An abnormal Pap smear means some cells collected from your cervix looked unusual under a microscope. It does not mean you have cancer. Most abnormal cells found during a Pap test result from a cervical or vaginal infection and are not cancerous. Even when the changes are more significant, they typically represent precancerous changes that can be monitored or treated long before cancer ever develops.
Why Cells Can Look Abnormal
Several things can cause cervical cells to appear unusual on a Pap test. The most common culprit is an HPV (human papillomavirus) infection, particularly the high-risk strains of HPV that can, over time, trigger cell changes in the cervix. But plenty of other, completely benign factors can also produce an abnormal result: a yeast or bacterial infection, irritation, benign growths, or hormonal shifts related to menopause, pregnancy, or birth control.
Because so many harmless conditions can trigger an abnormal reading, an abnormal Pap is really a signal to look more closely. It’s the starting point of a conversation, not a diagnosis.
Types of Abnormal Results
Your Pap results will use specific terms to describe what the lab saw. Understanding the category helps you gauge how significant the finding is.
ASC-US (atypical squamous cells of undetermined significance) is the most common abnormal Pap finding. It means some cells don’t look completely normal, but it’s not clear whether the changes are caused by HPV or something else entirely. Many ASC-US results resolve on their own without any treatment.
LSIL (low-grade squamous intraepithelial lesion) indicates low-grade cell changes usually caused by an HPV infection. “Low-grade” means the changes are mild and often clear up as your immune system fights off the virus. LSIL encompasses what older terminology called mild dysplasia.
HSIL (high-grade squamous intraepithelial lesion) is more serious. It means there are moderate to severe cell changes that have a higher chance of progressing toward cancer if left untreated. HSIL doesn’t mean cancer is present right now, but it does mean treatment is typically recommended to remove or destroy those abnormal cells before they have the chance to become cancerous.
AGC (atypical glandular cells) refers to unusual-looking cells from the glandular tissue of the cervix or uterus, rather than the flat squamous cells that cover the outer cervix. AGC results are less common and generally prompt a more thorough workup because glandular abnormalities can sometimes be harder to monitor.
The Role of HPV
High-risk HPV strains are the driving force behind most cervical cell changes that could eventually become cancer. That’s why your provider may run an HPV test alongside your Pap or as a follow-up. The HPV test checks specifically for the presence of high-risk virus types in your cervical cells.
Knowing your HPV status helps your provider determine how closely to monitor you. For example, an ASC-US result paired with a negative HPV test is very reassuring and may only need a repeat test in a few years. The same ASC-US result with a positive HPV test warrants closer follow-up, because the virus could be the reason for the cell changes and could cause further changes over time.
Most HPV infections clear on their own within one to two years, especially in younger people. It’s only when the virus persists that the risk of progressive cell changes rises.
What Happens After an Abnormal Result
Your next steps depend on the type of abnormality and your HPV status. For minor findings like ASC-US or LSIL with a low risk of progression, your provider may simply recommend a repeat HPV test or Pap in one year. Current guidelines use a risk-based approach: if your estimated risk of a serious precancerous change is below about 4%, repeat testing in one year is appropriate. If the risk is very low (below 0.55%), you may not need another test for three years.
For higher-risk results, or when repeat testing still shows abnormalities, the next step is usually a colposcopy. This is a closer look at your cervix done in your gynecologist’s office. You lie back as you would for a regular pelvic exam, and a speculum holds the vaginal walls open. The colposcope itself stays outside your body. It’s essentially a magnifying lens with a bright light that lets the provider examine the cervix in detail.
During the colposcopy, a mild solution is applied to your cervix with a cotton swab. This liquid makes abnormal areas stand out visually. You may feel a slight burning sensation. If any areas look concerning, the provider takes a small tissue sample (biopsy) for lab analysis. Some people describe the biopsy as a brief pinch or cramp. Taking an over-the-counter pain reliever beforehand can help. The whole visit is typically quick and doesn’t require any downtime afterward.
Treatment for Precancerous Changes
If a biopsy confirms high-grade precancerous cells, treatment aims to remove or destroy the abnormal tissue before it can progress. Two common approaches are LEEP and cryotherapy.
LEEP (loop electrosurgical excision procedure) uses a thin, electrically heated wire loop to cut away the abnormal tissue. Providers generally prefer LEEP because the removed tissue can be sent to a lab for further analysis, confirming exactly what was there and whether the margins are clear. Cryotherapy, on the other hand, uses extreme cold to freeze and destroy abnormal cells. It takes less than 10 minutes and you can return to your normal routine right away. The trade-off is that frozen tissue can’t be analyzed afterward, so it’s typically used for less complex cases.
Recovery from cryotherapy takes about three weeks, during which you’ll want to avoid vaginal intercourse, tampons, or inserting anything into the vagina to let the cervix heal and prevent infection. LEEP recovery is similar in scope. Both procedures are outpatient, meaning you go home the same day.
Screening Schedules to Know
Understanding when and how often you should be screened helps put an abnormal result in context. The U.S. Preventive Services Task Force recommends the following schedule:
- Ages 21 to 29: Pap test alone every 3 years.
- Ages 30 to 65: Pap test alone every 3 years, HPV test alone every 5 years, or both tests together every 5 years.
- Under 21: No screening recommended, regardless of sexual activity.
- Over 65: Screening can stop if you’ve had consistently normal results and aren’t at high risk.
- After hysterectomy: No screening needed if your cervix was removed and you have no history of high-grade precancerous changes or cervical cancer.
If you’ve had an abnormal result, your provider will likely adjust this schedule to monitor you more closely for a period before returning to routine intervals. The specific timeline depends on the severity of the finding and whether HPV is involved, but the overarching principle is straightforward: the higher the risk, the sooner and more closely you’re followed up.