Abnormal Pap Smears: Everything You Need To Know

Pap smears, also known as pap tests, are just one of many things women endure to maintain their vaginal health. Nobody wants a pap smear, but they’re essential for detecting potentially precancerous and cancerous processes in the cervix or colon. The Papanicolaou test (as it’s called medically) is a method of cervical screening to mainly test for cervical cancer in women. Gynecologists recommend pap tests for women ages 21 and older. 

Regular pap smears are important to detect cancer or HPV (human papillomavirus), which is the most common sexually transmitted infection. The virus is usually harmless but some types can lead to genital warts or cancer. Abnormal pap smear results could alert doctors to these possible health conditions. The sooner you have a diagnosis, the sooner you can get proper treatment. 


Women should get a pap smear every three years to check their cervix while women aged 30 to 65 can have a combination Pap smear/HPV test every five years. Before scheduling an appointment, let your doctor know if you’re menstruating because it may affect your results since your cervical cells might not show up with the additional red blood cells you’re producing. It is also recommended to avoid sexual intercourse, douching, and spermicidal products the day before the test because these interfering cells like yeast and bacteria can also influence your test results. Obviously, accuracy is the best policy when it comes to your health. 

It’s easier said than done but trying to relax during a pap smear can ease any discomfort throughout the procedure. Once you’re on an examination table with your legs spread and your feet in stirrups, the doctor will open the walls of your vagina with a speculum, a metal tool that’s used to access the cervix. Your doctor will then use a cotton swab to remove cervical cells, which they’ll send to the lab to test for abnormalities. The entire process shouldn’t take longer than 10 minutes, but the brief scraping can certainly cause mild discomfort. Still, there’s nothing to be concerned about—bleeding is normal in the first few days after your exam.

Pap smears can’t detect STIs as one might assume. “A pap smear can not detect herpes, syphilis, chlamydia, gonorrhea, or other common STDs and STIs. Additionally, it cannot detect ovarian or uterine cancers,” Priority STD explains


Most pap smear results are normal. But if you do have abnormal pap smear results, it doesn’t necessarily mean you have cancer. “Cancer is usually not the reason why your Pap test is abnormal. The most common reason for an abnormal Pap test is a vaginal or cervical infection that causes changes in the cells of your cervix. Most of these changes can be followed closely until they return to normal. Often, your body will clear the HPV infection that caused the changes all by itself,” the Young Women’s Health site explains. An estimated 79 million Americans currently have some form of HPV, and 14 million new infections occur each year, according to the CDC. 

But, some of these abnormal cells (if not found and treated), like HPV strains 16 and 18, can lead to cervical cancer. So, in most cases, doctors will do a pap test and an HPV test at the same time. You’re probably thinking: why take both tests? Well, according to the Office on Women’s Health, the Pap test can detect abnormal precancerous cells and cancerous cells early. The HPV test, on the other hand, can show whether you have a type of HPV that causes cervical cancer.

Other reasons why your cells can show up as abnormal include inconclusive results or a poor sample, as well as more serious conditions including inflammation, infection, STDs (herpes, trichomoniasis), or HPV as mentioned. 


Abnormal cells are often classified as either “low grade” or “high grade.” According to John Hopkins Medicine, a low-grade abnormal pap smear means that there are early changes in the size and shape of the squamous cells from the cervix’s surface. This categorization is often associated with HPV that may also cause genital warts. Most importantly, they are not clearly precancerous. The risk of having cervical cancer is less than 1 percent. These lesions often go away on their own within 18 to 24 months. 

High grade abnormal pap smears, on the other hand, means the squamous cells appear very different from normal cells. Thes precancerous lesions are more severe than with LSIL and can potentially develop into cancer if left untreated. 


If you receive abnormal Pap smear results, your doctor will likely recommend a colposcopy to get a closer look at your cervix. This procedure is not as scary as it sounds—it’s actually just an examination through a microscope. It can also require a cervical biopsy, which removes abnormal tissue to be tested in a lab. For patients 35 or older with high-grade cells, a biopsy will definitely be done. 

Additionally, if your test comes back unclear or inconclusive, your doctor will likely ask for a repeat test or a colposcopy and cone biopsy. A cone biopsy (shaped like a cone) is an extensive form of a cervical biopsy that removes abnormal tissue that is high in the cervical canal. 

If your doctor suspects HPV or cervical cancer, they will require additional testing to find out if that’s the case, as pap smears cannot reveal that.


In some cases, abnormal cells need to be removed to prevent them from becoming cancerous. This is done through cryosurgery, which is a type of surgery that involves the use of extreme cold to destroy abnormal tissues. 


In the early 1900s cervical cancer was the number one cause of death in women because it wasn’t preventable. Thankfully, cervical cancer has decreased drastically since the introduction of Pap smears in 1943. Because of this preventative care screening, the rate of cervical cancer dropped by about half in the United States and has continued dropping ever since.

Abnormal results cannot necessarily be prevented, but remaining proactive, getting regular pap smears, and getting vaccinated for HPV can all be helpful in ensuring serious health conditions do not develop.

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