Lisa Savage, MD


Article: Abnormal Pap Test Results

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The Pap test is a way to find cell changes on the cervix. If a Pap test shows these changes, the result will be called abnormal. In some cases, these abnormal cells may lead to cancer. You may need treatment. In most cases, the treatment will be performed in your doctor's office with good results.

The Cervix

The cervix is the lower, narrow end of a woman's uterus. It opens into the vagina (the birth canal). The cervix is covered by a thin layer of tissue. This tissue is like the skin inside your mouth.

The Pap Test

The Pap test, sometimes called a Pap smear or cervical cytology screening, is an important part of women's health care. This test looks at cells taken from the cervix.

Most labs in the United States use the "Bethesda System" to describe Pap test results. With this system, your results will be placed in one of several groups:

  • * Normal (negative): There are no signs of cancer or precancer.
  • * Atypical squamous cells (ASC): Some abnormal cells are seen.
  • * SIL (squamous intraepithelial lesion): Changes are seen in the cells that may show signs of precancer. o * LSIL: Early, mild changes are seen in the cells. o HSIL: Moderate or severe cell changes are seen.
  • * Atypical glandular cells: Cell changes show that further testing is needed because of an increased risk of precancer or cancer of the cervix, uterus or other female reproductive organs.
  • * Cancer: Abnormal cells have spread deeper into the cervix or to other tissues.

Abnormal Results

A Pap test result that is not normal usually is caused by an infection such as human papillomavirus (HPV) or types of vaginal irritation.

Squamous Intraepithelial Lesion

SIL is found in women of all ages. It can range from mild, moderate and severe to carcinoma in situ (CIS). CIS is not yet cancer.

Human Papillomavirus Infection

Human papillomavirus infection can cause abnormal Pap test results. However, most women infected with HPV have normal Pap test results. It is a very common infection that can be passed from person to person.

Certain types of HPV are linked to cancer in both women and men.

In some cases, an HPV test can be done to help clarify the Pap test results.

Further Testing

A woman who receives an abnormal Pap test result may need further testing. Sometimes you may only need a repeat Pap test because many cell changes go away on their own. Further testing methods, such as colposcopy and biopsy, can help identify the reason for the abnormal test result.


Colposcopy lets your doctor look at the cervix through a special device similar to a microscope. It can detect problems of the cervix that cannot be seen with the eye alone.


If an area of abnormal cells is seen, your doctor may decide that a cervical biopsy is needed.


Treatment of cervical changes depends on the severity of the problem.

Electrosurgical Excision

Electrosurgical excision often is used for women with HSIL. This method is sometimes called a loop electrosurgical excision procedure (LEEP). LEEP often is done in the doctor's office.

Cone Biopsy

Another technique used to obtain a tissue sample is a cone biopsy. In this procedure, a cone-shaped wedge of the cervix is removed. General or spinal anesthesia may be used for a cone biopsy.

Freezing and Laser Treatment

With cryotherapy, abnormal tissue is frozen and later sheds. Sometimes, laser treatment in which a beam of light destroys abnormal tissue is used.


Although problems seldom occur after treatment for cervical changes, there are some risks. You may be at increased risk for preterm birth or infertility. There is also a risk of infection after the procedure.


It may take a few weeks for your cervix to heal. While your cervix heals, you may have:

  • * Vaginal bleeding (less than a normal menstrual flow)
  • * Mild cramping
  • * A brownish-black discharge
  • * A watery discharge (with cryotherapy)

For a few weeks after the procedure, you should not have sex or use tampons or douches.

Finally ...

If you are concerned about abnormal Pap test results, talk to your doctor. Keep in mind that most problems that cause abnormal Pap test results, when found early, can be treated.

This excerpt from ACOG's Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.

To ensure the information is current and accurate, ACOG titles are reviewed every 18 months.


Copyright © Dr. Lisa Savage, MD. All rights reserved.