An abnormal Pap smear result can feel like a sudden storm in the middle of a calm pregnancy journey or routine health checkup. But here’s the truth: most abnormalities are not cancer. Let’s break down what these results mean, the common causes, and how specialists like Dr. Merchant guide patients through the next steps with clarity and care.

What Does an Abnormal Pap Smear Mean?
A Pap smear screens for changes in cervical cells, which line the cervix’s surface. An “abnormal” result simply means some cells look different from healthy ones. This doesn’t automatically signal cancer-in fact, most abnormalities are caused by infections, inflammation, or hormonal shifts.

Types of abnormalities include:

  • ASCUS (Atypical Squamous Cells of Undetermined Significance): Mild changes that are often inconclusive. Think of this as a “maybe” result requiring follow-up testing.
  • LSIL (Low-Grade Squamous Intraepithelial Lesion): Early cell changes linked to HPV infections, which frequently resolve without treatment.
  • HSIL (High-Grade Squamous Intraepithelial Lesion): More concerning changes that may progress to cancer if left untreated.Spoiler alert: Only a small fraction of abnormal results indicate cancer. The key is timely follow-up to rule out serious issues.

Common Causes of Abnormal Pap Smear Results

1. Human Papillomavirus (HPV)
HPV causes over 90% of cervical cell changes. This sexually transmitted infection has over 100 strains, but only about 14 are high-risk. HPV 16 and 18 alone account for 70% of cervical cancers. Low-risk strains like HPV 6 and 11 may cause genital warts but rarely cancer.

2. Inflammation or Infection
Yeast infections, bacterial vaginosis, or STIs like trichomoniasis can irritate cervical cells, leading to temporary abnormalities. For example, a study found that 16.67% of women with persistent inflammation on Pap smears had precancerous changes, underscoring the need for evaluation.

3. Hormonal Changes
Pregnancy, menopause, or hormonal therapies can alter cervical cells. During pregnancy, elevated estrogen levels may cause benign changes that mimic abnormalities. Postmenopausal women with low estrogen might also have atypical results due to cervical atrophy.

4. Pre-Cancerous or Cancerous Changes
Rarely, abnormal cells indicate dysplasia (pre-cancer) or cervical cancer. High-grade changes (HSIL) require prompt intervention, while low-grade (LSIL) often resolve on their own.

What Happens After an Abnormal Pap Smear?

Dr. Merchant and other specialists follow evidence-based protocols:

  • Repeat Pap or HPV Testing: Mild changes (ASCUS) may be monitored with a follow-up test in 6–12 months.
  • Colposcopy: This magnified exam of the cervix identifies abnormal areas for biopsy. At Johns Hopkins, tools like DYSIS improve precision in locating concerning cells.
  • Biopsy: A small tissue sample is analyzed to confirm dysplasia or cancer.

Most patients with LSIL or ASCUS only need monitoring, while HSIL may require procedures to remove abnormal cells.

How to Reduce Your Risk of Abnormal Results

Get Screened Regularly:

  • Women 21–29: Pap test every 3 years.
  • Women 30–65: Pap + HPV co-testing every 5 years.
  • Vaccinate Against HPV: The HPV vaccine protects against high-risk strains.
  • Avoid Vaginal Products Before Testing: Douches or spermicides can irritate the cervix and skew results.

Conclusion
An abnormal Pap smear is rarely an emergency but always a call to action. Whether it’s HPV, a temporary infection, or hormonal shifts, early detection allows for simple monitoring or minimally invasive treatments. Trust experts like Dr. Merchant to navigate follow-up care with expertise, ensuring your peace of mind and long-term health.

Remember: Regular screenings save lives. Stay proactive, stay informed, and never skip your Pap test.