When you have a pap smear, the doctor or nurse collects cells from the outer layer of the cervix — or neck of the womb — for examination under the microscope. If any of these cells have an irregular shape they may be in the early stages of transforming into cancer. If these cells are removed early, that cancer can be prevented.

The cells which are most susceptible to change occur in what is called the transition zone, which is the area where the walls of the inner canal of the cervix border the outer, visible part of the cervix.

A normal pap smear result must show cells of regular size and shape from the transition zone, as well as from the outer part of the cervix.

The pap smear is not perfect because it will detect any type of cell change. What this means is that there can be false-positive results where abnormal cells are seen, but which turn out to be normal on repeat testing.

You have an abnormal pap smear result

Your doctor has told you that your pap smear is abnormal. What now? There are two main questions to ask:

Does the abnormality look like cancer or an early form of cancer?
Are there any signs of infection with human papilloma virus (HPV) which is known to have an association with cancer of the cervix?

If your doctor answers yes to either of these questions, then you have a higher risk of contracting cancer of the cervix, or you may already have it. But, this is not as drastic as it sounds, since any cancerous cells detected can usually be removed and further progression of the cancer prevented.

If you have evidence of early cancer then you will be referred to a gynaecologist for something called colposcopy. During this procedure, a scope is put into the vagina allowing the gynaecologist a close view of the cervix to examine any abnormalities.

If you have evidence of HPV infection then you will have to have a repeat pap smear within three to six months to check for changes. If you also have evidence of early cancer, then you will be referred to a gynaecologist for colposcopy rather than a repeat pap smear.

Other questions

If the answer was no to either of these questions, then there are additional questions which will help you understand what was abnormal:

Was there any other sort of infection?
Was the sample OK? If it wasn't then the sample will be reported as abnormal to ensure a repeat sample.
How many pap smears do I need before going back to the usual annual routine?

More about pap smears

There are a number of terms and procedures related to abnormal pap smears which may be confusing. Understanding these is a great help when you are looking for information about any abnormal smears.

Colposcopy — if you have had a colposcopy then you have probably had a smear result which suggested early cancer, called cervical intraepithelial neoplasia or dysplasia. Your regular pap smears are usually yearly or more frequently, depending on how many normal smears you have had since the colposcopy.
LEEP, laser surgery, cone biopsy or surgery — these are all procedures carried out only on women with early cancer or cancerous cells in the cervix. A LEEP is a loop excisional electrosurgical procedure.
Human papilloma virus (HPV) — evidence of infection with this virus means that you have a higher risk of cancer of the cervix and should have yearly pap smears.
Nothing but repeat testing after abnormal pap smears — women who have only ever had repeat pap smears after an abnormal result have usually shown only irregular cells which did not fit the criteria for precancer. The cells may have become abnormal because of infection, hormonal changes or menopausal changes. Repeat pap smears are done to see if these abnormal cells may have changed into cancerous cells.
Infection — a pap smear can often detect infections such as candida, bacterial vaginosis or trichomonas. Candida and bacterial vaginosis are not usually treated unless you have symptoms. Trichomonas does need to be treated because it can be sexually transmitted and will cause symptoms.
Pap changes related to menopause — women who are post-menopausal can show changes in their vaginal and cervical cells. There is nothing dangerous in these changes, but they may be related to vaginal dryness, itching or burning.

The last word

An abnormal pap smear should always be taken seriously, but it is seldom cause for panic since if you are having regular pap smears any cancerous cells which have developed will be picked up early and can be removed entirely.

If your doctor tells you that a smear result is abnormal always make sure that you ask exactly what the problem is. Your own doctor is always the best source of information.