Abnormal Pap Smears

The Pap test, or Pap smear, is a screening test for cervical cancer. The test can detect changes in the cells on the cervix.  These changes may be cancerous, pre-cancerous, or caused by inflammation.

Types of Pap Smear Abnormalities are listed below:

Atypical Cells of Undetermined Significance - This means the cytologist has seen cells that are abnormal, but the cause of the abnormality is not clear.  A test for Human Papilloma Virus (HPV), the virus that causes cervical cancer, will then be performed.  If HPV is present a colposcopy will be recommended.  If no HPV is found, a pap smear will be repeated in one year.

• Low-grade Squamous Intraepithelial Lesion (LGSIL) - These changes may also be called dysplasia. If the cells are low-grade, the changes are mild. These changes have been linked to the Human Papilloma Virus (HPV). In about half of the cases of LGSIL, the cells will spontaneously return to normal. Further evaluation of a LGSIL by colposcopy is recommended though, because 25% of the lesions will progress to a high-grade lesion, and 25% will persist as LGSIL. 
• High-grade Squamous Intraepithelial Lesion (HGSIL) - These cervical changes are moderate to severe. If left untreated, 50 to 75% will progress to cervical cancer. If your report shows HGSIL, your doctor will recommend a colposcopy.
• Cancer - If the cells appear to be cancer, your doctor will want to do a biopsy to confirm the diagnosis.

A colposcopy is the painless viewing of the cervix and the vagina through a high-powered microscope called a colposcope. The colposcope looks like a pair of binoculars attached to a stand. It does not enter the vagina. Direct examination through the colposcope allows the detection of abnormalities on the cervix that can not be seen with the naked eye.  The area of abnormality can then be seen and a small biopsy may be taken for a definitive diagnosis.

Is There Any Preparation for the Test?

If you can take a non-steroidal anti-inflammatory medication such as Ibuprofen or Naproxen Sodium, it is suggested that you premedicate one hour befoe your appointment. Make your appointment for a time when you will not be menstruating (on your period). Refrain from intercourse, the use of spermicidal jelly, vaginal medications, douches, or tampons for at least 24 hours before the procedure as they can interfere with the accuracy of the test.

What Happens During the Test?

You will lie on the examining table with your feet in the stirrups, just like a regular pelvic exam. The provider will use a speculum to separate the walls of the vagina, just like during a normal Pap test. The speculum will remain in the vagina throughout the procedure, causing you to feel a little pressure. A vinegar solution (called acetic acid) will be applied to the cervix to remove mucous and debris. The colposcope will be placed near the vaginal opening. The provider will be able to see your vagina and cervix under magnification. Any areas showing abnormal cells will be biopsied. In a biopsy, a tiny sample of tissue will be removed from the area with a tweezer-like instrument. An endocervical scraping from the os (the opening in the middle of the cervix) may be taken as this is often where abnormal cells begin. You may feel a pinch or cramping when the tissue samples are taken. The samples will be sent to a pathology lab to be examined.

What Should I Look for After the Procedure?

If a biopsy was taken, you may have slight bleeding or spotting for a few days following the procedure. Additionally, you may notice a coffee ground or mustard-like discharge. This is normal. You may use pads, but no tampons for one week following the procedure. You should also refrain from douching or having sexual intercourse. If you have any cramping after the procedure, you may continue the Ibuprofen or Naproxen Sodium for relief.

Treatment

The need for treatment of an abnormal pap smear will be determined by the colposcopy results. 

If the dysplasia is mild, no treatment may be needed.  However, Pap smears will need to be performed more frequently and continued follow-up is very important.

If treatment is need a loop electrosurgical excision procedure (LEEP) is performed.  LEEP is used to remove the dysplasia from your cervix. 

The LEEP Procedure

Abnormal cells can be removed with LEEP. This allows new healthy cells to grow. LEEP is just one way to treat dysplasia.  Dysplasia also can be treated with other procedures such as cryosurgery, electrocautery, laser, or cone biopsy. The decision of which method to use depends on how much cervical tissue needs to be removed and where on the cervix the abnormal cells are located.

LEEP uses a thin wire loop that acts like a scalpel (surgical knife). An electric current is passed through the loop, which cuts away a thin layer of the surface cells.

The doctor will insert a speculum into your vagina in the same way as for a pelvic exam. The loop is inserted through the vagina to the cervix. Different sizes and shapes of loops can be used.

The procedure should be done when you're not having your menstrual period. This allows a better view of the cervix.  It should take only a few minutes.

During the procedure you will lie on your back and place your legs in stirrups. The doctor then will insert a speculum into your vagina in the same way as for a pelvic exam.

A solution is applied to your cervix to show the abnormal cells. Colposcopy will be used to magnify the cervix during the surgery.

Your cervix will be numbed with local anesthesia. It is given through a needle attached to a syringe. You will remain awake during the procedure. You may feel a dull ache or cramp.

The loop is inserted through the vagina to the cervix. There are different sizes and shapes of loops that can be used. After the procedure, a special paste may be applied to your cervix to stop any bleeding. The tissue that is removed will be studied in a lab to confirm the diagnosis.

Recovery

It may take a few weeks for your cervix to heal. While your cervix heals, you may have:

• Vaginal bleeding (less than a normal menstrual flow)
• Mild cramping
• A brownish-black discharge (from the paste used)

For a few weeks after the procedure, you should not have sex or use tampons or douches. If you have any discomfort, your doctor may prescribe pain relief.

© 2007 Women Partners in OB-GYN