Understanding your Pap smear results

Reviewing Pap smear results with your healthcare provider can help you understand what's normal, what's abnormal and what steps to take next.

Pap smears are an essential part of preventive care for women, but getting the results can be confusing or scary if you're not sure what they mean.

The good news is that most Pap test results do not indicate cancer, even if they are abnormal. But the results can help your healthcare provider identify early changes in your cervical cells before they become serious.

What is a Pap smear?

A Pap smear is a test that looks for cell changes in your cervix that could indicate cervical cancer. During the test, the doctor uses a small brush to collect cells from the surface of your cervix and the surrounding area, which are then examined under a microscope. The test is typically performed during a pelvic exam. The test can also be used to find conditions like human papillomavirus (HPV) or dysplasia, a precancerous condition often caused by HPV.

What are the risk factors for cervical cancer?

According to the National Cancer Institute, most cervical cancers are caused by HPV infection. There are more than 200 types of HPV, but only a few cause problems by turning cervical cells from normal to abnormal. HPV 16 and HPV 18 are two high-risk types that cause 70% of cervical cancers.

Certain factors increase the likelihood that someone with a high-risk HPV infection will develop cervical cancer:

• Smoking
• Weak immune system (HIV, transplant medicines, long-term steroids, etc.)
• Not getting regular Pap smears or HPV tests
• Not getting the HPV vaccine
• Many sexual partners, or a partner who has many partners
• First sex at a very young age
• Many full-term pregnancies, especially starting at a young age
• Long-term birth control pill use (many years in a row)

How to prepare for a Pap smear

To ensure the most accurate test results, you should do the following in the days leading up to the Pap smear:

• Try to schedule it when you are not on your period, if possible.
• For two days before the test, avoid sex, douching, vaginal creams, medicines, or spermicides.
• Tell your doctor if you are pregnant, have had an abnormal Pap smear or HPV test, or have any new symptoms like bleeding after sex or pelvic pain.

Some providers may perform the test if you're at the end of your period when bleeding is light, but it's best to check in case they want you to reschedule.

The smear only takes a few minutes, and while it might be uncomfortable, it shouldn't be painful. You may experience some light bleeding afterward; that is normal. If you have cramping or pain that lasts longer than a few minutes, or if the bleeding continues for more than 24 hours, contact your doctor.

Types of Pap smear test results

According to the Centers for Disease Control and Prevention (CDC), Pap test results can be normal, abnormal, unclear or unsatisfactory:

• Normal (negative): No cell changes were detected on your cervix. You will still need to have Pap tests in the future, as cell changes can still develop.
• Abnormal (positive): Cell changes were found on your cervix. Abnormal results do not mean you have cancer; they are likely caused by HPV. Changes can be minor (low-grade) or serious (high-grade). Most minor changes will resolve on their own. Your healthcare provider will recommend additional testing or monitoring to see if you have cervical cancer.
• Unclear: Your cells appear abnormal, but it is unclear if this is related to HPV. The changes might be caused by factors like infection or pregnancy. An HPV test can determine if the changes are due to HPV.
• Unsatisfactory: There aren't enough cells in the sample, or they are clumped together. You'll need to return for another test in two to four months.

Pap smear recommendations

Women should have their first Pap smear at age 21, regardless of sexual activity. How frequently you need screening depends on your age and medical history.

• Women 21 to 29: Get a Pap test only once every three years. Women aged 25 to 29 may have HPV testing alone, but Pap tests are preferred.
• Women 30 to 65: There are three testing options: co-testing with a Pap test and HPV test every five years, Pap test alone every three years or HPV test alone every five years.

Co-testing isn't recommended for women aged 21 to 29 because HPV infections are common in that age group. These infections usually resolve on their own within a few years without causing lasting cell changes. Co-testing would detect short-term, noncancerous infections, leading to unnecessary follow-ups.

After age 65, you may stop cervical cancer screening if:

• You have had at least two HPV tests or three Pap tests in the past 10 years with normal results.
• You have not previously had a cervical precancer.
• You have had your cervix removed as part of a total hysterectomy for a noncancerous condition.

Women who have had a hysterectomy may still need screening if the cervix was not removed.

Uncover problems early with Pap test results

Although they can be inconvenient, Pap smears are important for detecting early cervical changes before they turn serious. Understanding what your results mean and what to expect next can help reduce anxiety about the exam. If you're ever unsure about your results or recommended follow-up, talk to your doctor.