Better Me

I Have an Abnormal Pap Test—Now What?

A Pap test is an important preventive screening test for cervical cancer that’s performed on most 21 to 65-year-old women every few years. It’s fast and easy (albeit a bit uncomfortable) and it saves many lives.

If you’ve had the test several times over the years, you might not have given it much thought—other than the memory of the stirrups and cold speculum. That’s until you get a call from your doctor’s office letting you know that your Pap test is abnormal.

While your first thought may be about cancer, Jennifer Rubatt, MD, a gynecologic oncologist with Banner MD Anderson Cancer Center at McKee Medical Center in Loveland, CO, reassures us that there are many things that can influence the test.

“There are millions of women who have abnormal Pap smears each year, but, by and large, less than 1% of abnormal Pap tests are associated with cervical cancer,” Dr. Rubatt said. “By far, abnormal tests are not indicative of a cancer diagnosis.”

This being said, if you’re reading this article, you still probably have concerns. What does “abnormal” really mean and what happens now that you’ve got a positive result? We spoke with Dr. Rubatt to find out.

What does an abnormal Pap test mean?

An abnormal Pap test usually indicates changes, also called dysplasia, in the cells of your cervix. As Dr. Rubatt mentioned, just because you have an abnormal Pap test, it doesn’t mean that you have cancer. There are multiple reasons for having one, such as infections, pelvic inflammation, sexual activity, genital warts, human papillomavirus (HPV), precancerous cells and cancerous lesions.

What increases my risk for an abnormal Pap test?

One of the most common abnormal causes are due to HPV, a group of common viruses that spread from person to person during sexual contact. It’s one of the most common types of STDs, but it is nothing to be ashamed of.

Most of the time, your body will fight off and clear up the HPV virus on its own, but sometimes the infection doesn’t go away – even living in the cervix for years – and may eventually lead to cancer. While there’s no cure for HPV, regular screenings and the HPV vaccine can help reduce your risk for developing cervical cancer. The vaccine does have age restrictions, so ask your doctor to see if you’re eligible.

What happens after my abnormal Pap smear?

After you get the call from your doctor’s office that you have an abnormal pap smear, you’ll come back into the office where you may have a repeat Pap test, or you’ll have a noninvasive procedure called a colposcopy. A colposcopy is much like a Pap test, in that you’ll have the speculum and stirrups again, but this time, your provider will also use a special tool to get a better look at your cervix.

“We use a microscope, or a colposcope, to look more in-depth at the surface of the cervix to see in greater detail any abnormal cervical cells,” Dr. Rubatt said.

Once abnormal cells are identified, your provider will perform a biopsy, taking a small amount of tissue for further testing. While you typically feel pressure with the speculum in place, you’ll also feel a tiny pinch when the biopsy is performed—but it’s nothing to worry about. Afterward, you may feel some mild cramping and spotting, but you can go about your day as usual.

What if my colposcopy results aren’t normal?

Once your biopsy results are available, your provider will go over the changes in your tissue sample and possible treatment options.

Sometimes the changes are low-grade lesions, meaning these are unlikely to become cervical cancer. In this case, your doctor may want you to come back for a follow-up Pap test in six months and keep an eye on that area.

If the changes are moderate- to severe-grade lesions, however, the tissue will need to be removed to keep the cancer from developing. Your provider will explain the different removal methods that may be right for you, but typically a loop electrosurgical excision procedure (LEEP) is performed. This involves a thin wire loop that carries an electric current to essentially erase abnormal cells in the cervix.

“Sometimes freezing (or cryotherapy) and lasering of the cervix are offered, but if it’s a high-grade lesion, I recommend the LEEP because it goes deeper into the cervix to ensure all abnormal cells are removed,” Dr. Rubatt said.

What can I expect after my procedure?

After the LEEP procedure, you may experience some mild cramping for a few hours and some spotting and bleeding. “We use a medicine that helps us control bleeding related to the biopsy that can give some people a funny-looking discharge,” Dr. Rubatt said. “It should only last a couple of days.”

You can return back to work and daily activities the same day, but your doctor may ask you to refrain from exercise and other strenuous activities for a bit. Be sure to ask your doctor.

Important reminder: Don’t skip your well women’s exam

You may not need a Pap test each year, but you should have a pelvic exam done annually during your well-woman visit.

“Many women group together a pelvic exam and a pap test, but the two are separate,” Dr. Rubatt said. “Even if you don’t get a Pap test each year, you should still have a pelvic exam done by a healthcare professional where they can visually examine the surface of the cervix, vagina and vulva skin and palpate the uterus and ovaries to check for signs of illness or problems in your female organs.”

To find a Banner Health provider near you, visit

For more women’s health-related articles, check out:

Women's Health Gynecology Cancer