If you have recently learned that your pap test is abnormal, you are one of almost three million women who will receive the same news this year and each of you will likely feel concerned and confused about this result. It is important to understand that an abnormal pap test (also called ‘pap smear,’ ‘cervical cancer screening,’ or ‘cervical cytology’) is almost never a diagnosis of cervical cancer but, rather, an important message to you and your provider that the cells of your cervix are beginning to grow abnormally and some additional care is required.

So What, Exactly, is a Pap Test?

After your pap is obtained during your gynecologic exam, the cells of your cervix (the lowest portion of your uterus) are carefully examined under a microscope by a cytopathologist. This person is trained to detect abnormalities in the cells and to then determine how significant the abnormalities are. An abnormal pap is ‘graded’ according to the severity of the abnormality in the cells. The most common grade is ASC-US which means ‘abnormal squamous cells – undetermined significance.’ Thereafter, the grading system moves toward progressively more significant cellular abnormalities (ASC-H, LSIL, HSIL, CIS) culminating in the rarest but most severe diagnosis of cervical cancer (CIS). There are also occasionally notations on the presence of other types of cells (glandular) that, when present, need to be evaluated by your provider.

Why are the cells growing abnormally?

98% of abnormal pap smears are caused by the human-papilloma virus (HPV) which is transmitted between people through intimate contact. It’s almost as common as the common cold with estimates ranging from 75-85% of all sexually active people acquiring the virus at some point in their lives. There are dozens of strains of the virus but only four of them are implicated in cervical cell abnormalities and genital warts. We don’t completely understand why, amid these millions of infections, only a portion of women end up with abnormal paps. We do know, however, that smoking, early initiation of sexual activity (younger than age 16), multiple partners and infrequent condom use increases the likelihood of having an abnormal pap.

What can be done about it?

Despite the fact that this feels like bad news, you can take some comfort in knowing that pap smears are one of the most effective medical procedures ever invented. In countries where they are done routinely (like the United States), cervical cancer rates have dropped by more than 70% and those cases that do occur are typically in women who have not gotten or not followed up on their paps. Also, with 60+ years of practice, we now have extremely comprehensive and effective management guidelines for cervical cell changes. The most important thing that you can do is to get the recommended follow up which may include repeat pap smears on an every-six-month schedule, additional testing to clarify the presence and type of HPV (called HPV DNA testing) and colposcopy (discussed below). We often find that the cellular changes resolve on their own and no further intervention is required. If the changes are significant or they fail to resolve spontaneously with time, you may require further intervention to remove the abnormal cells. These procedures are called “LEEPs” or “cone biopsies” and will be carefully explained by your provider if that is the recommended follow up.

What’s a colposcopy and how does it feel?

A colposcopic exam is an opportunity for your provider to try to identify the specific location of the abnormal cells on your cervix and, possibly, to get further samples of these cells (biopsies) to determine how significant the changes are. For the exam, you will be placed in the same position as for a routine gynecologic exam. A speculum is inserted and the provider uses the colposcope (which looks like a cross between a microscope and a camera on a tripod) to magnify the cervix. A solution is brushed onto the cervix which will highlight abnormal cells. All of this is generally quick and painless. If the provider can locate patches of abnormal cells, he/she will likely want to take some biopsies to send back to the cytopathologist. A numbing agent will often be applied or injected and then the biopsies are quickly taken. There is generally some discomfort (pinching and/or cramping) with this procedure but it resolves soon. Any bleeding will be treated with another solution so that, once you’re done, you should be fairly comfortable. You will be instructed to insert nothing in the vagina for one week and informed that you might continue to see some slight discharge and bleeding during that time. Once the biopsy results are back, a recommendation on follow-up will be made.

What else should I know?

Again, the good news is that pap tests generally catch cellular changes very early when they are treatable. Your job is to take care of your body and follow the recommendations your provider makes so that, together, you can get the problem resolved. If you’re a smoker, this is yet another good reason to consider quitting. Also, we discourage attempting pregnancy until we are certain that the cervical cell changes have resolved or been adequately treated; the recommendation is to wait until you’ve had three normal paps in a row (typically spaced 6 months apart) before attempting conception. So, if you are not using birth control, please discuss this with your provider. As for condom use and transmission, if you are in a long-term relationship, your partner likely already has the same HPV infection that you have so condoms are unlikely to prevent transmission in this circumstance. But, if you are in a new relationship, condoms are the best method for avoiding transmission AND exposure to other strains of HPV (you can get multiple strains). Finally, the HPV vaccine, Gardasil, is widely available and very effective. While it cannot change the outcome of your current abnormal pap test, it could prevent you from getting alternative strains of HPV in the future.