Every few years starting at a particular age, your gynecologist starts recommending a pap smear along with your annual pelvic exam. So what’s the difference? And why do we need pap smears? We’ll go deep on what a pap smear is, why the result might be considered abnormal, and what this abnormality means for your health.
What is an abnormal pap smear?
A pap smear, a type of cervical screening test, removes cells from a specific part of the cervix for examination of the cells. Cellular changes in these samples can indicate health concerns, including cervical cancer. This test is often done in conjunction with a pelvic exam when you visit your gynecologist.
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What causes an abnormal pap smear?
Human Papillomavirus (HPV) is a sexually transmitted infection that is often the cause of an abnormal test result. Cellular changes due to HPV often go away on their own, but some types of HPV are known to have a high likelihood of leading to cervical cancer. Other infections, including bacterial and yeast infections, can also cause abnormal pap smear results. These infections are often treatable when caught early, and often treated with antibiotics. Abnormal results may also be due to menopause. It’s normal for your cells to change as you age.
Abnormal pap smear results may be impacted by:
- Sex without condoms (increases risk of HPV)
- Number of sexual partners (increases risk of HPV)
- An impaired immune system
What does it mean if you have an abnormal pap smear?
If you have an abnormal pap smear result, it does not mean you have cancer, although it’s a type of cervical cancer screening test. Less than one percent of these women receive a diagnosis of cervical cancer. Cell changes or HPV don’t usually display obvious symptoms but, if abnormal results are due to sexually transmitted infections, you might have noticeable discomfort. Abnormal vaginal discharge, discomfort (pain, burning, or itching) when you pee or have sex, or physical changes to your genitals are all possible. Some abnormalities of discharge might be changes in the amount, color, odor, or texture. You can also have sores, rashes, blisters, warts, or lumps on or around your genitals.
When classifying what’s going on, cellular changes might be called mild, moderate, or severe. Minor cell changes can disappear on their own, but they also can become something more serious. As the severity of cellular change increases, so does the risk of cervical cancer, especially if left untreated. Pap smear results that are considered abnormal come in many forms. When thin, flat cells change appearance, they might be called atypical squamous cells of undetermined significance (ASCUS).
Your primary care provider may also test for HPV if ASCUS is the result of your pap smear. If you are over the age of 30, it is recommended that you have co-testing for HPV done at the time of your pap smear. Squamous intraepithelial lesions might be precancerous and more testing is likely. If a pap smear shows atypical glandular cells, your primary care provider might order tests such as colposcopy to watch for cancer. With adenocarcinoma cells, cancer is more likely, and your primary care provider will probably recommend further testing. To get a more accurate diagnosis, you may need a colposcopy and biopsy.
When is further testing needed?
Sometimes doctors might recommend the watchful waiting approach, with a repeat pap smear +/- co testing with HPV in 6 months or 1 year. Instead of special testing or treatment, watchful waiting involves following a regular schedule of pap tests looking for any changes in your cells. Other times, further testing is necessary. Possible tests include:
- Colposcopy (usually before recommending any treatments)
- HIV test or tests for other infections
- Cone biopsy
- Another pap smear 6-12 months after the abnormal result
Cervical dysplasia, a precancerous condition, might be found with further testing. In these cases, abnormal cells are growing on the cervical lining. More severe cases can lead to cervical cancer if the condition is left untreated. It takes time for cervical dysplasia to become cervical cancer, often several years, and treatment is highly effective in the early stages.
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Getting in tune with your health
Regular pap smears help with the early detection of cervical cancer and can inform you about other possible health conditions. So when do you get tested? Recommendations say:
- If you are 21-29 years old, guidelines recommend a pap smear every three years
- If you are 30-65 years old, guidelines recommend a pap smear and an HPV test every five years
- More frequent testing may be needed if you have a history of cervical cancer or pap smear results showing precancerous cells, HIV/AIDs, a weakened immune system, or a history of smoking.
If you’ve had a total hysterectomy or are over the age of 65 and have had no positive cervical cancer tests, it might be possible to stop testing regularly. We recommend discussing your options with your primary care provider or OBGYN.
Treatment will depend on the cause and severity of the abnormality. If the result is due to infection, you might be prescribed medication. You can treat minor cellular changes due to menopause with estrogen cream. Moderately or severely affected cells will be removed or destroyed in treatment. Methods include cone biopsy, electrosurgical excision, cryotherapy, or laser therapy. If you have specific concerns, we suggest discussing your options with your primary care provider.