Your Pap Smear Was Abnormal. What Happens Next?

An abnormal Pap is not a cervical cancer diagnosis. But you deserve to understand what the result means—and what should happen from here.

Maybe your patient portal simply says abnormal.

Maybe the report includes unfamiliar terms such as ASC-US, LSIL, ASC-H, HSIL, or AGC.

Maybe your HPV test is positive too.

Or maybe someone has already told you that you need a colposcopy, but you still do not understand what they are looking for or how concerned you should be.

An abnormal Pap smear can mean several different things. Some results call for repeat testing. Some need a closer examination of the cervix. Some raise greater concern for cervical precancer than others.

The appropriate next step depends not only on the word printed on your newest report, but also on your HPV result, previous cervical screening, age, and other relevant history.

We help women put those pieces together.

Abnormal Pap and HPV evaluation in Chattanooga — no membership required.

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First: An Abnormal Pap Does Not Mean You Have Cervical Cancer

A Pap test is a screening test.

It looks for changes in cells collected from the surface of the cervix. When those cells do not look completely normal under a microscope, the result is reported as abnormal.

That does not automatically mean you have cervical precancer.

And it does not mean you have cervical cancer.

Some abnormal results reflect mild HPV-related changes that may resolve. Others suggest a greater possibility that a precancerous area could be present and should be evaluated more closely.

The Pap result helps estimate risk. It does not by itself provide the same information as a cervical biopsy.

That is why the next question is not simply:

“Is my Pap smear abnormal?”

It is:

“What kind of abnormality was found, and what does it mean in the context of my complete history?”

Read ACOG's Patient Guidance

 

What Does My Abnormal Pap Result Mean?
Pap results are generally reported using specific categories. The terminology can feel intimidating, but each term is trying to communicate a different level or type of cellular change.
ASC-US
Atypical squamous cells of undetermined significance
ASC-US is the most common abnormal Pap result.
It means some squamous cells do not look completely normal, but the changes are not clearly precancerous. HPV testing is often especially useful in determining what happens next.
An ASC-US result with a negative high-risk HPV test is a very different situation from ASC-US with a positive HPV test or a history of previous abnormalities. Depending on your age and screening history, the next step may be repeat HPV-based testing or colposcopy.
LSIL
Low-grade squamous intraepithelial lesion
LSIL means mildly abnormal squamous cells were seen. These changes are usually associated with HPV infection and often resolve as the immune system controls the infection.
LSIL does not mean you have cervical cancer.
Whether you need repeat testing or colposcopy depends on your age, HPV result, previous screening, and other risk factors.
ASC-H
Atypical squamous cells—cannot exclude HSIL
ASC-H means abnormal squamous cells were found and a high-grade abnormality cannot be ruled out.
Because an underlying high-grade lesion may be present, this result generally requires colposcopic evaluation rather than routine repeat screening alone.
The goal of colposcopy is to determine whether a significant abnormality is present and to biopsy clinically relevant areas when indicated.
HSIL
High-grade squamous intraepithelial lesion
HSIL indicates more concerning cellular changes and carries a greater likelihood of an underlying high-grade cervical precancer such as CIN2 or CIN3.
HSIL is still not the same as cervical cancer.
However, it should be taken seriously and evaluated promptly. Depending on your age, pregnancy status, previous results, and estimated risk, the next step may involve colposcopy with biopsy or, in selected high-risk situations, discussion of expedited treatment.
ACG
Atypical glandular cells
AGC means abnormal cells were identified from glandular tissue. Glandular cells are found within the cervical canal and also within the uterus.
Because glandular abnormalities can come from more than one location and may occasionally be associated with significant cervical or endometrial disease, AGC requires a different evaluation from routine low-grade squamous abnormalities.
That evaluation may include colposcopy, sampling from the endocervical canal, and—in some patients—assessment of the uterine lining.
Unsatisfactory Pap Test
The sample could not be adequately interpreted
An unsatisfactory Pap does not mean abnormal cells were found.
It means the laboratory could not reliably evaluate the sample. This can happen when there are too few cells or when blood, inflammation, or another factor obscures the specimen.
Repeat testing is usually needed, but the timing and whether HPV testing changes the plan depend on the complete result.
Dr. Hitchcock talking with patient in a relaxing setting.

What If My HPV Test Is Positive?

High-risk HPV causes almost all cervical precancers and cervical cancers.

But a positive HPV test does not mean you have cancer.

HPV is extremely common, and many infections become undetectable without ever causing a significant cervical lesion. What matters is whether a high-risk HPV type is present, whether it persists, whether HPV16 or HPV18 was identified, what the Pap shows, and what your previous screening history looks like.

For example:

– An HPV-positive result with normal cytology may lead to repeat testing or colposcopy, depending on the HPV type and previous history.
– ASC-US with a positive HPV test carries a different level of risk from ASC-US with a negative HPV test.
– HPV16 or HPV18 generally receives particular attention because those types are more strongly associated with cervical precancer and cancer.
– Persistent high-risk HPV matters more than treating every positive result as though it means the same thing.

The Pap and HPV results should be interpreted together.

Learn More About HPV & Pap Results
Why Two Women With the Same Pap Result May Have Different Next Steps

Modern cervical screening management is based on risk, not simply on one test result.

Current recommendations consider the combination of your newest result and the history that came before it. That means two women with the same Pap wording may reasonably receive different recommendations.

  • UNDERSTAND THE CURRENT RESULT

    What did the Pap and HPV tests actually show?

    ASC-US, LSIL, ASC-H, HSIL, and AGC are not interchangeable. Neither are a negative HPV test, a positive pooled high-risk HPV test, HPV16, or HPV18.

    We start with the actual laboratory reports rather than relying only on a phone message or a portal notification that says “abnormal.”

  • UNDERSTAND THE HISTORY

    What happened before this result?

    A first minor abnormality after a recent negative HPV-based screening test may carry less risk than the same result after persistent HPV or several years of abnormal testing.

    Previous Pap tests, HPV results, colposcopies, cervical biopsies, and treatments all help establish the context.

  • UNDERSTAND THE PATIENT

    What other factors affect the recommendation?

    Age, pregnancy, immune status, previous cervical treatment, symptoms, and the ability to complete appropriate follow-up may all matter.

    The goal is not to make the result sound less important or more frightening than it is.

    The goal is to estimate the risk accurately enough to choose a safe next step.

View ASCCP Management Guidelines
What Might Happen Next?
An abnormal Pap does not lead automatically to one procedure.
Depending on your results and history, the next step may be one of several things.
REPEAT HPV-BASED TESTING
Sometimes surveillance is the safest next step
Minor abnormalities often do not require an immediate procedure, particularly when recent screening history lowers the estimated risk. Repeat HPV testing, cotesting, or another recommended surveillance interval allows us to see whether HPV and the cellular changes resolve or persist. Surveillance is not ignoring an abnormality. It is a structured plan based on the likelihood that immediate biopsy would add enough benefit to justify the procedure.
COLPOSCOPY
A closer examination of the cervix
Colposcopy uses magnification and special solutions to identify areas of the cervix that may need biopsy. The colposcope remains outside the body. If an area appears abnormal, a small tissue sample may be taken and sent to pathology. In selected situations, sampling from inside the cervical canal may also be recommended. The purpose is to answer a question the Pap cannot answer by itself: Is cervical precancer actually present—and if so, where is it and how significant is it?
ADDITIONAL EVALUATION
Some results require a broader assessment
Glandular abnormalities, symptoms, an abnormal-appearing cervix, or disagreement between different test results may require evaluation beyond a routine colposcopy alone. The appropriate assessment depends on where the abnormal cells may have originated and what other clinical information is present.
TREATMENT
Treatment is generally based on risk or a confirmed high-grade abnormality—not simply the word “abnormal” on a Pap report
If evaluation shows CIN2, CIN3, adenocarcinoma in situ, or another significant abnormality, treatment may be recommended. Sometimes a high-risk screening result leads to discussion of expedited treatment without a preceding biopsy, but this applies only in selected circumstances and should involve shared decision-making. A Pap result is the beginning of that decision—not the entire treatment plan.

Do I Need a Colposcopy?

Maybe.

Colposcopy is commonly recommended after results such as ASC-H, HSIL, AGC, certain HPV16 or HPV18 results, or other combinations that cross the guideline threshold for further evaluation.

It may also be recommended after persistent lower-grade abnormalities or when previous history increases your estimated risk.

But not every abnormal Pap requires colposcopy.

If your clinician has already recommended one, we can help you understand why. If you have only received the laboratory result and are unsure what should happen next, start with that result.

You do not need to diagnose yourself before contacting us.

Abnormal Pap Evaluation in Chattanooga

If you live in Chattanooga, southeast Tennessee, or the surrounding region, Beyond the LEEP provides focused evaluation of abnormal cervical screening results.

Depending on your situation, we may be able to help with:

– Review of your Pap and HPV reports
– Review of previous cervical screening and treatment history
– Cervical dysplasia consultation or second opinion
– Colposcopy and directed cervical biopsy when indicated
– Endocervical sampling when appropriate
– Explanation of pathology results
– Follow-up planning after colposcopy
– Evaluation of persistent or recurrent abnormalities
– Discussion of treatment options if CIN2 or CIN3 is diagnosed
– Referral when another type of specialist care is needed

You do not need to be a Hitchcock Family Medicine member.

You do not need a referral to contact us.

And you do not need to know whether you need a consultation, colposcopy, or another type of appointment before you start.

Bring us the result. We will help determine the next step.

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Dr. Hitchcock talking with patient in a relaxing setting.

What If I Live Outside Chattanooga?

You should not have to travel hundreds of miles simply to receive routine follow-up that can be provided well close to home.

Many first-time or low-risk abnormal Pap results can be managed appropriately by a local primary care clinician or gynecologist.

But a focused cervical dysplasia evaluation may be useful when:

– You do not understand why a procedure has been recommended
– Your Pap, HPV, colposcopy, and biopsy results do not seem to agree
– You have had repeated abnormal results or persistent high-risk HPV
– You have been diagnosed with CIN2, CIN2-3, or CIN3
– You have been told you need a LEEP and want to understand the recommendation
– You have already undergone cervical treatment and another result is abnormal
– You are concerned about preserving cervical tissue for a future pregnancy
– You want to know whether another medically reasonable option exists
– You have had a difficult or painful colposcopy and need another evaluation

We welcome women traveling from outside Tennessee and across the country for cervical dysplasia consultation, second opinions, colposcopy, and selected treatment options.

Whenever possible, start with the records you already have before making travel arrangements. Reviewing those records helps us understand what may need to happen in person and whether traveling is likely to add meaningful value.

Traveling to Chattanooga for Care

Abnormal Pap & HPV Evaluation Pricing

Consultation / Second Opinion

$350

A consultation may include review of your available Pap, HPV, colposcopy, pathology, and previous treatment records; assessment of the complete cervical history; explanation of your estimated risk; and a plan for appropriate next steps.

Colposcopy

$350 + pathology fees

Pathology fees are usually approximately $50–$150, depending on the number and type of specimens submitted.

When you contact us, start with your results. Our team will help determine which type of visit is likely to be appropriate.

You do not need to be a Hitchcock Family Medicine member.

Members receive additional discounts on cervical dysplasia services.

Frequently Asked Questions
Does an abnormal Pap smear mean I have cervical cancer?
No. An abnormal Pap means that cells collected from the cervix did not look completely normal. Many abnormal results are caused by HPV-related changes that never become cancer. Some results do carry a greater likelihood of cervical precancer and need additional evaluation. The exact Pap category, HPV result, and previous history help determine how concerned we should be and what happens next.
Does an abnormal Pap mean I have HPV?
Not always, but high-risk HPV causes most clinically significant cervical cell changes. Pap testing looks at the appearance of cervical cells, while HPV testing looks for high-risk types of the virus. The two results provide different information and are often most useful when interpreted together.
If my HPV test is positive, does that mean my partner was unfaithful?
No. HPV can become detectable long after the original exposure, and a positive test cannot determine when the infection was acquired or from whom. A new positive result does not establish recent transmission or infidelity.
What is the difference between an abnormal Pap and CIN?
An abnormal Pap is a cytology result based on individual cells collected from the cervix. CIN—cervical intraepithelial neoplasia—is generally diagnosed from a tissue biopsy. Pap categories such as LSIL or HSIL estimate the possibility of an underlying lesion, while a biopsy can show whether CIN is actually present and how it is graded.
Will I definitely need a colposcopy?
No. Some abnormal results can be followed with repeat HPV-based testing rather than immediate colposcopy. Other results carry enough risk that colposcopy is recommended. The decision depends on the exact Pap and HPV combination together with your previous screening history and other factors.
If I need a colposcopy, will I definitely have a biopsy?
Not necessarily. Biopsy depends on your underlying risk and what is seen during the examination. When abnormal areas are visible, targeted biopsy is often important. In appropriately low-risk situations where the cervix appears completely normal, biopsy may not always be necessary.
Is a colposcopy the same as a Pap smear?
No. A Pap smear collects cells for laboratory screening. Colposcopy is a magnified examination of the cervix. A speculum is inserted similarly to a Pap test, but the colposcope stays outside the body. Solutions are placed on the cervix to make abnormal areas easier to identify, and biopsy may be performed when indicated.
Can I repeat the Pap instead of having a colposcopy?
Sometimes repeat testing is appropriate, but not for every result. Repeating a Pap when the estimated risk calls for colposcopy may delay diagnosis of a significant lesion. On the other hand, performing colposcopy when surveillance is recommended may add a procedure without meaningful benefit. The safest plan depends on the complete risk assessment.
What if my Pap is abnormal but my HPV test is negative?
That combination is generally reassuring, but the recommendation still depends on the type of cellular abnormality and your history. Some results, such as ASC-US with a negative high-risk HPV test, are usually managed very differently from ASC-H or AGC with a negative HPV result. HPV negativity should not be interpreted in isolation from the cytology category.
What if my Pap is normal but my HPV test is positive?
A positive high-risk HPV test with normal cytology does not mean precancer is present. Depending on the HPV type and prior history, the next step may be repeat HPV-based testing after an appropriate interval or colposcopy. HPV16 and HPV18 receive particular attention even when cytology is normal.
Do I need a second opinion for every abnormal Pap?
No. Many abnormal screening results are straightforward and can be managed appropriately by your current clinician. A second opinion may be useful when the recommendation is unclear, several results seem inconsistent, abnormalities persist, treatment is being proposed, or you simply do not understand the reasoning behind the plan.
Can I come directly to Beyond the LEEP for a colposcopy?
Yes. You do not need to be a Hitchcock Family Medicine member, and you do not need a referral to contact us. Send the Pap and HPV information you have so we can help determine whether colposcopy, consultation, or another next step is appropriate.
Can I travel to Chattanooga for an abnormal Pap evaluation?
Yes, although routine abnormal screening can often be managed well close to home. Traveling may be more useful when the situation is complex, when you want a focused second opinion, when you have already been diagnosed with cervical dysplasia, or when the next treatment decision is not clear. Whenever possible, send your available records before booking travel.
What if I am pregnant?
Pregnancy changes some aspects of cervical evaluation and treatment timing, but appropriate follow-up of an abnormal screening result is still important. Tell us that you are pregnant when you contact us. Certain procedures are avoided during pregnancy, and treatment is generally deferred unless cancer is suspected, but the correct approach depends on the result and estimated risk.
What if I am having abnormal bleeding or other symptoms?
A Pap test is a screening test and does not evaluate every possible cause of symptoms. Bleeding after sex, bleeding between periods, bleeding after menopause, unusual discharge, or persistent pelvic pain should be discussed directly with a clinician rather than assumed to be explained by a Pap result. Symptomatic evaluation may require a different or broader assessment.
Do you treat cervical cancer?
No. Beyond the LEEP focuses on abnormal cervical screening, colposcopy, cervical dysplasia, and selected precancer treatment. If your results or examination raise concern for invasive cervical cancer, we will recommend evaluation by an appropriate gynecologist or gynecologic oncologist.

Your Result Says “Abnormal.” You Do Not Have to Figure Out the Rest Alone.

You do not need to know which kind of appointment or treatment you need before contacting us.

If you have an abnormal Pap or HPV result, have been told you need a colposcopy, or simply do not understand what the report means, start with the information you already have.

We will help you understand:

– What the result actually says
– How HPV and previous screening affect the interpretation
– How concerned you should be
– Whether repeat testing, colposcopy, another evaluation, or referral is appropriate
– What should happen next

You bring the results.

We will help you understand what comes next.

Start with your results

Written and medically reviewed by Matthew Hitchcock, MD
Board-Certified Family Physician
Last reviewed: August 26, 2026

Colposcopy Dr. Hitchcock talking with patient in a relaxing setting. Second Opinion Imiquimod CIN2-3 Traveling

Have cervical dysplasia results and not sure what comes next?

You do not need to know exactly what kind of appointment or treatment you need before contacting us.

If you have an abnormal Pap or HPV result, need a colposcopy, have been diagnosed with CIN1, CIN2, or CIN3, have been told you may need a LEEP, or want a second opinion about your options, start with the results you already have.

Our team will review your request and help you understand the appropriate next step.

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