Abnormal Pap smear

Pap smear or Pap test is conducted as part of a woman’s routine health examination, after the age of 18 years. It is not a diagnostic test, but is a screening tool used to detect any abnormal cells in the cervix. The cervix is the lower part of the uterus that opens into the vagina.

Pap smears help in early detection of any serious medical conditions such as cervical cancer.

Abnormal Pap smear may indicate the presence of infection or abnormal cells called dysplasia. An abnormal Pap smear will not usually denote cancer. These results highlight the requirement of supplementary testing to identify and confirm an underlying problem.

Causes of abnormal Pap smear

An abnormal pap smear may indicate any of the following

  • An infection or an inflammation
  • Herpes
  • Trichomoniasis
  • Dysplasia (abnormal cells that may be pre-cancerous)
  • Recent sexual activity
  • HPV (Human Papilloma Virus) infection; also called genital warts

Presentation

Usually abnormal cells do not produce any symptoms. Moreover, even the presence of HPV in an abnormal Pap smear is asymptomatic. Therefore a regular Pap smear is beneficial in early detection of any abnormalities.

However, an abnormal Pap smear secondary to a sexually transmitted infection may induce the following symptoms

  • Abnormal discharge from the vagina, such as change in the amount, colour, odour, or texture
  • Abnormal sensations such as pain, burning, or itching in pelvic or genital area during urination or sex
  • Sores, lumps, blisters, rashes, or warts on or around the genitals

Treatment

Following an abnormal Pap smear, the next step is further testing to confirm the cause of the abnormal cells. A repeat Pap smear or test for human papilloma virus (HPV), a major risk factor for cervical cancer, may also be recommended.

Depending on the age of the patient and the type of abnormal cells, the doctor may recommend the following treatment options

  • Colposcopy: This is a procedure, usually done in the doctor’s room where the cervix is viewed with a special magnifying device. A biopsy can be taken from the cervix if necessary at this time.
  • Cone biopsy or LLETZ procedure: In this procedure, a triangle segment of cervical tissue including abnormal cells is removed by specially designed instruments for evaluation.
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