Things That Can Cause an Abnormal Pap Smear: Key Causes

What is a Pap Smear?

A Pap smear, also known as a Pap test, is a crucial screening tool used to detect changes in the cells of the cervix, the lower part of the uterus that opens into the vagina.

The primary goal of a Pap smear is to identify precancerous or cancerous cells early, thus enabling timely intervention and treatment. Regular Pap smears have significantly reduced the incidence and mortality rates of cervical cancer.

What Does It Mean to Have Abnormal Pap Smear Results?

When your Pap smear results come back as abnormal, it means that the test has detected changes in the cells of your cervix. 

It's essential to understand that an abnormal Pap smear does not necessarily mean you have cervical cancer. Various factors can cause these changes, many of which are not severe. However, further investigation is often required to determine the exact cause.

Docus provides a Pap Smear Test Interpretation tool that allows users to enter their test results for a quick and detailed explanation. This tool can assist in understanding lab results and preparing for discussions with healthcare providers. However, it's important to remember that these tools are not replacements for professional medical advice, diagnosis, or treatment.

Common Causes of Abnormal Pap Smear Results

Human Papillomavirus (HPV)

Human Papillomavirus (HPV) is a common virus transmitted through sexual activity. According to the Centers for Disease Control and Prevention (CDC), almost every sexually active person will contract HPV at some point in their lives. HPV is the leading cause of abnormal Pap smear results, accounting for nearly 70% of cases.

HPV has many strains, some of which are high-risk and can lead to cervical cancer. Other strains may cause genital warts but are not cancerous. Most HPV infections resolve on their own without causing any health problems. 

However, persistent infection with high-risk HPV strains can lead to significant cellular changes in the cervix, increasing the risk of cervical dysplasia and cervical cancer.

Cervical Dysplasia (CIN)

Cervical dysplasia, also known as cervical intraepithelial neoplasia (CIN), refers to abnormal changes in the cells on the surface of the cervix. These changes are precancerous and can be classified into three stages based on severity:

• CIN 1: Mild dysplasia with slight abnormalities.
• CIN 2: Moderate dysplasia with more pronounced cell changes.
• CIN 3: Severe dysplasia that affects the entire thickness of the cervical lining.

While CIN itself is not cancer, it can progress to cervical cancer if left untreated, especially in the case of CIN 2 and CIN 3. Early detection and treatment of cervical dysplasia are crucial to prevent the progression of cervical cancer.

Cervical Cancer

Cervical cancer begins in the cells of the cervix and can develop slowly over many years. It is often preceded by cervical dysplasia.

The World Health Organization (WHO) reports that cervical cancer ranks as the fourth most common cancer among women worldwide, with approximately 660,000 new cases and around 350,000 deaths in 2022.

Cervical cancer may not cause noticeable symptoms in its early stages, making regular screening through Pap smears essential for early detection. Early-stage cervical cancer can be treated more effectively and has a higher chance of being cured.

Trichomoniasis and Other STIs

Trichomoniasis is a sexually transmitted infection (STI) caused by the parasite Trichomonas vaginalis. It can lead to abnormal Pap smear results due to inflammation and cellular changes in the cervix.

Other STIs, such as chlamydia, gonorrhea, and herpes, can also cause inflammation and changes in cervical cells, leading to abnormal Pap smear results.

Vaginal Infection

Vaginal infections, such as bacterial vaginosis and yeast infections, can also result in abnormal Pap smear results. These infections cause inflammation and cellular changes in the cervix.

Bacterial vaginosis is caused by an imbalance of bacteria in the vagina, while an overgrowth of Candida fungus causes yeast infections. Both conditions are treatable, and managing them effectively can help prevent abnormal Pap smear results.

Harmless Causes

Not all abnormal Pap smear results indicate a serious problem. Benign reasons for abnormal results can include:

• Recent Sexual Activity: Temporary changes in cervical cells due to intercourse.
• Menstruation: Pap smear during or close to the period can be misleading because menstruation causes hormonal changes.
• Use of Tampons and Products: Temporary changes due to the use of tampons or certain vaginal products before the test.

If you experience any of these symptoms, it’s crucial to consult your healthcare provider promptly. Early diagnosis and treatment of these conditions can prevent complications and improve your health outcomes.

Diagnosis and Follow-Up Tests

When a Pap smear indicates abnormal results, your healthcare provider will perform additional tests to determine the cause and appropriate treatment. Here is an overview of the diagnostic process and follow-up tests:

Initial Consultation

After receiving abnormal Pap smear results, your healthcare provider will discuss the findings with you. They will review your medical history, conduct a physical examination, and ask about any symptoms you may be experiencing.

Colposcopy

A colposcopy is a follow-up procedure that allows your doctor to examine your cervix more closely. During this procedure:

• Preparation: You will lie on an examination table, similar to a Pap smear.
• Speculum Insertion: A speculum is inserted to hold the vaginal walls open.
• Colposcope Use: A colposcope, which is a special microscope, is positioned outside the vagina to provide a magnified view of the cervix.
• Application of Solution: A solution is applied to the cervix to highlight any abnormal areas.

If your doctor sees any suspicious areas during the colposcopy, they may take a biopsy.

Biopsy

A biopsy involves taking a small sample of cervical tissue for further examination. There are different types of cervical biopsies:

• Punch Biopsy: Small samples of tissue are taken from the cervix.
• Endocervical Curettage: Tissue is scraped from the cervical canal.
• Cone Biopsy: A larger, cone-shaped sample of tissue is removed, usually under anesthesia.

The biopsy sample is sent to a laboratory where it is examined for abnormal or precancerous cells. This helps determine the extent and severity of the cell changes.

Additional Tests

Depending on the initial findings, your healthcare provider may recommend other tests such as:

• HPV Test: To check for the presence of high-risk HPV strains.
• STD Screenings: To rule out sexually transmitted infections that may cause abnormal results.

Note: Remember, while these procedures may sound intimidating, they are crucial for early detection and treatment of potential issues. If you have any concerns or symptoms, consult your healthcare provider promptly.

Treatment Options

When an abnormal Pap smear result is identified, the treatment approach depends on the underlying cause. Here’s an overview of the treatment options for different conditions:

HPV (Human Papillomavirus)

In many cases, especially with low-risk HPV strains, doctors recommend regular monitoring through follow-up Pap smears and HPV tests. For high-risk HPV strains leading to precancerous changes, treatment options include:

• Cryotherapy: Freezing abnormal cells to destroy them.
• Laser Therapy: Using a laser to remove abnormal tissue.
• LEEP (Loop Electrosurgical Excision Procedure): Using an electrically charged wire loop to excise abnormal cells.

Cervical Dysplasia (CIN)

For mild dysplasia (CIN 1), doctors may recommend regular monitoring as it often resolves on its own. For moderate to severe dysplasia (CIN 2 and CIN 3), treatment options include:

• Cryotherapy: Freezing the abnormal cells.
• Laser Therapy: Removing abnormal tissue with a laser.
• LEEP: Excision of abnormal cells with a wire loop.
• Cone Biopsy: Surgical removal of a cone-shaped section of abnormal tissue.

Cervical Cancer

When detected early, cervical cancer can be treated effectively with:

• Surgery: Removal of cancerous tissue, which may include a hysterectomy (removal of the uterus) in some cases.
• Radiation Therapy: Using high-energy rays to kill cancer cells.
• Chemotherapy: Using drugs to kill cancer cells.

Trichomoniasis and Other STIs

• Antibiotics: Trichomoniasis and other bacterial STIs are treated with prescribed antibiotics. 
• Antiviral Medications: STIs caused by viruses, such as herpes, are managed with antiviral medications to reduce symptoms and prevent outbreaks.

Vaginal Infections

• Antibiotics: Bacterial vaginosis is treated with antibiotics to restore the normal bacterial balance in the vagina.
• Antifungal medications: Yeast infections are treated with antifungal medications available as creams, suppositories, or oral tablets.

Preventive Tips for Accurate Pap Smear Results

To ensure the most accurate Pap smear results and avoid false abnormalities, follow these practical tips:

1. Schedule Your Test Properly: Aim to have your Pap smear at least five days after your period has ended to avoid menstrual blood affecting the results.
2. Avoid Sexual Activity: Refrain from sexual intercourse for at least 48 hours before your test. Sexual activity can cause temporary changes in cervical cells.
3. Avoid Vaginal Products: Do not use tampons, douches, vaginal creams, spermicides, or lubricants for at least 48 hours before your test. These products can alter the cells in your cervix.
4. Manage Infections: If you have symptoms of a vaginal infection (e.g., itching, unusual discharge), consult your healthcare provider and get treated before your Pap smear.
5. Follow Medical Advice: Always follow the specific instructions given by your healthcare provider regarding preparation for a Pap smear.