Abnormal Pap Test

As part of your routine gynecologic exam, you will have a Pap test (also called a Pap smear). A Pap test is used to identify abnormal cell changes on your cervix and to screen for cervical cancer.

An abnormal Pap test indicates that cells on your cervix have changed. An abnormal Pap test result is not uncommon because the cells of the cervix normally undergo constant change. About 5% to 10% of women who have a yearly Pap test will have an abnormal result, but only a small percentage of these abnormal results indicate changes that may progress to cervical cancer.

What causes an abnormal Pap test?

Many abnormal Pap tests are caused by viral infections, such as human papillomavirus (HPV) infection, or other types of infection, such as those caused by bacteria, fungi (yeast), or protozoa (Trichomonas). Natural cervical cell changes (atrophic vaginitis) related to menopause can also cause an abnormal Pap test. Usually cell changes return to normal on their own or after an infection has been treated or has resolved on its own.

In some cases, untreated cervical cell changes that cause abnormal Pap tests may progress to precancerous or cancerous stages. Certain high-risk types of HPV, especially types 16 and 18, have been linked to the development of cervical cancer. However, changes in cervical cells usually progress slowly and take many years to become cancer cells.

What increases my risk for an abnormal Pap test?

Most cervical cell changes are the result of high-risk sexual behaviors by you or your partner, such as having multiple sex partners and not using condoms. These behaviors increase your risk of infections and sexually transmitted diseases (STDs). If you are in a single-partner (monogamous) relationship, an abnormal Pap result caused by HPV may not indicate current high-risk behavior. Since the HPV virus remains in body cells for many years, abnormal cervical cell changes can be the result of an HPV infection years earlier.

Smoking or having an impaired immune system also may increase your risk for cervical cell changes.

Having regular Pap test screening and follow-up evaluation of any abnormal results can reduce your risk of developing cervical cancer.

Will I have symptoms that indicate cervical cell changes?

Abnormal cervical cell changes themselves do not cause symptoms. An HPV infection, the most common cause of abnormal cervical cell changes, usually does not cause symptoms. This is why regular Pap test screening is so important.

If an STD is the cause of your abnormal Pap test, you may have symptoms from the STD. STDs can have a variety of symptoms, including:

  • Abnormal vaginal discharge, such as a change in the amount, color, odor, or texture.
  • Pain, burning, or itching in the pelvic or genital area during urination or during sexual intercourse.
  • Sores, lumps, blisters, rashes, or warts on or around the genitals.

What will I need to do if I have an abnormal Pap test?

Even though most abnormal Pap tests are caused by infections or inflammation that can be treated, you will need a follow-up evaluation to make sure your abnormal cell changes have been resolved. Your treatment choices will vary depending on whether your abnormal cell changes are mild, moderate, or severe.

  • If you have minor cervical cell changes, you may choose monitoring by your doctor (watchful waiting), an HPV test, or in some cases colposcopy.
  • If you have moderate to severe cervical cell changes, you will need further evaluation by colposcopy and possibly a cervical biopsy. Then treatment that specifically destroys or removes the abnormal cells may be recommended depending on the biopsy result