4 things that can cause an abnormal Pap smear

Women's Health

by Baylor Scott & White Health

Mar 3, 2024

In women's health, few screenings are as vital as a Pap smear. This simple test is key in the prevention and early detection of cervical cancer and offers insight into many aspects of your gynecological health. While the majority of test results are normal, sometimes you may receive an “abnormal” Pap smear.

Here’s what to know about normal and abnormal Pap smears.

Why Pap smears are important

The Pap smear is a cervical cancer screening that allows your doctor to detect abnormal cells in the cervix before they progress to pre-cancer or cancer. It is a hugely important part of a woman’s health routine, as it’s currently the only screening test available for gynecological cancers.

A Pap smear is performed during a pelvic exam where a small brush is used to remove cells from the surface of the cervix. It was invented by Dr. Papanicolaou, which is why it’s known as a Pap smear or Pap test. After the procedure, the cells are then tested in a lab and your OBGYN shares the results with you.

The majority of test results are normal, which means you just need to continue routine screening—every three to five years depending on your age. But sometimes the results can come back as “abnormal.”

Why would a Pap smear come back abnormal?

It’s normal to worry anytime you receive an abnormal test result but know that an abnormal Pap smear doesn't necessarily mean something serious. Most often, it just indicates a need for further monitoring or follow-up tests. Your doctor will look at your test results and assess your risk as either low grade, high grade or “undetermined significance.”

When you get your test results back, your doctor will discuss all the options with you. The next steps could include:

  • Increasing surveillance by repeating a Pap smear in a year
  • A biopsy of the cervix, also called a colposcopy
  • A procedure to remove abnormal tissue from the cervix, known as an excisional procedure

Many women who have had abnormal Pap smear results go on to have normal results in subsequent screenings, which highlights the importance of regular monitoring and follow-ups with your doctor.

What causes an abnormal Pap smear?

There are several reasons why your Pap smear results may come back as abnormal and need further testing. The most common reasons are:

  • An infection of human papillomavirus (HPV)
  • An inflammation or infection of the cervix, known as cervicitis
  • Abnormal cells of the cervix, also called dysplasia
  • An “insufficient” or “unsatisfactory” Pap smear result is when not enough cells are collected from the cervix. This is not technically an abnormal Pap smear but rather an inadequate test that will require repeating the Pap smear in a few months.

Is an abnormal Pap smear always HPV?

The most common reason for abnormal Pap smear results is HPV. HPV is the leading risk factor for cervical dysplasia, which can develop into cervical cancer. Nearly all cervical cancers are caused by persistent high-risk HPV infections.

The highest rates of HPV infections occur in adolescents and young adults. While the vast majority of HPV infections (between 80 to 90%) will clear on their own, HPV infections that are persistent and have aggressive strains of the virus are more likely to cause an abnormal Pap smear result.

If your abnormal Pap smear is caused by an HPV infection, your doctor will likely proceed with the next step of investigation with a colposcopy procedure. This is performed in the doctor’s office.

The severity of the dysplasia is graded on a scale:

  • CIN1 is the mildest form of dysplasia and will likely only require increasing surveillance with more frequent Pap smears.
  • CIN2 is a moderate form of dysplasia.
  • CIN3 is the most severe form of dysplasia and has the highest risk of developing into cervical cancer if left untreated.

With CIN2 or CIN3 results, your doctor will discuss with your options for an excisional procedure of the cervix, with the goal of removing the abnormal cells before they can develop further.

Most sexually active people will develop HPV in their lifetime. People who are immunosuppressed have a higher chance of developing an HPV infection, and there are certain lifestyle factors and risks that also increase your risk:

  • Having multiple sexual partners
  • Smoking
  • Unprotected intercourse

The most effective prevention you have against developing this condition is the HPV vaccine, also known as the Gardasil vaccine. You can talk with your doctor about whether the HPV vaccine is the right choice for you.

Should I be worried about an abnormal Pap smear?

Persistent abnormal Pap smears, as well as a positive HPV status, put women at increased risk for developing severe cervical dysplasia, which can progress to cervical cancer. This is why it is so important for women to be screened routinely from the age of 21 and to continue close follow up with your doctor if you have an abnormal Pap smear.

By staying informed and proactive about your cervical health, you're empowering yourself to make the best decisions for your overall wellness.

Be sure to visit your OBGYN for regular checkups and conversations about your health. Find one near you.

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