What to Expect After an Abnormal Pap Smear

Colposcopy, a commonly performed test detects cervix changes
Abnormal Pap: What Is a Colposcopy?

When doctors want to do a careful evaluation of an abnormal Pap test, they usually recommend a colposcopy. This complicated word really means a fairly simple procedure — examining the cervix in detail with a pair of high-tech binoculars. The whole thing usually takes less than 10 minutes.

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1. Getting ready

First, the doctor or nurse will talk to you about your Pap results, explain the procedure, and get your consent. They’ll want to know if you’re pregnant, because it makes a difference in the procedures they do.

Next the doctor will put in a speculum, just like for a Pap test, and then bring the colposcope into place. The colposcope might look pretty intimidating, but it stays outside of you, so don’t worry.

2. The white-spot test

A vinegar solution is applied to the cervix using large Q-tips. Most people don’t feel this part at all, but occasionally someone will feel mild stinging.

The vinegar will turn the abnormal areas of the cervix white. This can take up to three minutes to take full effect, and it’s kind of boring until that happens. You just have to wait.

Once the vinegar has done its work, the doctor will carefully look at each area of the cervix. A cervix looks like a donut from this angle. There might need to be a little pushing and pulling using small Q-tips while we try to see as far as we can down the donut hole.

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3. Taking a sample

If an area of whiteness is found, the doctor will use a small instrument to take a speck of it for testing. This is known as a biopsy. There may be more than one area. Biopsies can pinch or pull, but they are over in a second. Most people don’t feel too much pain with them. The small pieces will be put into containers to send to the pathologist to evaluate.

Next, the doctor will usually take a sampling from down inside the cervix. This is generally done with four swipes of a small, sharp instrument, or with a mascara-brush-type wand.

This part can cramp, but it’s very important to make sure there are no abnormalities beyond where we can see. This part is not usually done in pregnancy.

4. Finishing up

If the biopsies stirred up any bleeding, pressure will be held over the areas. It may be necessary to use medication to stop the bleeding.

One method, silver nitrate, leaves dark ashes behind. These may fall out later into your underwear, looking like cigarette ashes. Another medication, Monsel’s solution, is a thick, amber-colored liquid that may also fall out later in dark chunks. Many women will wear a pad for a few days afterwards, just in case.

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Then the speculum is removed, and it’s all over!

My advice to women is to find out how long it will be before the results are in, and call the office if you haven’t heard in a reasonable amount of time. Your doctor will make a plan with you then, based on the biopsy results. If the results are consistent with low-grade changes or less, the plan will probably be to repeat the Pap in six months.


One other thing to consider is the HPV vaccine. You may think it’s too late to get it if you have already been infected with one kind of HPV. But since the vaccine protects against several strains, it may be worth getting anyway.

Contributor: Elisa Ross, MD

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