Abnormal Pap Smear: What It Means and What Comes Next

What does an abnormal Pap smear result actually mean?

A Pap smear collects cells from the cervix and examines them under a microscope. "Abnormal" covers a wide range of findings — from very minor changes that often clear on their own to more significant changes that need follow-up. The result is reported using standardized categories:

• ASC-US (Atypical Squamous Cells of Undetermined Significance): The mildest abnormality. Most often related to HPV and very likely to resolve.
• LSIL (Low-Grade Squamous Intraepithelial Lesion): Minor cell changes, still often linked to HPV. High chance of clearing without treatment.
• ASC-H: Atypical cells where a higher-grade change cannot be excluded — requires further evaluation.
• HSIL (High-Grade Squamous Intraepithelial Lesion): More significant cell changes. These require prompt follow-up, though they are still pre-cancerous, not cancer itself.
• AGC (Atypical Glandular Cells): A different type of abnormality warranting thorough evaluation.

Current cervical cancer screening guidelines recommend that women aged 21–29 have Pap testing every three years, while those aged 30–65 may choose Pap testing alone every three years, hrHPV testing alone every five years, or co-testing every five years 2Ref 2US Preventive Services Task Force (2018).Cervical Cancer: Screening.Recommended cervical cancer screening intervals: Pap every 3 years (ages 21–65), hrHPV every 5 years or co-testing every 5 years (ages 30–65). The key point: even the more significant results (HSIL) represent pre-cancerous changes, not cancer. The entire purpose of screening is to find and address these changes before cancer develops.

What is a colposcopy and will I need one?

A colposcopy is a close-up examination of the cervix using a magnifying instrument called a colposcope. The procedure is done in your gynecologist's office and typically takes about 15–20 minutes. A vinegar solution is applied to the cervix to make any abnormal areas more visible. If something looks concerning, a small biopsy may be taken.

Whether you need a colposcopy depends on your Pap result, your HPV test result, and your age 1Ref 1American College of Obstetricians and Gynecologists (2023).Colposcopy and Cervical Biopsies (Patient FAQ).Description of colposcopy procedure, biopsy classification (CIN 1–3), and treatment with LEEP when abnormal cells are found. For a first-time ASC-US result, many clinicians will first test for HPV; if the HPV test is negative, more frequent monitoring is often chosen over immediate colposcopy. For HSIL results, a colposcopy is generally recommended promptly.

The 2019 ASCCP risk-based management guidelines shifted toward a risk-based approach: your follow-up is determined by your overall risk level — combining your current result, prior screening history, and HPV status — rather than by a single result in isolation 4Ref 4Perkins RB, Guido RS, Castle PE, Chelmow D, Einstein MH, Garcia F, Huh WK, Kim JJ, Moscicki AB, Nayar R, Saraiya M, Sawaya GF, Wentzensen N, Schiffman M (2020).2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors.Risk-based framework for follow-up decisions after abnormal Pap results, integrating current result with HPV status and screening history.

What happens if a biopsy is needed?

A cervical biopsy removes a very small piece of tissue for laboratory analysis. Results are classified as:

• CIN 1 (Cervical Intraepithelial Neoplasia, grade 1): Mild changes. Most resolve on their own; surveillance is usually the approach.
• CIN 2 and CIN 3: More significant pre-cancerous changes. Treatment is generally recommended, though the approach may vary by age and circumstances.

Treatment for CIN 2/3, when needed, is usually a LEEP (loop electrosurgical excision procedure) or cryotherapy — outpatient procedures that remove or destroy the abnormal tissue. These are highly effective 1Ref 1American College of Obstetricians and Gynecologists (2023).Colposcopy and Cervical Biopsies (Patient FAQ).Description of colposcopy procedure, biopsy classification (CIN 1–3), and treatment with LEEP when abnormal cells are found.

If my Pap is abnormal, does it mean I have HPV?

Often, but not always. The majority of abnormal Pap results — especially LSIL and ASC-US — are driven by HPV infection. HPV is extremely common; more than 90 percent of new HPV infections, including high-risk types, clear or become undetectable within two years 3Ref 3Centers for Disease Control and Prevention (2025).Reducing Risk for Cervical Cancer.More than 90% of HPV infections clear within 2 years; HPV vaccine reduced cervical precancer incidence ~80% in vaccinated young adults (2008–2022). Most sexually active adults will have it at some point in their lives, and most clear it naturally.

Having HPV does not mean you will develop cervical cancer. It means the virus is present, and your screening schedule needs to be followed to detect any cell changes if they develop. An HPV-positive result with a normal Pap is a reason for closer follow-up, not for alarm.

How does the HPV vaccine relate to Pap smear screening?

The HPV vaccine protects against the types of HPV that most often cause cervical cancer. Surveillance data show that cervical precancer incidence dropped by approximately 80 percent among screened women aged 20–24 — the group most likely to have received vaccination — between 2008 and 2022 3Ref 3Centers for Disease Control and Prevention (2025).Reducing Risk for Cervical Cancer.More than 90% of HPV infections clear within 2 years; HPV vaccine reduced cervical precancer incidence ~80% in vaccinated young adults (2008–2022).

Importantly, vaccination does not replace Pap smear screening. The vaccine prevents new HPV infections but does not treat existing infections or cell changes. People who have been vaccinated still need cervical cancer screening on the recommended schedule.

How long does it take to get results, and what should I do while waiting?

Lab results typically return within one to two weeks. If your clinician has not contacted you by then, it is reasonable to call the office. While waiting, you do not need to restrict any activities — an abnormal Pap does not mean you need to avoid sex, exercise, or other normal routines while awaiting results.

If your result requires a colposcopy or other follow-up, complete that follow-up on the recommended timeline. Delays in follow-up are the main way pre-cancerous changes are missed.