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After an Abnormal Pap: 4 Things You Should Do Next

An abnormal Pap test result doesn’t have to be scary when you know the right steps to take

First, understand what a Pap test is

A Pap test (or Pap smear) is a routine screening that looks for abnormal cells on the cervix that could lead to cervical cancer. During the test, a health care provider uses an instrument called a speculum to widen the vagina so the cervix is visible. The provider then uses another instrument to brush or scrape a small sample of cervical cells that are sent away for laboratory analysis. (This Pap smear myth drives ob/gyns crazy.)

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Don’t panic: an abnormal Pap is not uncommon

If your Pap test comes back with an abnormal result, there’s no need to flip out or feel alone—you have plenty of company. “An abnormal Pap smear result can be a scary experience, but it's very important not to panic,” says Abigail Cutler, MD, Greater New Haven OB/GYN Group, an affiliated practice of Yale Medicine, Connecticut. Most women with abnormal cervical cancer screening results do not have cancer, according to the American Academy of Family Physicians (AAFP). Remember that an abnormal result does not mean you have cancer; it only means there are cell changes on your cervix that may progress to cancer over time if left untreated. “The reason you're getting a Pap smear is exactly so we have an opportunity to detect any suspicious changes on your cervix before they become a problem,” says Dr. Cutler. Here are 13 health secrets your vagina wishes it could tell you.

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Understand what an ‘abnormal’ Pap smear means

An “abnormal” Pap test result could mean a number of things. In some cases, the initial test can determine enough information from your tissue sample to characterize the abnormality as “low grade” (less severe) or “high grade” (more severe), according to the AAFP. In other cases, the test can’t tell enough about the abnormality to determine its significance. In general, the most common culprit behind an abnormal Pap test result is a human papilloma virus (HPV) infection, which can lead to changes in the cells of the cervix that could become cancer over time. HPV—which is contracted during sexual activity—is so common that most sexually active people will get an HPV infection in their lifetime, says Dr. Cutler. And HPV is so often linked to cervical cell abnormalities that an HPV screening can be performed along with routine Pap testing in women age 30 and older, in order to more thoroughly assess a woman’s risk of developing cancer. Often, HPV causes no symptoms and most infections go away on their own; even if the virus did cause any “low grade” pre-cancerous changes to the cervical cells, those often go away, too. However, some women have a high-risk HPV infection that lasts a long time and can cause “high grade” pre-cancerous cervical changes that are more likely to lead to cancer, per the AAFP. These are other cancer signs women often ignore.

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Go for further testing

Following an abnormal Pap result, your doctor may say you need further tests. The kind of testing will be determined by your age and the type of abnormality. Tests could include a repeat Pap test, a colposcopy (in which your doctor uses a magnifying lens to more closely examine your cervix), or a biopsy (in which your doctor takes a tiny sample of cervical cells for more careful study).

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Follow your doctor’s orders

Often, follow-up testing concludes the abnormality isn’t a cause for immediate concern, in which case your doctor may simply recommend continuing routine Pap tests in the future. “But if the results of follow-up tests indicate high-grade changes, you may need treatments to remove the abnormal cells,” says Dr. Cutler. Treatment could include cryotherapy (the destruction of abnormal tissue by freezing), laser therapy (the destruction or removal of abnormal tissue with a laser), or a loop electrosurgical excision procedure (the removal of abnormal tissue using a thin, electrified wire loop), per the AAFP. “You will need follow-up testing after treatment and will need to resume regular cervical cancer screening after the follow-up is complete.” But the good news is by going to your doctor for regular Pap tests in the first place—even women who have been vaccinated against HPV need routine testing—you give yourself the opportunity to find out about any abnormalities and take action to prevent them from developing into cancer. “The reason we get Pap smears is to catch concerning changes on your cervix before they become problems,” Dr. Cutler reaffirms. Here's everything doctors wish you knew about cervical cancer.

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Medically reviewed by Tia Jackson-Bey, MD, on March 30, 2020