A Pap test, or Pap smear, is a routine part of a woman's annual wellness exam. It involves collecting a small sample of cells from the cervix, which are then analyzed in a lab for abnormal cell changes. The Pap test helps diagnose cervical cancer and human papillomavirus (HPV).

An abnormal Pap smear doesn't necessarily mean you have HPV or cervical cancer. It detects any changes in cervical cells that may also indicate other issues, such as inflammation or infection. False positives can occur, so further testing is often recommended to ensure comprehensive care when results are abnormal.

Types of Pap Smear Results

Results are classified into three categories: normal, unclear, and abnormal.

Normal or Negative Result

A normal result means no changes in the cervical cells have been detected. This is a healthy diagnosis, however, the patient should continue to receive regular Pap smears.

Unclear Result

Unclear results are not uncommon. They simply indicate that the findings are inconclusive—cervical cells may or may not be abnormal. This could be due to insufficient cell samples collected during the test, the presence of a disease or infection as well as changes caused by hormones or inflammation. Factors such as sexual intercourse, douching, or vaginal cream application in the two days before the Pap smear test can also affect the results.

Abnormal or Positive Result

An abnormal result typically indicates changes in cervical cells, which can stem from various conditions. These changes may range from mild, often caused by infection, to moderate or severe, which could signal potentially serious pre-cancerous or cancerous tissues.

Follow-Up for Abnormal Pap Smears

The doctor will recommend additional testing or treatment based on the patient's age and the type of dysplasia or abnormal cells found in the cervix.

Repeated Pap Smear

Some patients may need to repeat the Pap smear every three months until results turn normal. This is standard practice for minor changes in cervical cells, which often resolve without treatment. However, these follow-up appointments are crucial to confirm that the initial results were abnormal.

Colposcopy

The doctor may recommend a colposcopy test if the Pap smear results are abnormal. During this procedure, a microscope is used to closely examine the cervix, and a biopsy is taken if needed. The exam is similar to a Pap smear, as a speculum is inserted into the vagina to make the cervix visible. Once the biopsy results are available, the doctor will recommend any necessary treatment to prevent cervical cancer.

Loop Electrosurgical Excision Procedure (LEEP)

Some patients may require a minor surgery called a loop electrosurgical excision procedure (LEEP) to remove precancerous cells from the cervix. During this procedure, abnormal cells are removed to prevent the development of cervical cancer. Wire loops, attached to an electrosurgical generator, cut away the affected tissue by heating and bursting the cells. The removed tissue is then sent to a lab for further evaluation to ensure the abnormal area has been fully excised.

False positive results from Pap smears can occasionally occur. While recent research and new technology have led to more accurate tests, these options are often more expensive and may not be covered by insurance. In the case of a false positive, the doctor may recommend an additional test to confirm the results. There is also a risk of false negative results. It is recommended that women receive regular Pap smears as part of their annual wellness exam. Patients should discuss all test results and treatment options with the doctor.