Receiving a call or a patient portal message stating that your recent Pap smear was abnormal can cause an immediate wave of anxiety. It is completely natural to worry, but the most important thing to know right away is that an abnormal cervical screening result rarely means you have cancer. Instead, it typically indicates that mild cellular changes have been detected on your cervix. These changes require careful follow-up monitoring or further diagnostic testing to ensure they do not develop into something more serious over time.
Understanding your result and knowing what abnormal pap smear next steps include can help you approach your follow-up care with clarity and confidence.
What Causes an Abnormal Pap Smear Result?
A Pap smear is a screening tool designed to collect a small sample of cells from the surface of your cervix so they can be examined under a microscope. The most common driver of an abnormal result is the Human Papillomavirus, which is a highly common virus passed through sexual contact. Most adults will contract HPV at some point in their lives, and the immune system often clears the virus on its own without you ever knowing it was present.
However, in some cases, certain strains of the virus persist and cause temporary changes in the cervical cells. Other non-viral factors can also cause a mildly abnormal result, including localized cervical inflammation, recent sexual intercourse before the test, or a vaginal infection like yeast or bacterial vaginosis.
Deciphering the Terminology of Cervical Screenings
When you review your lab report, you will see specific medical abbreviations that describe the nature of the atypical cells. Knowing what these terms mean can make the discussion with your provider much easier.
- ASC-US: Atypical Squamous Cells of Undetermined Significance. This is the most common abnormal result. It means the cells look slightly unusual, but it is unclear whether the change is due to HPV, inflammation, or a simple irritation.
- LSIL: Low-Grade Squamous Intraepithelial Lesion. This indicates mild cellular changes that are typically caused by a recent HPV infection. These changes often revert to normal on their own without treatment.
- HSIL: High-Grade Squamous Intraepithelial Lesion. This suggests more significant, moderate-to-severe cellular changes that are less likely to resolve on their own and require prompt diagnostic follow-up to prevent progression.
| Cervical screening result | What the lab finding indicates | Typical medical recommendation |
| ASC-US | Mildly atypical cells with an unclear underlying cause | An HPV test is performed; if negative, you repeat screening in a year. If positive, a colposcopy may be needed |
| Positive HPV Test | The presence of the virus is detected, regardless of current cell changes | Dependent on your age and prior screening history; often monitored or evaluated with a colposcopy |
| LSIL or HSIL | Low-grade or high-grade cellular changes are present on the cervical surface | A colposcopy is typically scheduled promptly to examine the cervical tissue closely |
The Next Step: What is a Colposcopy?
If your screening result indicates a more prominent change or a persistent HPV infection, your provider will likely recommend a colposcopy. A colposcopy is a simple, highly effective in-office procedure that allows your doctor to look closely at your cervix using a specialized magnifying instrument called a colposcope. The instrument remains outside your body throughout the brief visit.
During the procedure, you will position on the exam table just as you do for a routine Pap smear. Your provider will insert a speculum and apply a mild vinegar solution to your cervix using a cotton swab. This solution highlights any atypical cells, causing them to appear white under the colposcope light. If unusual areas are identified, your provider will take a tiny tissue sample, which is called a biopsy. This sample is sent to a laboratory for definitive analysis.
How to Prepare Before Your Colposcopy Appointment
Preparing for a colposcopy requires minimal effort, but a few guidelines can support an accurate result. Try to schedule the procedure for a week when you do not expect to have your menstrual period, as heavy bleeding can obscure the view of the cervical tissue. For 24 to 48 hours before your appointment, do not engage in vaginal intercourse, and avoid using tampons, vaginal creams, douching products, or vaginal medications.
If a biopsy is performed, you may feel a brief pinch or mild cramping. Taking an over-the-counter pain reliever like acetaminophen shortly before you arrive can help minimize any post-procedure discomfort.
Trusting Your Care Team for Personalized Follow-Up
The ultimate goal of cervical screening is early detection. Because cervical cell changes develop very slowly over many years, staying current with your recommended follow-up appointments is the most effective way to prevent cervical complications entirely. Once your biopsy results return from the lab, your provider will discuss whether you simply need a repeat Pap test in a year or whether a minor procedure is appropriate to remove the atypical cells.
Your gynecologic care should always feel like a collaborative partnership. Bring your questions and your concerns to your care team, and let them guide you safely through your screening results.
If you have received an abnormal cervical screening result or need to schedule a follow-up colposcopy, schedule an appointment with Women’s Integrated Healthcare in Southlake or Fort Worth.
References
- American College of Obstetricians and Gynecologists. (2021). Cervical Cancer Screening: Updated Guidelines.
- American Society for Colposcopy and Cervical Pathology. (2020). 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors.
