they send the sample to a lab for testing.
There’s a ton of confusion surrounding who should and who should not get Paps, plus how often they’re recommended. Some of this depends on your personal health history, ACOG explains, but in general, people who have a cervix and are between 21 and 29 should get a Pap at least once every three years, while those who are 30 to 65 should get a Pap and a test for human papillomavirus (HPV) at least once every five years or a Pap on its own at least once every three years, according to the U.S. Preventive Services Task Force. If you receive abnormal Pap smear results, your doctor may recommend testing more frequently than that.
Making sure to go in for a Pap smear as recommended isn’t the most fun way to spend your time, but it’s an incredibly important tool for catching any changes that could eventually become cervical cancer. If it helps, here’s how you can try to make a Pap smear as easy as possible on you and your vagina. (And you should still see your gyno every year even if you’re not due for a Pap smear—it’s an essential part of staying on top of your sexual and reproductive health in general.)
What does an abnormal Pap smear mean?
Since you’re reading this piece, you’re probably wondering what exactly an abnormal Pap smear says about your health. First things first: Abnormal does not necessarily mean cancerous. It can be hard to concentrate on this fact when you’re scared, but try to remember that if you’re really freaked out.
"It generates a lot of anxiety and concern, but the reality is there are a lot of abnormal Pap smears that are not cancer," Nicole S. Nevadunsky, M.D., associate professor in the division of gynecologic oncology at Montefiore Einstein Center for Cancer Care, tells SELF. The majority of abnormal results look that way because of an HPV virus, she adds. There are more than 100 different HPV viruses, so it’s no surprise that HPV is the most common sexually transmitted infection in the U.S. (Another factor: HPV is spread through skin-to-skin contact, so you don’t even need to exchange sexual fluids to transmit it—which is why barrier protection like condoms doesn’t fully protect against it.) The grand majority of the time, HPV infections don’t harm people’s health at all. With that said, there are some that can cause genital warts, and others can cause certain types of cancer, like that of the cervix, penis, vagina, vulva, anus, and throat.
Since having HPV doesn’t automatically lead to cancer, that means abnormal Pap smear results definitely don’t automatically indicate cancer. An abnormal Pap smear doesn’t even necessarily hint at you having precancerous cells. Sometimes it just means an HPV virus is causing slight changes in your cervical cells, and the good news is that people often clear HPV from their bodies in six months to two years, especially people under the age of 30.
If you got abnormal Pap smear results and are concerned, ask your doctor for more information on what they found during your Pap smear and how that will determine their next steps.
What can cause an abnormal Pap smear besides HPV?
Depending on the specific results, an abnormal Pap smear could mean you have HPV (which, as we mentioned, is really common and often NBD), or your doctor has identified some amount of cervical dysplasia (abnormal cells on the surface of cervix, which can range from mild to severe). To make this easier to understand, here’s a breakdown of potential abnormal Pap smear results:
The most common abnormal Pap smear result is ASCUS, according to ACOG. This stands for atypical squamous cells of undetermined significance. Squamous cells are naturally present on the surface of even the healthiest cervix, the Mayo Clinic explains. An ASCUS result often signals that these cells have changed slightly in response to an HPV infection, but they can also change a bit as a result of inflammation from issues like yeast infections and benign polyps or cysts.
An abnormal Pap smear result referred to as LSIL (low-grade squamous intraepithelial lesion) can be considered the next step up in seriousness—but even then it isn’t necessarily something to worry about. The presence of LSIL cells "overwhelmingly [indicates] that there's a current HPV infection," Dr. Nevadunsky says, adding that there's a very low chance it’s going to be cancer if your Pap results show LSIL.
Another possible abnormal Pap smear result is HSIL (high-grade squamous intraepithelial lesion). HSIL cells signal a more serious change than LSIL cells and are oftentimes called precancerous because there's a greater chance they may become cancerous. There’s also ASC-H (atypical squamous cells, cannot exclude HSIL), which means there are cervical cell changes that may indicate HSIL. Finally, AGC (atypical glandular cells) is another abnormal Pap smear result, but instead of squamous cells, it’s referring to a different type of cell that is naturally present in the cervix and also inside the uterus, ACOG explains. This type of change in these glandular cells can also signal precancer and potentially cancer.
What happens after an abnormal Pap smear?
It depends on your result and how cautious you and your doctor want to be. Here’s how it breaks down, per ACOG:
For an ASCUS abnormal Pap smear result: The next step here depends largely on your age. If you’re between 21 and 29, your doctor may just ask you to come in for a repeat Pap anywhere up to a year from receiving your abnormal result. But they might also want you to come in for an HPV test to determine which strain is causing the infection and whether or not it's type 16 or 18, both of which are considered high-risk because they are most likely to cause cervical cancer.
If you’re 30 or older, that HPV test result becomes more important in determining next steps. (Remember, HPV is more likely to clear from your body when you’re under 30.) If your test is HPV-negative at this age, your doctor may recommend simply coming in for another Pap and HPV test in three years. If your test is HPV-positive, they might want to do a colposcopy, which is when the doctor examines your cervix with a magnifying tool to look for abnormal cells.
Depending on what they see, they may take a small biopsy (tissue sample) to test it for cancer. Dr. Nevadunsky explains that there are two main reasons to do a biopsy: "If we find something that concerns us and looks like precancerous cells, or if there's a part of the cervix we want to look at that we can’t see." If your biopsy results come back negative, your doctor may still want to see you in less than a year to keep checking in on the abnormality until it clears up.
For an LSIL abnormal Pap smear result: Even though you can still clear any related HPV infection at this stage, it’s possible that “the doctor's going to want to take a closer look" just in case it is one of the more worrisome strains that can lead to cervical cancer, Dr. Nevadunsky says. The exception is if you’re 21 to 24 years old—in that case, they may just recommend another Pap in a year. But if you’re 25 to 29 with an LSIL result, your doctor might suggest a colposcopy, ACOG says. If you’re 30 or older and received an LSIL along with an HPV-negative result, they might recommend either repeating your Pap in a year or going for the colposcopy now. You can discuss the pros and cons with them to get a firm understanding of which option makes more sense for you. If you’re 30 or older and received an LSIL plus an HPV-positive result, the medical guidance recommends going ahead with the colposcopy for some better clarity on what’s going on with those cervical cells.
For an HSIL or ASC-H abnormal Pap smear result: No matter your age, a doctor will likely recommend more procedures like a colposcopy after HSIL or ASC-H abnormal Pap smear results, according to ACOG.
For an AGC abnormal Pap smear result: This one’s a bit different since glandular cells are on both the cervix and in the uterus. According to ACOG, there’s a variety of routes your doctor can take when follow-up testing after an AGC abnormal Pap smear result, including a colposcopy, sampling tissue from the cervical canal, and sampling tissue from the uterus.
As you can see, so much of this depends on things like your age and what was actually detected during your abnormal Pap smear. Don't be afraid to ask your doctor exactly what they suggest—and what that will entail—as soon as they say your results came back abnormal.
What happens in a colposcopy?
Okay, let’s do a deeper dive into this since it’s sometimes a necessary part of following up after an abnormal Pap smear result (and since having a doctor spend even more time beyond a Pap smear examining your cervix sounds pretty unpleasant, to say the least).
A colposcopy typically takes about 10 to 20 minutes, according to the Mayo Clinic. As we mentioned, during a colposcopy your doctor will use a magnifying tool (unsurprisingly called a colposcope) to examine your cervix, along with the help of a bright light, the Mayo Clinic says. After inserting a speculum (which you’ll already be familiar with from Paps), the doctor will clear mucus from your cervix and vagina with cotton so they can get a better look. They might apply a solution to your cervix for an even clearer picture of what’s going on. The solution makes it easier to see abnormal cells.
It’s one thing to know how a colposcopy will happen. It’s another thing to know how it will feel. You already know the deal with speculums: They might be uncomfortable but shouldn’t actually be painful. As for the colposcopy part, the solution might cause some burning or tingling, according to the Mayo Clinic. "Some people say it’s irritating, but it doesn't typically hurt," Dr. Nevadunsky says.
If your doctor notices any suspicious areas during this exam, they'll take a small piece of tissue to biopsy, using a special tool to cut off a sample. This may be uncomfortable but won’t necessarily be painful, according to the Mayo Clinic.
After a colposcopy, you might see some spotting for the next day or so. A biopsy can lengthen that spotting timeframe to a few days, and you might also experience dark discharge and some soreness for a few days as well. The Mayo Clinic recommends avoiding putting anything in your vagina (so no tampons and no penetrative sex) for a week after your biopsy or for as long as your doctor recommends. You shouldn’t have any of these types of restrictions after a colposcopy. Still can’t hurt to check with your doctor about that, though.
What happens after a cervical biopsy?
If the biopsy results come back from the lab and show no precancerous cells, your doctor will typically just ask you to come back for a repeat Pap smear at some point sooner than usual, like within a year.
A biopsy can return a number of possible results that will require more immediate follow-up procedures, like a result showing the presence of precancerous or cancerous cells. In that kind of scenario, your doctor may recommend an excisional treatment, which is used to confirm the presence of precancerous or cancerous cells and how severe they are, ACOG explains.
There are two common ways doctors perform excisional treatment for this situation: a loop electrosurgical excision procedure (LEEP) and conization.
LEEP uses a thin wire loop that functions like a scalpel to cut away a thin layer of surface cells from the cervix. Like a colposcopy, it can take around 10 to 20 minutes, the Cleveland Clinic explains. First, your doctor will insert a speculum, then apply local anesthesia with a needle to numb your cervix. Once you’re numbed, the doctor will use a thin wire loop (with a slight electrical charge, which helps to prevent bleeding) to remove cells from your cervix. After that, your doctor might apply a paste to your cervix to help control post-LEEP bleeding.
Even with that, heavy bleeding is the most common issue in the first three weeks after a LEEP, ACOG says. If you experience heavier bleeding than your usual period, you’re seeing clots, or you’re experiencing severe abdominal pain, get in touch with your doctor ASAP. Side effects like a watery slightly pink discharge, mild cramps, and a dark discharge can be normal after a LEEP, but anything more intense than that warrants some medical attention. As with a cervical biopsy, you shouldn’t put anything into your vagina for as long as your doctor recommends after a LEEP, though this directive can last for a few weeks after the procedure.
Next up: conization, or when a doctor removes a small cone-shaped part of the cervix with abnormal cells for further investigation. This actually happens under general anesthesia, the U.S. National Library of Medicine notes. That makes it easier to sample deeper levels of cervical tissue, the Mayo Clinic explains, and sometimes it’s actually possible to use conization to completely remove cancer if the cancer is small enough.
After conization, you might deal with some cramping and other discomfort, the U.S. National Library of Medicine says, and you might also see some bloody, heavy, or even yellow discharge for a few weeks post-procedure. As with these other exams, your doctor will want you to hold off on things like using tampons and having sex until you’re sufficiently healed, which can take four to six weeks.
What happens if they find precancer or cancer?
"The good news about all this is that if there are precancerous cells there, it does take them a very long time—years—to grow into cancerous cells," Dr. Nevadunsky explains. “With good surveillance, we’re able to prevent precancerous lesions from becoming invasive.” That doesn't mean you should delay; follow all of your doctor's suggestions for follow-up appointments and exams.
If you do have cervical cancer, your treatment plan will be individualized based on the specifics of your case and what you and your doctor determine makes the best sense. Treatment options include chemotherapy, radiation, and various types of surgery, the Mayo Clinic says.
In addition to laser surgery, cryotherapy (freezing abnormal cervical tissue), and conization, another option is a trachelectomy, which removes the cervix and some surrounding tissue but doesn’t remove the uterus. (This can allow someone with cervical cancer to possibly still get pregnant in the future.) Hysterectomy to remove the cervix, uterus, part of the vagina, and some lymph nodes is also an option for treating cervical cancer, although that negates the possibility of physically carrying a pregnancy in the future. Clearly, there are a lot of different factors to weigh in this scenario, which is why talking all of this through in detail with your care team is really important.
When detected early, the prognosis and survival rate for cervical cancer is very high. If cervical cancer is found when it’s still localized to the cervix and uterus, the five-year relative survival rate is 92%, according to the American Cancer Society. (A relative survival rate is how likely someone with cancer is to survive for five years compared with someone in the general population.)
That's why it's so vital to visit your gynecologist for an annual exam and be diligent about regular cervical cancer screenings. Also, talk to your doctor about getting the HPV vaccine if you haven’t already.
If you receive abnormal Pap smear results, chances are you're going to be fine, but going to follow-up appointments and having the right procedures done is the best way you can treat any problems early and take control of your health.
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