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My Pap Is Abnormal. How Worried Should I Be?

How to interpret abnormal test results

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It’s never a good feeling to get a call from your doctor’s office telling you about an abnormality on your Pap test. But most of the time, there’s not much to worry about.

Paps can pick up subtle abnormalities in the cells of the cervix. Officially, a Pap is looking for cervical cancer and its precursors, but sometimes it will find other conditions, such as yeast or infection. Even if your Pap shows a “pre-cancerous” result, you should know that very few actually go on to become cancer.

Different kinds of results

There are several levels of abnormalities reported on Paps. At the lowest level of concern is the common finding of ASCUS, atypical squamous cells of undetermined significance. That name tells the story — we’re not sure what they mean unless there is further testing.

If the testing reveals no HPV, there’s nothing to worry about. If HPV is found, most likely it will be more carefully evaluated with a colposcopy, a simple, painless, 10- to 15-minute procedure that is further described later in this post.

Other findings on Pap are known as “dysplasia” or “CIN.” These are classified as mild, moderate or severe, or CIN 1, CIN 2 and CIN 3, respectively. Any of these findings require further evaluation in the office with colposcopy. Even though these conditions are considered potentially pre-cancerous, most of the time they resolve on their own, or with a small procedure to remove the abnormal area.


The process of obtaining a Pap involves scraping the whole cervix and examining the cells which are picked up. This is known as a “screening” test, and indicates who may benefit from a more detailed “diagnostic” test to confirm the level of abnormality.

The confirmatory “diagnostic” test is known as colposcopy. The cervix is examined in detail, using a kind of binoculars. This usually takes less than 10 minutes and is performed in the office. If abnormalities are seen, a small sample of the area may be taken (biopsy) and sent for evaluation. This will guide further treatment.

The procedure goes like this:

  1. A speculum is placed in the vagina, just like a Pap.
  2. Then, vinegar (yes!) is placed on the cervix, to turn any abnormal areas white.
  3. If any white areas are seen, a small biopsy is taken. There is sometimes a scraping of the inner part of the cervix, which can cramp.
  4. Any bleeding areas are treated, and the procedure is over.

The results of the colpscopy will direct your provider to the next steps to keeping you safe from cervical cancer.

Tags: ASCUS, colposcopy, dysplasia, HPV, ob/gyn, pap smear, pap test

Elisa Ross, MD, is a obstetrician and gynecologist in Cleveland Clinic’s Women’s Health Institute. She loves caring for and educating women.

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