What Happens After an Abnormal Pap Test?

Want to protect yourself from cervical cancer? Your first step is getting a regular Pap test. That way, if you have precancerous cells, they’re detected early.

Cervical cancer usually starts as a precancerous condition called dysplasia, which can be detected by a Pap and is 100 percent treatable, if caught early.

But, what happens if your Pap comes back with abnormal results? James Pavelka MD, a gynecologic oncologist with Tristate Gynecologic Oncology, discusses what happens next – and why you shouldn’t panic.

Abnormal Pap Test Results: What Do They Mean?

“It’s important to remember that an abnormal Pap smear is a pretty common experience for many women,” Dr. Pavelka explains.

An abnormal Pap usually means there have been mild changes in the cells of the cervix. Results could mean one of the following:

• There are atypical cells of uncertain significance.
• The changes may be due to the human papillomavirus.
• There are changes that may lead to cancer.

However, Pap tests only detect changes about 60-percent of the time, “which is why repeat Paps over time are important,” he points out. “Not only does it miss stuff that might be there, but sometimes inflammation or mild infections can create the appearance of precancerous changes when there are really none there.”

• Learn more about Pap test results.
• Learn more about human papillomavirus.

“I Received an Abnormal Pap Test. What’s Next?”

Your next step is usually a minor procedure called a colposcopy. This procedure is a visual examination of the cervix using a low-powered microscope used to find and then biopsy abnormal areas in your cervix that may lead to cervical cancer.

“The pap smear is really just a triage test that tells us who could use a colposcopy and who doesn’t need one,” Dr. Pavelka says.

• Learn more about colposcopy.

Preparing for a Colposcopy

Colposcopies do not require any special preparation. However, Dr. Pavelka says that at least 24 hours before the exam:

• Do not douche.
• Do not place any products, like tampons, into the vagina.
• Do not have sex.
• Notify your doctor or nurse if you are pregnant or could be pregnant.

He also says to avoid scheduling your colposcopy for a day when you may be on your menstrual cycle. “It may be wisest to change the appointment to a time when there would be no bleeding, just because that could obscure what we’re able to see.”

During the Procedure

Initially, your gynecologist will insert a speculum, similar to one used during a Pap test, into the vagina. Next, he or she will apply a couple different solutions to help highlight any precancerous changes.

The first solution is a strong vinegar solution, which is used to remove the mucus that covers the surface and highlights abnormal areas. Your doctor may also apply a second solution – which is an iodine solution – to identify any abnormalities.

“When we look at the cervix … unless we know for certain that something is benign, we should perform biopsies to help get a true diagnosis of what the cervical changes may be,” Dr. Pavelka explains.

After the Procedure

After the colposcopy, it is not uncommon for a woman to experience a small amount of vaginal drainage or spotting. “Sometimes there’s a bit of discharge just related to the solutions used to highlight the abnormal cells,” Dr. Pavelka points out.

One solution in particular, called Monsel’s solution, may leave a dark brown discharge, resembling coffee grounds behind.

From there, the gynecologist will send the biopsies to a pathologist. “After the colposcopic exam, generally speaking, we would have a discussion … about the findings, the timing of pathology and the possible treatment that would occur based on the possible results that we could get,” he says.

Biopsy results usually take one to two weeks. You will either receive a follow-up phone call from your gynecologist’s office to discuss results, or your doctor may prefer to consult in person.

If the results show low-grade dysplasia, your doctor will probably recommend scheduling another Pap test six months later.