Topic Overview

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.

Cause

Most abnormal Pap tests are caused by HPV infections.

Other types of infection—such as those caused by bacteria, yeast, or protozoa (Trichomonas)—sometimes lead to minor changes on a Pap test called atypical squamous cells.

Natural cell changes that may happen during and after menopause can also cause an abnormal Pap test.

What increases your risk of having an abnormal test result?

Certain sexual behaviors —such as having sex without condoms and having more than one sex partner—increase your risk of getting an HPV infection. And an HPV infection raises your risk for having abnormal test results.

Other things that may also play a role in increasing your risk include:

• Smoking.
• Having an impaired immune system.
• Having been exposed to the drug DES while your mother was pregnant with you, though this is rare.

If you have had one abnormal Pap test result, you’re more likely to have another in the future.

Types of Results

Lab specialists label abnormal cells according to how abnormal they are—how different they are from normal cells. Knowing what type of abnormal cells you have helps your doctor decide on treatment.

Minor cell changes

Minor cell changes may disappear without treatment. But sometimes they turn into more serious cell changes. Types of minor cell changes are:

• ASC-US or ASC-H. These are changes for which the cause is unknown. ASC-US changes usually stay the same or return to normal. ASC-H changes are also minor but have a higher likelihood of becoming more serious.
• LSIL. These changes may be more likely to become more severe over time, but even when they do, they usually return to normal.

Moderate to severe cell changes

Moderate to severe cell changes —HSIL and AGC—are more likely to be precancerous and turn into cervical cancer if left untreated.

In some countries, other labeling systems are used. These systems may use the term dysplasia to describe cervical cell changes. Or they may simply describe the changes as mild, moderate, or severe.

Follow-Up Tests

When your Pap test result is abnormal, you always need to follow up with your doctor. Often this just means having regular checkups and Pap tests. But sometimes it means more tests or treatment.

It’s very important to complete any further testing that your doctor recommends.

Watchful waiting

Most women won’t need special testing or treatment. Instead, they’ll follow a schedule of regular Pap tests to watch for cell changes. This is called watchful waiting. It may be recommended when:

• You have a treatable infection in the vagina or cervix.
• You have an HPV infection. Most low-risk types of HPV go away on their own within 6 to 18 months.
• Your cell changes are minor.

It’s okay to do nothing but watch and wait, because minor cell changes such as ASC-US or LSIL don’t usually become more severe during a short period of watchful waiting.

Watchful waiting may not be a good choice if you don’t think you’ll be able to follow your doctor’s recommendations about having regular Pap tests. Talk with your doctor about your testing choices.

More testing

After an abnormal Pap test, you may need more tests to look for infection or to find out more about your cell changes. These tests include:

• HPV test. This test looks for high-risk types of HPV (human papillomavirus). Knowing whether you have a high-risk type of HPV can help guide your treatment decisions.
• Colposcopy. In this test, your doctor uses a magnifying instrument to look at your vagina and cervix. The doctor takes a small sample of tissue so that it can be examined under a microscope.
• Cone biopsy. A cone biopsy removes a little more tissue than a cervical biopsy. It may also serve as treatment by removing the abnormal cells.
• Tests for other infections,such as other sexually transmitted infections, a yeast infection, or a bacterial infection.

Treatment

The type of treatment you have will depend on what caused the abnormal test results.

Infection: If your abnormal test results were caused by a vaginal infection or a sexually transmitted infection, you can be treated with medicine.

Menopause: Women near menopause may have abnormal results because of normal body changes during menopause. These minor cell changes may improve with the use of estrogen cream.

Moderate or severe cell changes, such as HSIL. Your treatment will focus on destroying or removing the abnormal tissue. Treatment choices include:

• Cone biopsy.
• Loop electrosurgical excision procedure (LEEP), which uses a thin, low-voltage electrified wire loop to cut out abnormal cervical cells.
• Cryotherapy, which destroys abnormal cervical cells by freezing them.
• Laser therapy, which uses a laser beam to destroy abnormal cervical cells.

For cervical cancer, treatment will focus on destroying or removing the cancer. To learn more, see the topic Cervical Cancer.

A pregnant woman with an abnormal Pap test is monitored closely throughout her pregnancy. Monitoring may include a colposcopy. The goal is to rule out cervical cancer, a rare diagnosis. If cancer is ruled out, treatment for abnormal cell changes is done after delivery.