Abnormal Pap Tests

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gynecologist office If you are reading this guide, you’ve probably already had a Pap test and may have been told by your health care provider (HCP) that your Pap test results were abnormal. Maybe you’re worried and wondering what this means and how it will affect you. However, knowing the possible reasons for abnormal results will help.

What is a Pap test?

A Pap test, also called a “Pap smear,” is part of a pelvic exam. The word “Pap” is short for Papanicolaou, which is the last name of the doctor that studied changes in cervical cells. A Pap test is usually done at age 21 unless you have special risks such as immune problems, HIV, or early sexual activity or pregnancy. It’s the only way to check the cells on your cervix for changes that can lead to cancer. Your HCP usually checks for STIs (sexually transmitted infections) such as chlamydia and gonorrhea at the same time.

How is a Pap test done?

As part of your pelvic exam, your HCP will take a thin plastic wand and a tiny brush and gently wipe away some of the cells from your cervix. Most girls don’t feel anything at all. A few girls may feel a little cramping as their cervix is gently brushed. If you feel anything, it usually lasts less than 1 minute. These cells are placed in a bottle or on a glass slide and sent to a laboratory.

A trained technician then examines the sample of cells under a microscope to see if the cells are normal, or if there are any problems. The lab then gives the results to your health care provider, who will contact you if the results are NOT normal.

Does it mean that I have cancer if I’ve been told I have an abnormal Pap?

No. 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. Sometimes special treatments are needed. Regular Pap tests and treatment, if needed, can prevent most types of cervical cancer.

What does my Pap test result really mean?

Although most Pap tests come back as normal, it’s not unusual for the test results to be abnormal if you are an adolescent.

The following words explain Pap test results:

  • Normal – This means that your cervix is healthy. Your HCP will tell you when you need your next Pap test.
  • Unsatisfactory – For some reason the sample of cells was not a good sample and can’t be read by the lab technician. Your HCP will let you know when the Pap test needs to be repeated.
  • Benign changes – This means that your Pap test was basically normal. However, you may have an infection that is causing inflammation of the cervical cells. Your HCP may do a pelvic exam to check for the cause of the infection and prescribe treatment if needed. Your HCP will tell you when you need to have a follow-up Pap test.
  • ASCUS – (which is short for “Atypical Squamous Cells of Undetermined Significance”) This simply means there are some funny looking cells on the test and more tests may be done to figure out if HPV (human papillomavirus) is the reason for the changes.

If you are healthy and your Pap shows ASCUS, you will need to have your Pap test repeated in one year. If the test (at the one year mark) is still abnormal you may need a colposcopy.

The following guidelines are for teens and young women who are 21 years of age or younger:

  • ASCUS-H – This result means that the cervical cells are not the typical cells that are found on the cervix. They are most likely related to HPV. They are considered “atypical cells of undetermined significance.” The “H” at the end of this abbreviation means that there is a possibility that “high-grade changes” may be the cause of the problem. If this is your Pap test result, you will need to have a colposcopy.
  • LSIL (Low Grade Squamous Intraepithelial Lesion) – This result usually means that you have been infected with the human papillomavirus (HPV). You will be asked to return in 12 months for a repeat Pap test. If the repeat Pap test comes back abnormal, you may be referred for colposcopy.
  • HSIL (High Grade Intraepithelial Lesion) – This result means that the cells on your cervix have changed. The results are more serious than low-grade changes. You likely do not have cancer now, but without treatment you are at risk for developing cervical cancer. Treatment can prevent this. Your HCP will recommend that you have a colposcopy.
  • AGC (Atypical Glandular Cells) – This result means that there are changes in the glandular cells of the cervix. You will need a colposcopy.
  • Cancer – Although this is very rare in young women, if your Pap test comes back showing cancer cells, you need to be seen by a gynecologist who specializes in patients with cancer (oncologist). Treatment is necessary right away and usually includes surgery. The earlier the treatment, the better your chances are of staying healthy.

If your health care provider tells you that you have LSIL or HSIL on your colposcopy test, you will need to return to your HCP for follow-up visits and have a Pap test every year for 20 years.

What if I need a repeat Pap test?

Your HCP will decide if and when you need to have your Pap test repeated.

If the Pap test is going to be repeated, you should:

  • Schedule your appointment after any vaginal or cervical infection, yeast infection, or STI has been treated (wait 2 weeks after your last dose of medicine).
  • Schedule your appointment after your period has completely stopped.
  • Not place anything in your vagina for 48 hours before your Pap test. This includes tampons, douches, creams, and foams.
  • Not have sexual intercourse for 48 hours before the test.
  • Tell your HCP if you think you might be pregnant.
  • Tell your HCP if you have any other health conditions or allergies.

What if my HCP wants me to have a colposcopy?

After the nurse asks questions (for example; “When was your last period?”), and gives you information about what to expect, you will be given a gown to wear and be asked to remove your clothing from the waist down. The health care provider will then come in and speak with you, and have you sign a consent form for the procedure. You will then lie down on the exam table and place your feet in foot holders (the same position as a pelvic exam). Next, the HCP will gently insert a speculum (just like when you have your Pap test) into your vagina in order to separate the vaginal walls so your cervix can be seen easily. The colposcope is a magnifying tool that is placed near the opening of your vagina. Your doctor will be able to see your cervix through the magnifying lens.

It might make you feel better to know that the colposcope is only placed at the outside of your vagina and does not touch you. It’s similar to a large magnifying glass that helps your HCP see the tiny cells on your cervix. Your HCP will first swab your cervix and vagina with a vinegar solution. The solution temporarily causes the unhealthy cells to change color, so your HCP can get a better look. If there are unhealthy cells, it’s likely that your HCP will do a biopsy. This is when your HCP gently removes a tiny sample of tissue (much smaller than ¼ of the size of a pencil eraser) with an instrument similar to a pair of tweezers. The tissue sample is then placed in a jar with a preservative liquid and is sent to the lab to be checked out.

Will the colposcopy procedure hurt?

The colposcopy itself usually isn’t uncomfortable. It’s really a long pelvic exam and a way for your HCP to look at your cervix. A biopsy, sometimes done at the time of a colposcopy, may be a bit uncomfortable, but this part takes less than one minute. When the tiny tissue sample is removed, some young women feel nothing, while others describe a “pinching” feeling or “mild cramps”. Your HCP may suggest taking an over the counter pain reliever such as ibuprofen or naproxen sodium before the procedure to help decrease any discomfort you may have. This is especially helpful if you tend to have menstrual cramps or if you have discomfort when you have a Pap test done. Ask about taking the medicine that you usually take for menstrual cramps. The entire colposcopy procedure takes about 15-20 minutes.

What happens after the colposcopy is over?

After the colposcopy, your HCP will explain what he or she saw through the high powered lens and if a sample of tissue was taken. It usually takes about 2-3 weeks for the results of the biopsy to be ready. Make sure to make a follow-up appointment. Be sure your HCP has your correct phone number so he or she can contact you.

  • It’s common to have slight bleeding or spotting that lasts a few days after the biopsy.
  • Use pads (not tampons) for any bleeding you might have.
  • You may see brownish material or clumps along with blood on your underwear or pad. This is not tissue. This is from a certain kind of solution your HCP used, called “Monsel’s”. The brownish clumps will last about 1 to 5 days.
  • It’s even possible to have a “blackish discharge” if the health care provider used a solution called “silver nitrate” to control the bleeding. Again, this will not last long.
  • Do not have sexual intercourse, douche, use tampons, or place anything in your vagina for at least 2 weeks.

What should I be concerned about after a colposcopy?

There are certain things your HCP should be contacted about.

Call immediately if you have:

  • Any heavy bleeding (heavier than your normal menstrual period)
  • Any bright red bleeding and you are not on your period
  • A vaginal discharge that has an odor (other than blood)
  • Severe abdominal/pelvic (belly) pain