I Have an Abnormal Pap — Now What?

Written By Kristina Calligan
Doctor informing patient about test results. Arcadia Women's Wellness, Phoenix Arizona.

An abnormal Pap result can feel scary, especially when the first thing your mind hears is “cancer.” Take a breath. Most abnormal Pap or HPV results do not mean you have cervical cancer. More often, they mean we found human papillomavirus (HPV), inflammation, or early cervical cell changes that need the right follow-up.

At Arcadia Women’s Wellness, our goal is to make the next step clear, calm, and as comfortable as possible.

What does a Pap test actually check?

A Pap test looks for abnormal cells on the cervix. An HPV test looks for high-risk types of HPV that can cause cervical cell changes over time. These tests are often done together, depending on your age and screening history.

If your result is abnormal, the most important question is not simply, “Is my Pap abnormal?” It is, “What kind of abnormal result is it, what does my HPV test show, and what is my personal risk based on my history?”

Common abnormal Pap results include ASC-US, LSIL, ASC-H, HSIL, AGC, and unsatisfactory results. ASC-US means some cells look slightly atypical, but the cause is not clear. LSIL usually suggests low-grade changes often related to HPV. ASC-H, HSIL, and AGC can carry a higher risk and often need a closer evaluation. An unsatisfactory result usually means there were not enough cells to read clearly, so the test may need to be repeated.

A positive HPV test does not mean you have cancer. It means high-risk HPV was detected. HPV is extremely common, and many infections clear on their own. However, persistent high-risk HPV, especially HPV 16 or 18, deserves careful follow-up because it is more strongly linked with cervical precancer and cervical cancer.

What happens next?

Follow-up is based on national risk-based guidelines. That means your next step is determined by your current Pap and HPV result, your age, your prior Pap history, whether you have had previous cervical procedures, and your overall risk.

Sometimes the safest plan is repeat testing in one year. Sometimes we recommend a colposcopy. In certain high-risk situations, treatment may be discussed sooner. The goal is to avoid overtreating mild changes that may go away, while also not missing changes that need treatment.

What is a colposcopy?

A colposcopy is an in-office procedure that lets your provider look closely at the cervix using a bright light and magnification. The colposcope stays outside the body. A speculum is placed, similar to a Pap test, and a vinegar-like solution is applied to the cervix to highlight areas that may look abnormal.

If an area needs a closer look, a small biopsy may be taken. Some patients may also need an endocervical sample, sometimes called an ECC, which collects cells from the canal of the cervix. These samples are sent to pathology to determine whether the changes are mild, moderate, severe, or rarely cancerous.

Colposcopy results help guide the next step. Mild changes may be watched with repeat testing. Higher-grade changes may require treatment, such as a LEEP procedure, to remove abnormal tissue before it has a chance to progress.

Let’s talk about pain management

Many women are told that colposcopy or cervical biopsy is “just a pinch.” For some patients, that is true. For others, it is more uncomfortable, especially if they have a history of pelvic pain, trauma, anxiety, difficult pelvic exams, vulvar pain, endometriosis, vaginismus, or prior painful procedures.

At Arcadia Women’s Wellness, we believe pain should be discussed before the procedure, not after. Comfort options may include taking ibuprofen, naproxen, or acetaminophen before the visit if it is safe for you; using a smaller speculum when appropriate; taking extra time with positioning; using breathing techniques; pausing whenever needed; and talking through each step before it happens. 

Depending on the procedure and your medical history, we may also discuss local numbing options, such as topical anesthetic or injectable lidocaine, especially if a biopsy, ECC, or cervical treatment is anticipated. For patients with significant anxiety, we can talk through additional planning options before the appointment, including whether you should have a support person or driver.

Pain control is personal. What one patient tolerates easily may feel very different for another patient. You are allowed to ask what to expect, what options are available, and how we can make the visit feel more manageable. Nurse Practitioner, Kristina Calligan FNP frequently uses topical lidocaine prior to each biopsy and feels “explaining the procedure as I am doing it and using what I call verbal anesthesia, having patients cough or moves their hands often helps the procedure to have minimal discomfort”.

When should you call after a colposcopy?

Light spotting, dark discharge, or mild cramping can happen after a biopsy. Call your provider if you have heavy bleeding, fever, chills, worsening pelvic pain, or foul-smelling discharge. You should also call if you are unsure about your instructions or if something does not feel right.

The bottom line

An abnormal Pap can be unsettling, but it is also an opportunity to prevent cervical cancer before it starts. The most important step is not panic. The most important step is follow-up.

At Arcadia Women’s Wellness, we help patients understand their results, review whether colposcopy is needed, discuss pain management options, and create a clear plan for what comes next. You can schedule an appointment with Arcadia Women’s Wellness here.

Medical disclaimer: This article is for education only and does not replace individualized medical advice.

 

Sources:

Kristina Calligan
Next

Heavy Periods: When Should You Be Evaluated?