Understanding your pap smear results and what comes next if you get an abnormal result

Receiving your pap smear results in the mail is undeniably daunting, but remembering the procedure is an essential—and highly effective—part of cervical cancer prevention should help to ease anxiety. 

Admittedly, a smear test is not exactly enjoyable, but it’s the best way to maintain a healthy vagina and avoid ill health. Having regular smears is just as, if not more, important than knowing how to do kegel exercises, or taking your daily probiotic. Cervical cancer is the fourth most common type of cancer to affect women worldwide, with pap smear tests offering a lifeline of early detection with a simple swab that takes just minutes to collect. 

Whether you’ve been having screenings for years, or are yet to attend your first one, pap smear results can sometimes be a little perplexing, but they needn’t be. We spoke with gynecologists and women’s health experts to break down what your pap smear results really mean and how to understand them—as well as what comes next. 

What is the pap smear procedure? 

So, what is a pap smear and how long does it take? Your pap smear test is a routine procedure that checks the cervix for any signs that could lead to cervical cancer. Usually carried out by a nurse, doctor, or a dedicated OB/GYN, the screening is made up of three parts that collectively take around 10-15 minutes. 

• The first will be a verbal exchange in which you’ll be asked questions about your sexual, hormonal, and reproductive health that cover your sexual and general medical history. 
• The next part of the test is to check how your cervix looks. The cervix is the spongy tissue between the neck of the womb and the vaginal canal. Your practitioner will take a look at your cervix to see if it looks healthy.
• The final part of the exam is a sample swab to collect cells from the cervix for testing. 

What can a pap smear detect? 

The lab will be testing your cervical cells for a number of things.

• The first is the HPV or human papillomavirus. There are over 100 strains of the virus, but only certain types increase the chances of developing cervical cancer. The lab will be checking for the presence of high-risk strains, which include 16, 18, 31, 33, and 45. Types 16 and 18 cause around 70% of cervical cancers, while the other three account for most of the remaining 30%. Most adults carry HPV and the human immune system is well equipped to fight it off. However, in some cases, certain strains can compromise healthy cells, which increases the risk of certain cancers developing. 
• The lab will also be looking for any abnormal cells. These cells may have already been affected by these strains of HPV. If neither high-risk strains of HPV or abnormal cervical cells are detected, your results will come back as 'normal' and you won’t need any further testing until your next pap smear, which will be due in two or more years. If this is the case, continue using condoms or dental dams to reduce the risk of spreading potentially harmful HPV strains between partners and maintain a healthy lifestyle to promote healthy cell turnover.

It should take between three and four weeks to receive your test results. If your pap smear results are 'abnormal' or 'inconclusive' this could mean a number of things. It’s important to remember abnormal results don’t mean you have cancer and, at this point, making a follow-up appointment is the best thing to do, both for your health and your peace of mind. 

What do pap smear results mean?

After your screening, you will receive two results—one for the pap test which looks at your cells and one for the HPV test which looks for the HPV virus. 

You can expect to get one of three results back from a pap smear test—normal, abnormal, or unclear (inconclusive).  If your result is normal, then you need not take any further action until your next smear test in typically three-five years. If your test comes back abnormal or unclear (inconclusive), don't panic—this routine screening is in place so that abnormal cells can be detected early on. 

Your HPV test result will either be negative or positive. If it is negative, you do not have an HPV type that is linked to cervical cancer. If it is positive, it does not mean you have cervical cancer—it does, however, mean you have an HPV type that could be linked to cervical cancer, and you'll have further tests to assess this. 

Abnormal pap smear result

If your screening results are abnormal, don’t panic. There’s a process in place to support you and you can act quickly to make sure the risk is substantially reduced.

The existence of abnormal cells is known as cervical dysplasia. Abnormal cells are also sometimes called ‘carcinoma in situ’ or ‘precancer’ but as we’ve mentioned, this does not mean the cells are cancerous. Abnormal cells are categorized into four types—CIN 1, CIN 2, CIN 3, and CGIN. 

• CIN 1—it's unlikely the cells will become cancerous and no further treatment will be needed. You’ll be invited back for a pap smear test in the next twelve to twenty-four months.
• CIN 2—there's only a moderate chance the cells will become cancerous but treatment to remove them is recommended.
• CIN 3—there's a high chance the cells will become cancerous and treatment to remove them will be recommended.
• CGIN—there's also a high chance the cells will become cancerous and treatment to remove them is recommended.

Abnormal cells are either low grade or high grade. Low-grade cells are only slightly abnormal. High-grade cells look less like normal cells and may develop into cancer. If your results show abnormal cells, you may be invited back so your practitioner can take a biopsy. Or you may simply be invited in for preventative treatment in which the abnormal cells will be removed. 

“Many women fear that having an abnormal smear means you have cervical cancer, however, this is unlikely," says Dr Longhurst. “In reality, a cervical smear will rarely detect cancer. Smears identify those women at high risk of developing cancer so that we can step in early and prevent it. It may be challenging to digest all the information about cervical smears or understand your result. This is something that healthcare professionals can help with. Receiving an abnormal smear result may feel daunting. This is understandable, particularly as there is a lot of misinformation surrounding the subject."

Inconclusive pap smear result

Inconclusive results are not necessarily a bad thing but an unclear result does mean you’ll probably have to repeat your screening so a clear result can be established. “Inconclusive results could be caused by an insufficient sample amount, which can happen,” says Dr Enam Abood of the Harley Street Health Centre. “It could also mean the histopathologist simply cannot conclude a normal nor abnormal smear. This outcome usually means you’ll have to wait three months before repeating your smear test.”

Your inconclusive result might be shown as ASC-US which stands for ‘atypical squamous cells of undetermined significance'. This means the cells didn’t look like normal cells, but they also didn’t show clear signs of being abnormal. There are, of course, other factors that can affect the clarity of your sample results. If you’ve used tampons or menstrual cups, had sex, or recently had an IUD fitted, these things can contribute to an inconclusive result. As can any lube, blood, mucus, or discharge caused by infections like candida or thrush. 

If your results are unclear, you’ll be invited to attend a second screening, usually a month after your first one to give your cervix time to settle after the first swab. The swab will be taken using a soft plastic brush so it shouldn’t hurt, however, the cervix is sensitive and not used to direct stimulation of this kind, which is why you may experience a little spotting or discomfort after a test. Your second screening should yield clearer results, which will either be 'normal' or 'abnormal'. If you have another inconclusive result, you’ll be invited back, potentially for treatment. 

What is a colposcopy? 

It can be alarming to receive an abnormal result, but there are steps in place to ensure you're given further treatment, if needed, as quickly as possible. So what happens next? You’ll be invited for a colposcopy. 

A colposcopy is a procedure in which your doctor uses a microscope to inspect your cervix. Your doctor will use a special solution during the colposcopy that acts as a dye to help differentiate normal areas from abnormal ones. During a colposcopy, your doctor may wish to take a biopsy, a pinhead-sized amount of tissue from the cervix. Unlike an IUD fitting, nothing will enter your cervix during the procedure, but you may still experience some discomfort, which is why a local anesthetic is used for a biopsy procedure. Breathe through the experience and try to relax. It won’t take long and the numbing effects of the anesthetic should ease any discomfort. Remember that you can ask your doctor to stop at any time if you are in pain or feel panicked. 

After a colposcopy and/or biopsy, you may feel have a slightly sore vagina and feel a little uncomfortable for the remainder of the day. You’ll be advised to rest, avoid heavy lifting and drink plenty of fluids. It’s also advisable to avoid penetrative sex and masturbation, as well as using accessories like kegel balls for at least 48 hours to avoid an infection or causing any inflammation or irritation to the cervix. You may feel some cramping, similar to moderate period pain, and if you found it difficult to relax during your appointment, your muscles may also be sore. That evening, try breathing exercises, or some yoga nidra before bed to calm your nerves and relax your muscles, eat plenty of magnesium-rich foods and if you experience spotting, which can happen after a biopsy, use a pad or period underwear for a day or so.

In some cases, particularly if your pap smear results show CIN3 or CGIN cells, your doctor may want to offer treatment to remove the suspicious cells right away. There are a number of ways to remove abnormal cells from the cervix, and your doctor will talk you through which method is right for you.  

How are abnormal cells removed?

Abnormal cells are removed from the cervix using a variety of methods. Your doctor will be able to help you decide which method is right for you.

• Cryosurgery—this is one of the quickest methods, which according to Planned Parenthood, has a success rate of about 85 to 90 percent. During this treatment, abnormal cells are eradicated using freezing liquid nitrogen via a cryoprobe so that the body can replace them with healthy cells. Cryosurgery on the cervix takes about ten minutes to perform and will be done under local anesthesia. You may also want to take some drugstore pain medication before the procedure and afterward to lessen the effects of any cramping. Discharge is common after cryo so bring a pad or period pants to your appointment. 
• LEEP—cells can also be removed by way of a procedure called LEEP or loop electrosurgical excision procedure, which will be performed with a local anesthetic. During a LEEP, a thin wire loop is used to remove abnormal tissue. Your cervix will then be cauterized to stop any bleeding and the whole procedure should take approximately ten minutes. Remember to schedule your procedure for one week after your period. This will help your doctor to recognize the difference between any vaginal bleeding caused by your procedure and menstrual blood. 
• Laser—other methods of removing cells whilst awake include laser which destroys the cells or cold coagulation (burning with a heat source). 
• Cone biopsy—a cone biopsy takes about 15 minutes and will usually be performed under a general anesthetic, meaning you’ll be asleep during the surgery and won’t feel anything. A cone biopsy is normally done with a scalpel, known as a surgical knife or cold knife cone biopsy. After your surgeon has removed the tissue, they will place some gauze inside your vagina to stop any bleeding. A pad or period pants are also a good idea after this procedure, as are over-the-counter painkillers to deal with any cramping. 

Advice for undergoing a procedure 

“This is a potentially worrying time for the person undergoing this procedure,” says gynecological cancer nurse specialist Tracie Miles, The Eve Appeal’s nurse with the Ask Eve service. “Preparation is key so ask questions ahead of your appointment. If you are unsure about anything, ask your doctor or nurse or call the Ask Eve helpline—this is free, confidential and expert and staffed by a specialist nurse. It’s a taboo-free service and the mantra is that no question is too embarrassing.” 

Always ask your doctor how to prepare for a procedure and above all, try to stay calm. Abnormal cells are not cancer and it’s important to remember this. When it comes to cervical health, prevention is the best approach so be sure to attend every appointment and keep notes on your progress. This will help with any follow-up appointments and future pap smear tests. If you feel stressed or anxious, make this clear to your practitioner and try to focus your mind by practicing breathing techniques (our guide on how to breathe better might help here) and meditation to relax your muscles. 

“The idea of entering a room and being exposed to a couple of strangers can feel a little disconcerting and it is normal to feel anxious about this," says Dr Longhurst. "Remember, these are healthcare professionals who are so used to this procedure. Their focus is solely on identifying your need for treatment and helping you feel as comfortable as possible throughout. They will not be judging what you are wearing or what your body looks like. Don’t forget to plan a treat for yourself for afterward, then you have something to look forward to.” 

Talking about your results and any upcoming procedures with friends and family can also be helpful in destigmatizing and normalizing your feelings. Abnormal cells are common and many women experience receiving an abnormal test result. Screenings and treatments save lives so understanding what to expect, what your pap smear results really mean and the importance of good vaginal health are some of the best things you can do to safeguard your wellbeing for years to come.