My Pap Smear Was Abnormal. Should I Be Worried?

My Pap Smear Was Abnormal. Should I Be Worried?

Does an irregular Pap test always mean you have cervical cancer?

A Pap smear, a test that screens for cervical cancer, may not be the most dignified medical test for a woman—even peeing on a stick to see if you’re pregnant pales in comparison to lying on an exam table, stripped from the waist down, with your feet up in stirrups. But it’s an important one. According to the Centers for Disease Control and Prevention (CDC), around 12,000 women in the US develop cervical cancer each year, and about 4,000 women die from it. Because cervical cancer often has no symptoms until it becomes advanced, getting screened early is critical.

Pap smear results are usually described as "normal" (no changes in cervical cells), "unclear" (cervical cells might be abnormal) or "abnormal" (cell changes found). The good news: Relatively few Pap smear results are abnormal. “It's actually not that common," explains Glenn Bigsby, DO, a gynecologic oncologist at Presbyterian/St. Luke's Medical Center and Pediatrix Obstetrix Medical Group of Colorado in Littleton. "Probably about 10 to 15 percent of patients in general will have an abnormal Pap smear during their lifetime.”

Still, getting an abnormal result can be scary. If your test is abnormal, don't panic: It doesn’t always mean you have cancer. Here's what could be behind your Pap results:

  1. HPV. The biggest risk factor for an abnormal Pap smear is HPV, a sexually transmitted infection that can lead to cervical cancer, says Dr. Bigsby. Getting the HPV vaccine—which experts recommend for all girls and boys ages 9 through 26—can "significantly decrease your risk of getting HPV, and/or an abnormal Pap smear," Bigsby explains.
  2. Infection. Sometimes an ordinary yeast infection will throw off a Pap test result. “The test is not designed to diagnose infections," says Bigsby. "They’re just sometimes found at the time of the Pap smear.” If a yeast infection shows up, your doctor will be able to determine proper treatment.
  3. Menopause. Women in menopause may have abnormal Pap results caused by vaginal dryness or thinning of the walls of the vagina or cervix. These changes are triggered by the loss of estrogen during menopause and are not related to HPV or cancer.

If your Pap results are abnormal—or even unclear—your doctor may order one or more of these tests:

  • Repeat Pap. Sometimes a Pap smear shows irregular cells called atypical squamous cells of undetermined significance, or ASC-US. Often these cells are simply caused by inflammation, and they'll soon return to normal on their own. “We’ll repeat those Pap smears in a short amount of time, just to be sure," Bigsby says.
  • HPV test. This test can be done either as part of regular screening, or if your Pap shows irregular cells. "Typically we don't do HPV testing on a regular basis until you’re over the age of around 25 to 30," Bigsby says. The test looks for pieces of HPV DNA within cervical cells, and the cells are collected the same way as the Pap—in fact, they may be done with the same sample.
  • Colposcopy. “A colposcopy is a more directed diagnosis of precancerous cells,” says Bigsby. The procedure takes 10 to 20 minutes in your doctor’s office. Just like a regular pelvic exam, you’ll lie on an exam table with your legs up so the doctor can position a speculum in your vagina to hold it open and create a clear view of your cervix, which your doctor will examine with the help of a special magnifying lens. He or she may swipe a solution on your cervix to highlight suspicious cells, which could cause some stinging or tingling.
  • Biopsy. There are several types of cervical biopsies, but all involve taking a sample of tissue to check for signs of developing cancer. The test usually doesn’t hurt, although you may feel some pressure or cramping. The biopsy can confirm a cancer diagnosis. If the doctor is able to get all the cancerous or pre-cancerous cells at once, you may not need further treatment.

Related Video: How Frequently Should I Get a Pap Smear?

Medically reviewed in August 2018.

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