An abnormal Pap smear may show that you have an infection or dysplasia which can also be called an abnormal cell.  Your Pap test should be done to know whether you have a problem or not and if the results of your test are positive, that means your GP has found abnormal or unusual cells on your cervix, but this doesn’t mean you have cervical cancer.

Having an abnormal pap smear in most cases means there have been cell changes caused by the human papillomavirus (HPV). The human papillomavirus is the most common sexually transmitted infection (STI) that can be linked to cervical cancer. Changes to your cervical cells caused by HPV are in stages which may be mild, moderate, or severe.

Abnormal Pap smear Causes

Abnormal results mean there is an inflammation which is probably not a problem to worry about,  or you have HPV which is common, or in some cases, your doctor has identified potentially precancerous cells.

The most common abnormal Pap result is atypical squamous cells of undetermined significance (ASCUS) that forms as a result of inflammation from yeast infections, and bacterial vaginosis. It may also result from something as simple as washing underwear with new detergent or using condoms different from what you have been used to.

Low-grade squamous intraepithelial lesion (LSIL) is the next critical stage after ASCUS, but you can rest assured it is not something to worry about. Presence of LSIL cells shows that there is a current HPV infection. At this stage, a test for HPV may be conducted to determine if the strain causing the infection is the same as the one causing cervical cancer.

Colposcopy is the next step of Pap test to be taken after LSIL and biopsy may follow after that if necessary. Women under 25, or above 30 that are confirmed HPV negative will be asked by their GP to repeat Pap in 12 months instead of jumping right to a colposcopy. The chance of LSIL developing into cancer is very low if precancerous cells are present, there will have to be proper follow-up schedule with regular Pap smears to check and make sure they don’t come back.

When Pap smears come back with a red flag, they are most likely to be HSIL (high-grade squamous intraepithelial lesion), but could also be “atypical squamous cells.

HSIL cells cause a more serious change than LSIL cells and are called “precancerous” sometimes because there is a greater chance of becoming cancerous. At this stage, colposcopy is the next step, and the results will determine if biopsy will be included.

A biopsy can only be done for two reasons which are:

  • if there is a resemblance of precancerous cells
  • or if there is a part of the cervix that needs to be seen.

If biopsy results are negative, there is a need to see your GP regularly to keep checking in on the abnormality until it clears up.

Treatment for an abnormal Pap smear

When you are positive to Pap test, it shows the presence of abnormal cells which is also referred to as abnormal Pap. This is just a test, not a diagnosis, so a positive result does not prove that you have cancer or dysplasia which is a pre-cancerous condition. It would be best if you carried out further evaluation such as another Pap smear, a colposcopy, or a biopsy.

One out of every ten Pap smears shows some abnormality but most are not always serious. You will need to carry out further testing to determine if you have infections, inflammation, a yeast infection, trichomoniasis, herpes or the Human Papillomavirus (HPV). The main risk of cervical cancer is HPV but do not develop into cervical cancer if abnormal cells caused by HPV are treated.

A screening test can be done in conjunction with a Pap smear to determine if you have HPV. High-risk types of HPV can be detected by HPV DNA test before any abnormal cells can be detected on the cervix. The screening is mostly recommended for women over the age of 30, who are at an increased risk of HPV infection turning into pre-cancerous cells.

A persisting abnormal cell needs further treatment which may include the following:

  • Colposcopy: In thisexamination, a speculum is inserted into the vagina, and the cervix is painted with a vinegar solution that makes any abnormal areas identifiable. When an abnormal area is located, a biopsy is carried out which involves the removal of some tissues from the identified area for accurate diagnosis by a pathologist.

  • Cryosurgery: this is also called freezing of the abnormal cells. It is usually performed next after colposcopy. Cone biopsy is a procedure in which a triangle of cervical tissues are removed including the abnormal cells which may lead to bleeding and watery discharge.
  • The LEEP procedure: In the LEEP procedure, the loop-shaped instrument is used to remove the abnormal area of the cervix. It is similar to a cone biopsy where bleeding and discharge also follows.

Check-ups after treatment

Check-ups are necessary after treatment to make sure all the abnormal cells are gone and the cervix has healed. Early abnormal cell detection helps to minimise the risk of cancer developing.  Women should be advised after treatment by their GP on how often they will need to have routine Pap smears.

Having abnormal pap smear during pregnancy

Having a Pap smear during pregnancy is very safe. Colposcopy could be performed during pregnancy if your Pap smear results are abnormal. However, further treatment will probably be delayed until after your baby is born. The birth of your baby will wash away any abnormal cervical cells. Having an abnormal Pap smear does not pose a risk to your baby.