Getting a call that your Pap smear came back abnormal can be alarming. But before worry sets in, it is important to understand what that actually means. An abnormal Pap smear does not mean you have cancer. In the vast majority of cases, it means something much more manageable is going on, and that your body’s early warning system is doing exactly what it is supposed to do.
At Tidewater Physicians for Women, Pap smears and follow-up care for abnormal results are part of the comprehensive gynecology and women’s health services we provide in Virginia Beach and Norfolk. Here is a clear breakdown of what abnormal results mean and what happens next.
What a Pap Smear Tests
A Pap smear collects cells from the cervix and examines them for changes in their appearance. The test is designed to detect precancerous changes before they ever develop into cervical cancer, which is exactly what makes it one of the most effective cancer screening tools available. Pap smears are often combined with HPV testing since most cervical cell changes are caused by certain strains of human papillomavirus. A co-test that includes both provides more complete information and guides follow-up decisions more precisely.
The Spectrum of Abnormal Results
ASC-US: Atypical Squamous Cells of Undetermined Significance
This is the most common abnormal result and the least concerning. It means some cells look slightly unusual, but the change is not clearly defined. ASC-US is most often caused by HPV, inflammation, or a minor infection, not precancer. The typical next step is HPV testing if not already done, or a repeat Pap in 1 to 3 years. Many ASC-US results resolve completely on their own as the immune system clears whatever caused the change.
LSIL: Low-Grade Squamous Intraepithelial Lesion
LSIL indicates mild cell changes, typically caused by HPV infection. In most cases, especially in younger women, these changes resolve without any treatment as the immune system does its work. Follow-up usually involves a colposcopy or a repeat Pap in a defined timeframe, depending on your age and HPV status.
HSIL: High-Grade Squamous Intraepithelial Lesion
HSIL represents more significant cell changes that are more likely to progress to cervical cancer if left unaddressed. This result typically warrants prompt follow-up, usually a colposcopy and possibly a biopsy. If the biopsy confirms high-grade changes (classified as CIN 2 or CIN 3), treatment is usually recommended to remove the abnormal tissue before it can progress further.
AGC: Atypical Glandular Cells
AGC involves cells from the glandular lining of the cervix or uterus rather than the surface cells. This result requires more thorough evaluation, typically colposcopy plus endocervical sampling and sometimes endometrial sampling, because glandular cell changes can occasionally indicate abnormalities higher up in the uterus.
ASC-H: Atypical Squamous Cells, Cannot Exclude HSIL
A step above ASC-US, this finding suggests cells that cannot be clearly classified but may represent high-grade changes. Colposcopy is typically the next step, similar to HSIL management.
What Is a Colposcopy?
If your Pap result warrants a closer look, your provider may recommend a colposcopy. A colposcope is a magnifying instrument that allows a detailed examination of the cervix after applying a solution that highlights any abnormal areas. If something looks concerning, a small biopsy may be taken during the same appointment. The procedure is typically well-tolerated with mild cramping and takes only a few minutes. Colposcopy is one of the in-office procedures we offer at Tidewater Physicians for Women, so no hospital visit is required.
What Is a LEEP Procedure?
LEEP stands for Loop Electrosurgical Excision Procedure. A thin wire loop carrying a small electrical current is used to remove the abnormal tissue from the cervix. The tissue is sent to a lab to confirm the margins are clear. LEEP is typically performed in-office or in an outpatient setting, takes only a few minutes, and has an excellent success rate for treating high-grade cervical changes.
HPV and Its Role in Cervical Cell Changes
Human papillomavirus is responsible for nearly all cervical cell changes detected on Pap smears. HPV is extremely common and most infections are cleared by the immune system within 1 to 2 years without causing any lasting problems. It is the persistent infection with high-risk strains, particularly types 16 and 18, that can lead to cell changes over time. A positive HPV test is not a reason to panic. It is information that helps guide how closely and how often your cervix needs to be monitored.
How Often You Need a Pap Smear
Current guidelines from ACOG and the U.S. Preventive Services Task Force recommend:
- Ages 21 to 29: Pap smear alone every 3 years. HPV testing is not recommended in this age group.
- Ages 30 to 65: Preferred approach is co-testing (Pap plus HPV) every 5 years. Pap smear alone every 3 years is also acceptable.
- After age 65: Screening can be discontinued if you have had adequate prior screening with normal results and no history of high-grade abnormalities in the past 25 years.
Women with a history of abnormal results, high-risk HPV, or certain medical conditions may need more frequent screening. Your provider will tailor your schedule accordingly.
The Most Important Thing to Do
Follow through on recommended follow-up. Abnormal Pap results are not emergencies, but they do require attention. The entire system, from Pap smears to colposcopy to LEEP, exists to catch and address changes early, well before cancer has a chance to develop. The vast majority of women who follow through on recommended care never develop cervical cancer. That outcome is exactly what this screening is designed to achieve.
If you have questions about a recent result or it is time for your annual exam, our gynecology team in Virginia Beach and Norfolk is here to walk you through it at every step.
Questions About Your Pap Results? Let’s Talk.
We know an unexpected result can feel unsettling. Our team is here to explain what your results mean, what follow-up is recommended, and what you can expect along the way.
To learn more or schedule an appointment, Schedule your gynecology appointment in Virginia Beach or Norfolk or call us at 757-461-3890.
