One of the challenges some women face is trying to make sense of a Pap test result that isn’t “normal” or “negative.” It can be easy to jump to the conclusion that something really awful is going on—cancer, an inability to have children, or other gloomy scenarios. By the way, that’s almost never the case! Hopefully, what follows will clarify how to interpret the results of your next Pap test.
What is a Pap test?
A Pap test involves a healthcare provider swabbing some cells from a woman’s cervix and sending them in a special liquid to a lab for testing. The cells are evaluated for changes that could (but probably won’t) lead to cancer. If you are 30 or older or have had an abnormal Pap result, some of the liquid may also tested to see if human papilloma virus (HPV) is present. There are two broad categories of HPV: “low-risk” types and “high-risk” types. Low-risk types do not increase a woman’s chance of getting a serious disease (like cervical cancer). So basically, most women will get two pieces of information: 1) the result of the Pap test itself; and 2) the presence or absence of high-risk HPV on her cervix (which is reported as “positive” or “negative”). The HPV testing makes the recommendation we give you about how to follow up on your Pap result more accurate.
What is HPV?
Human papilloma virus is transmitted from one person to another via sex. About 75% of adults have been exposed to HPV, but in about 2/3rd of cases, your immune system will clear this virus (just like it clears a common cold virus). Nobody has symptoms (like discomfort, burning or discharge), so unless a woman has an abnormal Pap test result, she would never know she had contracted this virus. The virus sometimes, but not always, causes a Pap test to come back with abnormal results. If your immune system gets rid of the HPV, your Pap test results will stay normal or go back to normal.
What are the possible Pap results I could get?
Negative for intra-epithelial lesions and malignancy (NILM): This means your test was “normal,” or “negative.” That’s great news! You’ll be given advice on how often to have Pap tests over the next several years. That can mean you might not need a Pap test for another three years! Just remember that every situation is a little different, and your provider will take your unique situation into account when he or she advises you.
Atypical Squamous Cells of Undetermined Significance (ASCUS): This is not awful news. It just means “unclear.” Looking at the cells from your cervix, the pathologist did not think your cells were abnormal or scary looking. However, some subtle change(s) were noted that mean the Pap test couldn’t be called “normal.” What really helps clarify the situation is whether or not the high-risk HPV type(s) were detected. Either way, there may not be anything wrong with your cervix. And very likely, any abnormality that might be there in the cervix is probably mild.
Atypical Squamous Cells, can’t rule out high grade abnormalities (ASC-H): Again, this is essentially “unclear.” It means the pathologist could not be certain, while looking under the microscope, that your cervix cells were definitely abnormal. However, there were some cells that made the pathologist think there could be some moderate or severe abnormalities of the cervix. Your provider may recommend a “colposcopy” following this type of result to help figure out if anything further needs to be done. I’ll describe this more below – but relax, it’s not a big deal!
Low-grade Intraepithelial Lesion (LSIL): This is what it sounds like—the test showed mildly abnormal changes. In many cases, it’s best to do a colposcopy to make sure the changes to your cervix are just mild in nature.
High-grade Intraepithelial Lesion (HSIL): This means that there were cells showing moderate or severe changes noted under the microscope. Further evaluation (a colposcopy) is important here. Please remember that this HSIL result on your Pap test does not mean you have cervical cancer. In fact, it’s still very unlikely.
Atypical Glandular Cells of Undetermined Significance (AGUS): This is another “unclear” result, and this result isn’t very common. Your provider will want to do further testing to get a clear diagnosis.
Cervical cancer cells are present. This is quite uncommon. Your provider will call you and help you get in to see the right specialist.
So, my doctor says I need a colposcopy. What is that?
During a colposcopy, the gynecologist will put a speculum in the vagina to see the cervix, just like during a Pap test. He or she will put vinegar on the cervix with cotton-tipped swabs, which can make an abnormal area turn white. Since the cervix is ordinarily pink, being able to see the possibly abnormal area(s) can really be helpful—and it doesn’t hurt. After looking at the area, the doctor may decide to take a flake (a tiny biopsy) from the area of the cervix that turned white. Some women report no pain when a biopsy is done, and some report a little “pinch” feeling.
A biopsy isn’t always necessary after a colposcopy. But if a biopsy is done, you’ll get a phone call in a few days with the final result and your doctor’s recommendation for follow up.
Don’t hesitate to ask about your Pap test results. If you’re not sure you know what a particular result means, please call us! If you’re worried and wonder “just how bad is this?”—call us! Our job is to help you understand what the result means and what you should do next. We want to help you get through any abnormal result safely.
If you have not been seeing a women’s healthcare specialist regularly, contact one of our offices to schedule an annual exam today. Your provider will talk about your Pap test history and help you decide how to proceed.
Dr. Pickering is an OB/GYN physician in the Hillsboro office of Women's Healthcare Associates. He grew up in in Arlington, Texas and attended Brigham Young University in Utah for his undergraduate degree in business. He went to the University of Texas Southwestern Medical School and completed his OB/GYN training at Vanderbilt University Medical Center in Tennessee. He enjoys helping women understand the options they have for solving problems related to periods, pelvic pain and contraception. He is a skilled minimally-invasive surgeon and is certified in the use of the da Vinci robot in gynecologic surgery. He is fluent in Spanish. Read more about Dr. Pickering >