Women's Health Matters

Text Size
Jump to body content

What an abnormal Pap smear means, and what comes next

Abnormal Pap smears happen. Here's what you need to know. 

women holding hands

No one wants to get a call from their healthcare provider explaining that their recent Pap smear came back abnormal. First things first: Take a deep breath - if your results ever come back abnormal, know that going to follow-up appointments and having the right procedures done is the best way to find and treat problems early. “Over the last 60 years, cervical cancer rates have decreased by 70 to 80 percent in Canada due to the use of the Pap,” says Dr. Amanda Selk, a gynecologist at Women’s College Hospital.

What causes abnormal Pap results?
The Pap smear is testing for changes or abnormalities in cervical cells that could be precancerous. What happens after an abnormal Pap smear will depend on your situation and the details of your results. “The most common abnormal Pap result is ASCUS (atypical squamous cells of undetermined significance), says Dr. Selk. “These cells can form as a result of inflammation from yeast infections, bacterial vaginosis or recent sexual activity.” In this case, your healthcare provider may ask you to come back for another Pap test in another six months. Some provinces use human papillomavirus (HPV) tests to follow up on abnormal Pap results as part of their cervical cancer screening programs. HPV testing is most effective for women aged 30 and older.

What about HPV?
Other times abnormal results signal an HPV infection. A Pap result referred to as LSIL (low-grade squamous intraepithelial lesion) can indicate there’s a current HPV infection, which, in most cases, will clear on its own without any other intervention. Your healthcare provider will likely have you follow up with a Pap smear in six months or they may send you to colposcopy.

Pap smears that come back with a red flag are most likely HSIL (high-grade squamous intraepithelial lesion), which signal a more serious change than LSIL cells. With HSIL, the next step for people of any age is a colposcopy, a diagnostic procedure in which a gynecologist examines your cervix with a microscope and applies a solution made of acetic acid (essentially vinegar) to the area. Some people say this procedure is uncomfortable, but it doesn’t typically hurt. If your doctor notices any changes during this exam, they may take a small piece of tissue (a biopsy), which can return a number of possible results that will require follow-up procedures.

Sometimes, an excisional treatment may be appropriate, especially when HSIL is found. A loop electrosurgical excision procedure (LEEP) uses a thin wire loop to cut away a thin layer of surface cells. This procedure removes very abnormal cells, so they don’t progress to cancer. Your cervix is numbed to ease discomfort. The process is relatively quick and, similar to the colposcopy, may be uncomfortable but typically doesn’t hurt. 

The bottom line
Try not to panic. These screenings and procedures are designed to detect and treat changes to your cervix in order to prevent cancer. In addition, the HPV vaccination has the potential to substantially reduce HPV infections and subsequently cervical cancer. The success of the HPV vaccine in countries like Australia, which introduced a free national HPV vaccination program in 2007, has shown a significant decline in infections that cause cervical cancer later in life.

THE EXPERT Dr. Amanda Selk, gynecologist, Women’s College Hospital

This information is provided by Women's College Hospital and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition. This document was last reviewed on February 28, 2020.

Jump to top page
  • A publication of:
  • Women's College Hospital