Most of us have a shared experience when it comes to going to the gynecologist – and it’s safe to say it isn’t exactly an enjoyable one. For starters, scheduling an hour to strip down and be prodded seems like a hassle, plus an annual Pap smear can feel like a deeply personal, though necessary, invasion of space. Then, there’s the whole fear of the unknown… What if something is wrong?
Despite how unpleasant the experience may be, we’re actually really lucky that Pap smears exist as part of our preventative care — even when they give us results that aren’t ideal. “Pap smears are a wonderful invention that has really served, when utilized appropriately, to markedly decrease the incidence of cervical cancer in women globally,” says Kecia Gaither, MD, a double board-certified OBGYN who specializes in maternal fetal medicine.
Dr. Gaither explains that the test is specifically designed to pick up precancerous and cancerous lesions, as well as other abnormalities, as a form of very early detection. And, as we all know, the earlier you detect something the easier treatment will be. So, what happens when a Pap smear comes back abnormal?
Getting a phone call from your doctor is undeniably scary, but our experts say there’s no need to panic. Abnormal Pap smears are more common than you think. It's estimated that 10 percent of tests come back with an abnormal finding. Plus, even though it’s not ideal news, this is why you had the test to begin with — to catch anything remotely “off” in those very preliminary stages so you can take action. Really, it’s quite empowering. Read on to learn what an abnormal Pap smear may mean and what happens next.
There are four primary causes for an abnormal Pap smear result:
“Yeast infections, herpes, and trichomoniasis (a sexually transmitted vaginal infection) are three of the more common vaginal infections that can be noted on a Pap smear evaluation,” says Dr. Gaither.
Human Papillomavirus (HPV) Infection
During a Pap smear, your gyno will test for the high-risk strains of HPV that are associated with the development of cervical cancer. If a high-risk strain is detected, he or she will want to evaluate further.
Cervical dysplasia is a potentially precancerous finding that denotes abnormalities of the surface cells of the cervix, explains Dr. Gaither. It is not cancer. Dysplasia simply means that the cells appear atypical. In addition to precancer, dysplasia can also be the result of irritation from an IUD or HPV flare-up.
Because cervical cancer is relatively slow growing and without symptoms until the very advanced stages, Dr. Gaither says it’s important to test for this regularly. The Pap smear can detect precancers and cell changes early on, so appropriate action can be taken.
What Happens Next: The Standard Medical Protocol
Keep in mind that Pap tests are just an initial test, says Anita Sit, MD, vice chair of the department of obstetrics and gynecology with Santa Clara Valley Medical Center. “Most women with an abnormal Pap smear do not have cancer. If your test comes back with cells that look abnormal, your doctor or nurse will follow up with another test to find out for sure what is going on,” she adds.
Depending on your age and the result of your Pap smear, your doctor might order an HPV test on the collected sample from your original smear. The HPV test checks for high-risk strains of HPV (16, 18, 31, 33, 45, 52, 58) that can cause cancer. If no HPV is detected, then your doctor may recommend a follow-up Pap smear in six to 12 months to check the progress. “If you wait a few months and have another Pap test, you could find that the cells are back to normal,” says Dr. Sit. “You might also need an HPV test at the same time.”
If a high-risk strain of HPV is detected and/or your original Pap smear came back with high-grade abnormal cells, then a colposcopy test will be ordered. “For this test, your doctor or nurse looks at your cervix using a microscope-like device that allows them to see the cervix in fine detail,” Dr. Sit explains. Your doctor might also do a biopsy, taking tiny samples of tissue from the cervix to be checked for abnormalities, she adds.
If your colposcopy test comes back normal, you will be put on a higher-frequency Pap smear calendar (typically two to three times per year) to monitor your cervical activity. If the test finds precancer or cervical cancer, then rest knowing that there are highly effective treatments available to you, and that curing the precancer or cancer is promising at this stage.
In this case, you and your doctor will determine the best route to take. “Your health provider may opt for a cone biopsy, which is a cone-shaped specimen that’s removed from your cervix; LEEP, a diagnostic excision procedure utilizing loop cautery; or cryotherapy, a machine that freezes abnormal cells off the surface of the cervix,” says Dr. Gaither. Laser treatments may also be an option at your OBGYN.
Each of these procedures are meant to remove the precancerous or cancerous cells, leaving you with a healthy cervix. Following the procedure, your doctor will recommend that you have Pap test every three to six months for one to two years in order to monitor your cervical health. Should an abnormal Pap smear occur again, you may be required to repeat the above process. (In very rare or extreme cases, especially if you have a family history of cervical cancer, your doctor may recommend a hysterectomy.)
At the end of the day, hearing the word “abnormal” associated with your health isn’t ideal. However, abnormal Pap smears are perhaps more common than you may think and having the ability to detect abnormalities early on is a medical gift. No matter how unpleasant, feel confident and empowered knowing that you’re a strong advocate for your own health.
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