How Often Do You Need a Pap Smear? Screening Guidelines by Age
Cervical cancer screening by age: when to start, how often you need a Pap smear or HPV test, when you can stop, and what the latest US guideline changes mean.
Abnormal Pap Smear Results: What They Mean
What abnormal Pap smear results mean, from ASC-US and LSIL to HSIL, how HPV results change next steps, what colposcopy involves and when treatment is needed.
Key takeaways
- Abnormal Pap results are common and rarely mean cancer; most are caused by HPV and many clear on their own.
- Next steps are based on your overall risk: your result, HPV status and history.
- Colposcopy is a short, office-based check; treatment for precancer is highly effective.
On this page
Hearing that your Pap smear was “abnormal” can be frightening. But abnormal results are common, and they very rarely mean cancer. Most are caused by HPV infections, and many of the cell changes go away without treatment. Here’s what the terms on your report mean and what usually happens next.
What the results mean
| Result | What it means | Common next step |
|---|---|---|
| NILM | Normal: no abnormal cells | Routine screening |
| ASC-US | Slightly unusual cells of unclear significance, the most common abnormal result | Depends on the HPV test |
| LSIL | Low-grade changes, usually from HPV | Often colposcopy or repeat testing |
| ASC-H | Unusual cells; high-grade changes can’t be ruled out | Colposcopy |
| HSIL | High-grade changes more likely to progress | Colposcopy, sometimes treatment |
| AGC | Unusual glandular cells | Colposcopy and often further tests |
| Unsatisfactory | Not enough cells to read | Repeat test in 2–4 months |
Why the HPV result matters
Clinicians in the US follow risk-based guidelines from ASCCP and its partner organizations. Instead of reacting to a single result, they estimate your risk of serious precancer from your current Pap and HPV results plus your past results. That risk decides the next step: repeat testing in a year, colposcopy or treatment. For example, ASC-US with a negative HPV test usually just means a repeat test later, while a positive result for HPV 16 or 18 often leads to colposcopy. Our guide to the HPV test explains how it works.
What happens at a colposcopy
A colposcopy is a closer look at your cervix, done in the office in about 10 to 20 minutes.
- Like a Pap test, a speculum is placed in the vagina.
- A mild vinegar solution is applied to the cervix, which makes abnormal areas easier to see.
- The clinician looks through a colposcope, a magnifying instrument that stays outside your body.
- If they see an abnormal area, they take a small biopsy. This can pinch or cramp briefly.
Afterward, light spotting or dark discharge for a few days is normal. Many clinics suggest taking an over-the-counter pain reliever beforehand; ask what they recommend.
Biopsy results
Biopsies are graded as CIN (cervical intraepithelial neoplasia):
- CIN 1: low-grade changes that usually clear on their own; monitoring is typical.
- CIN 2: moderate changes; treatment or close monitoring, depending on your age and pregnancy plans.
- CIN 3: high-grade changes; treatment is recommended to prevent cancer.
Treatment for precancer
Treatments remove or destroy the abnormal area, most often with LEEP, which uses a thin wire loop, usually in the office. Others include cone biopsy and ablation. They’re highly effective. Excisional treatments can slightly raise the risk of preterm birth in future pregnancies, so mention any pregnancy plans. After treatment for high-grade changes, you’ll need regular follow-up testing for many years.
Coping with the wait
Waiting for results is stressful. Remember that screening exists to find changes early, when they’re easy to treat. Write down your questions for the appointment; our list of questions to ask your gynecologist can help. For the overall screening schedule, see Pap smear guidelines by age.
Frequently asked questions
Does an abnormal Pap mean I have cancer?
Almost never. Most abnormal results reflect HPV-related changes that are either harmless or precancerous and treatable.
Can abnormal cells go away on their own?
Yes, often. Low-grade changes frequently clear as the immune system clears HPV, especially in younger people.
Can I get pregnant after a LEEP?
Yes. Most people have healthy pregnancies afterward. Tell your obstetric care team about the procedure, as they may monitor your cervix during pregnancy.
Sources
Every article is edited by a human and checked against our editorial policy. Spotted a mistake? Tell us.
Keep reading
What Is an HPV Test? Who Needs One and What Results Mean
What an HPV test checks for, how it differs from a Pap smear, who should get one and how often, self-collection options and what positive results mean.
Your First Gynecologist Visit: What to Expect
What happens at a first gynecologist visit, when to go, whether you need a pelvic exam, the questions you’ll be asked and how to prepare so you feel in control.