6 Abnormal Pap Smear Causes and What They Mean

But in other cases, Pap smear abnormalities can occur due to other reasons besides cancer, like a sexually transmitted infection (STI) or a bacterial infection. If you get an abnormal Pap smear result, your doctor will explain what it indicates and what further testing or treatment you need, if any.

“Individuals who should get a Pap smear are people who are born physiologic/biologic as a woman at the age of 21, even if they have never been sexually active,” says Didi Saint Louis, MD, MPH, an associate professor of obstetrics and gynecology at Morehouse School of Medicine in Atlanta, where she serves as third-year ob-gyn clerkship director and Ryan Program family planning director.

“The recommended timing for a Pap smear depends on your age and test results. If a person is between the ages of 21 and 29, a person should get a Pap smear every three years. For those who are between the ages of 30 and 65, the recommendation for testing is every five years,” says Dr. Saint Louis.

It can feel scary to get an abnormal result on a Pap test. But knowing what can cause abnormalities is helpful. Here are six abnormal Pap smear causes and what they might mean.

1. Human Papillomavirus (HPV)

“Sometimes we need to understand what type of HPV is present to understand the next steps,” explains Aparna Sridhar, MD, associate clinical professor of obstetrics and gynecology at the David Geffen School of Medicine in Los Angeles.

HPV infection can affect anyone who’s sexually active, and generally it doesn't show any signs or symptoms. This is why, if you’re diagnosed with the virus, it is important to discuss it with your sexual partner.

The HPV vaccine may also be given to help with treatment for moderate or severe CIN.

2. Cervical Dysplasia (CIN)

Cervical dysplasia is also called cervical intraepithelial neoplasia (CIN). There are many stages of cervical dysplasia. If you have mild or low-grade dysplasia, your healthcare provider may simply choose to monitor you for the time being with follow-up exams until any further changes occur. “Early detection is key for identifying precancerous cells in the cervix and offering treatment or more surveillance,” Dr. Sridhar adds.

• Cryotherapy A technique that kills the abnormal cells by freezing them
• Minimally Invasive Surgery A procedure to cut and remove the abnormal tissue

3. Cervical Cancer

• Unusual bleeding (which includes bleeding between periods, after menopause, or after you’ve had sex)
• Abnormal vaginal discharge or vaginal discomfort
• Pain that won’t go away in the back, legs, or pelvic area
• Weight loss, fatigue, or loss of appetite
• Swelling in the legs

4. Trichomoniasis and Other STIs

• Pain during sex
• Foul-smelling vaginal discharge
• Symptoms of a urinary tract infection, like pain or a burning sensation when you pee
• Vaginal itching
• Pelvic pain

5. Vaginal Infection

• Vaginal itching
• Foul-smelling discharge
• Pelvic pain
• Bleeding between periods

Your doctor will recommend a form of treatment depending on the type of infection that you have. For example, if your infection is bacterial, you will have to take an antibiotic, but if it’s fungal, an antifungal treatment is most likely.

Your doctor may also perform a follow-up screening test to rule out any additional problems.

6. Harmless Abnormal Pap Smear Causes

• Schedule your test at least five days after your menstrual period has stopped.
• Limit the use of tampons, spermicide gels, lubricants, or other vaginal creams or moisturizers for up to seven days before your test.
• Avoid vaginal sex in the 48 hours leading up to your test.

When a Pap smear result comes back abnormal, Saint Louis says, “There can be some precancerous cells detected, and this doesn’t always result in a cancer diagnosis. The recommended next steps depend on your age, any past and present Pap smear results, and your overall health.”

If a result comes back abnormal, Saint Louis explains that the following scenarios can happen:

• Your healthcare provider discusses your Pap smear results with you and explains what they mean.
• Your healthcare provider asks you to repeat your Pap or HPV testing in 6 to 12 months. This will give your body time to clear an HPV infection and allow abnormal cells to return to normal on their own.
• You may be asked to return for a colposcopy, which is a diagnostic procedure that allows your provider to examine the cervix more closely.

“Some of the reasons a Pap smear is abnormal are due to an HPV infection, hormonal changes, or other infections like trichomoniasis, inflammation caused by intercourse, foreign bodies, lubricants, douching, or spermicides,” Saint Louis explains.

An abnormal Pap smear result can occur from time to time. “Abnormal Pap smear results occur in about 3 percent to 5 percent of all screening Pap tests performed in the United States,” Saint Louis says.

If you receive an abnormal Pap smear result, it’s important to talk to your healthcare provider about what your results could mean, whether you need more testing, and any next steps they recommend.

You can take certain steps if your Pap smear results come back abnormal. Saint Louis advises the following:

• Talk to your healthcare provider about next steps.
• Inquire about additional testing, monitoring, or treatment.
• Get the HPV vaccine if you haven’t already.
• Use condoms during sex.
• Keep up with regular cervical cancer screenings.