Pap smear results follow a standardized reporting system, and most results fall into one of a few categories that range from completely normal to abnormal cells that need further evaluation. The most common result by far is “negative,” meaning no abnormal cells were found. Understanding what each category means can help you make sense of your report and know what comes next.
How Pap Smear Reports Are Structured
Nearly all labs in the United States use the Bethesda System to report Pap smear results. Your report will typically include three key pieces of information: whether the sample was adequate for testing, a general category (normal or abnormal), and a specific interpretation if anything unusual was found. Some reports also include HPV test results if co-testing was ordered.
Specimen Adequacy: The First Thing to Check
Before any cells are evaluated, the lab determines whether enough cells were collected to give a reliable reading. Most reports will say “satisfactory for evaluation.” About 2% of samples come back labeled “unsatisfactory,” meaning the lab couldn’t properly assess the specimen. This doesn’t mean something is wrong with your cervix. Common reasons include too much blood or inflammation obscuring the cells, excess lubricant in the sample, hormonal changes causing cell thinning, or simply a collection issue. An unsatisfactory result means you’ll need to repeat the test.
Normal Results (NILM)
A normal Pap smear result is reported as NILM, which stands for “negative for intraepithelial lesion or malignancy.” This means no cancer cells or precancerous changes were found. Your report may still mention minor findings like signs of a yeast infection, bacterial changes, or mild inflammation. These are noted for your provider’s awareness but are not a cause for concern about cancer.
With a normal result, your next screening depends on your age. Women aged 21 to 29 are recommended to have a Pap test every three years. Women aged 30 to 65 can be screened with an HPV test alone every five years (the preferred approach), a combined Pap and HPV test every five years, or a Pap test alone every three years if HPV testing isn’t available.
ASC-US: The Most Common Abnormal Finding
ASC-US stands for “atypical squamous cells of undetermined significance.” It’s the most common abnormal Pap result, and it means some cells looked slightly unusual but not clearly abnormal. Many things besides HPV can cause this, including yeast infections, hormonal shifts from pregnancy or menopause, cervical irritation, or polyps.
When you get an ASC-US result, your provider will typically order an HPV test if one wasn’t already done. A negative HPV test is reassuring, since the cell changes are likely caused by something benign. You’d then return for a repeat screening in one to three years. A positive HPV test, on the other hand, means additional follow-up is needed, which may include a closer examination of the cervix called a colposcopy.
About 10 to 15% of women with ASC-US have underlying moderate or severe precancerous changes, which is why the HPV test matters so much for sorting out who needs closer monitoring.
ASC-H: A More Concerning Gray Zone
ASC-H means “atypical squamous cells, cannot exclude a high-grade lesion.” It’s much less common than ASC-US, making up only 5 to 10% of all atypical squamous cell results. The key difference is that the unusual cells look more like the immature, smaller cells associated with serious precancerous changes.
This result carries significantly more risk. Roughly 37 to 40% of women with ASC-H have moderate to severe precancerous changes on further testing. Because of this higher risk, a colposcopy is recommended right away rather than waiting for an HPV test to guide the decision.
LSIL: Low-Grade Changes
LSIL stands for “low-grade squamous intraepithelial lesion.” This result means cells show mild changes typically caused by an HPV infection. The cells still look relatively mature but have enlarged, darker nuclei and sometimes a characteristic clearing around the nucleus called koilocytosis, which is a hallmark of HPV’s effect on cells.
LSIL corresponds to what’s also called CIN 1, or mild dysplasia. The majority of LSIL cases, particularly in younger women, resolve on their own as the immune system clears the HPV infection. Your provider will determine follow-up based on your age, HPV status, and screening history. For many women, this means a colposcopy or closer surveillance over the next one to two years rather than immediate treatment.
HSIL: High-Grade Changes
HSIL stands for “high-grade squamous intraepithelial lesion” and indicates more significant precancerous changes. The cells are smaller, less mature, and show a higher ratio of nucleus to surrounding cell material compared to LSIL. HSIL corresponds to CIN 2 or CIN 3 (moderate to severe dysplasia).
This result requires prompt action. A colposcopy with biopsy is recommended to determine the exact extent and severity of the changes. HSIL is not cancer, but it represents the kind of precancerous change that, if left unmonitored and untreated, could progress to cervical cancer over years to decades. Treatment options for confirmed high-grade changes are highly effective and usually involve removing or destroying the affected tissue in an outpatient procedure.
Glandular Cell Abnormalities (AGC)
While most Pap smear abnormalities involve squamous cells on the outer surface of the cervix, some reports flag unusual glandular cells. Glandular cells line the inner cervical canal and the uterus, so abnormalities here can sometimes point to issues in areas that are harder to visualize.
A result of AGC (atypical glandular cells) means glandular cells look more abnormal than what you’d see from simple irritation or repair but don’t clearly indicate cancer. All women with glandular abnormalities are referred for colposcopy along with sampling of the cervical canal. An ultrasound or biopsy of the uterine lining may also be recommended, since glandular changes can originate from either the cervix or the uterus. HPV testing alone is not sufficient to triage these results.
How HPV Results Change the Picture
If your Pap was done alongside an HPV test (called co-testing), the combination of both results shapes your risk assessment and next steps more precisely than either test alone. Current guidelines take a broader view than just your most recent screening. Your provider will also factor in previous test results, any history of treatment for precancerous changes, and your age when deciding on follow-up.
The general principle: a normal Pap with a negative HPV test is the most reassuring combination and allows for the longest interval before your next screen. An abnormal Pap with a positive HPV test, particularly for high-risk HPV strains, moves the timeline forward and may prompt a colposcopy. Even a normal Pap with a positive HPV test warrants closer surveillance, since the virus can cause changes that haven’t yet become visible on the Pap.
What a Colposcopy Involves
Several abnormal Pap results lead to a colposcopy as the next step. During this procedure, your provider uses a magnifying instrument to examine the cervix closely after applying a dilute vinegar solution, which makes abnormal areas easier to see. If suspicious areas are identified, small tissue samples are taken for biopsy. The procedure is similar to a Pap smear in positioning but takes longer, usually 10 to 20 minutes. You may feel mild cramping during biopsies.
A colposcopy is generally recommended when the estimated risk of having CIN 3 or worse is above 4%. Specific results that typically trigger an immediate referral include HSIL, ASC-H, AGC, and ASC-US or LSIL with a positive high-risk HPV test. A persistently abnormal or unsatisfactory Pap, even with treatment, can also lead to colposcopy.
Putting Your Results in Context
The single most important thing to understand about Pap results is that an abnormal finding does not mean you have cancer. The entire purpose of screening is to catch cell changes long before they could become cancer, and the vast majority of abnormalities either resolve on their own or are easily treated. Even HSIL, the most concerning precancerous category, is highly treatable when detected through screening. Your specific result, combined with your HPV status, age, and screening history, determines a follow-up plan tailored to your actual level of risk.