4 Things That Can Cause An Abnormal Pap Smear Besides Cancer

A Pap smear, also known as a Pap test or cervical screening, is a routine screening procedure gynecologists use to examine any changes in the cervix’s cellular composition or to prevent and detect cervical cancer.

During a Pap test, a small sample of cells from the cervix (the lower part of the vagina) will be scraped gently by the healthcare professional. 

These cells are then inspected under a microscope to look for any anomalies. 

When Pap smear results return as ‘normal,’ the cervical cell sample appears healthy without any concerning issues. 

In contrast, an abnormal Pap smear signifies irregularities or abnormalities in the cervical cell sample, but it does not directly indicate cervical cancer. 

It’s natural to feel anxious about getting back an abnormal Pap smear result, but don’t assume the worst before talking to a doctor about the results and deciding what to do next. 

Continue reading to understand the things that may lead to an abnormal Pap smear and how to manage the results appropriately.

What are the common reasons for abnormal Pap smears?

Studies indicate that many women may experience at least one abnormal Pap result during their lifetime

However, most abnormal Pap smear causes are not life-threatening and may be promptly treated.

The following are the possible reasons for abnormal results: 

1) HPV

Human papillomaviruses (HPV), the most common sexually transmitted infection, can be responsible for cellular changes in the cervix and, thus, an abnormal Pap result.

It is prevalent, affecting 80% of individuals over their sexual lifetime, with females having an 84.6% lifetime risk of contracting it.

2) Infections and Other STIs

Research from 2020 highlights a concerning frequency of abnormal Pap smear results, revealing that a staggering 96% of these cases are associated with sexually transmitted infections. 

Another study indicates that bacterial infections are responsible for 14% of the abnormal Pap test findings. 

The most prevalent infections identified are:

  • Gonorrhea is a bacterial condition that may be spread sexually and affects both sexes. Individuals may have uncomfortable urination and abnormal vaginal discharge.
  • Chlamydia usually affects young women. Many people with chlamydia may not develop symptoms but can still infect others through sexual contact. Genital discomfort and vaginal discharge are two symptoms that may appear. 
  • Bacterial vaginosis is an infection resulting from an imbalance between good and bad vaginal bacteria. Odorous discharge (which may appear yellow or white) and a ‘fishy’ smell after intercourse are symptoms that are usually noticed by women. 
  • Yeast infections usually affect the vagina, but in severe or recurring cases, they can cause inflammation and abnormalities in the cells of the cervix that can be seen on a Pap smear. 
  • Trichomoniasis in women between the ages of 16 and 35 typically has numerous symptoms, such as vaginal itching, burning, pain while urinating, and vaginal discharge.

If you notice these symptoms, it is advisable to seek guidance from your gynecologist.

3) Hormonal Changes

Hormonal changes might impact the results of a Pap smear test. Age-related menstrual cycle changes, pregnancy, hormone replacement treatment, especially estrogen, birth control pill use, and menopause are all examples of life events that might cause this. 

4) Cervical Dysplasia

Cervical dysplasia refers to an irregularity in the cells that line the cervix, more like a precancerous condition, which leads to an abnormal Pap smear result. 

If left untreated, there might be a risk of its progression into cervical cancer.

Dysplasia comes in various stages, with doctors monitoring mild or low-grade cases with regular follow-up exams. 

If severe, they may recommend removing affected cells to prevent further complications.

5) Cervical Cancer

Cervical cancer is a less prevalent cause of an abnormal Pap smear. It is, nevertheless, the most dangerous and toughest to treat. 

It is frequently asymptomatic, developing symptoms only during its later stages. Bleeding between periods, an increased flow of menstrual fluid, pelvic pain, or discomfort during or after sexual activity are all potential warning signs.

The earlier detection and intervention occur, the more favorable the prognosis for prevention or cure.

It is possible to reduce the risk of developing cervical cancer by:

  • HPV vaccination is highly recommended, as it can prevent up to 93% of cervical cancers.
  • The most recent ASCCP recommendations encourage women between the ages of 21 and 29 to get a Pap test every three years. A Pap smear should also be taken every 3–5 years, beginning at age 30 and continuing until age 65. 
  • Quitting tobacco use
  • Using condoms
  • Limiting sexual partners

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What can cause a false-abnormal Pap test? 

A false-abnormal result could be caused by the use of vaginal medication or ointments, cleaning products, gels, or douches within 48 hours of a screening test. 

Sexual activity with the same or different partners can also alter the results. Avoiding these things is always suggested before the test. 

Additionally, having an abnormal Pap test is more likely if you smoke or if your immune system is compromised.

What happens after an abnormal cervical screening?

If your Pap test results are abnormal, your doctor will provide recommendations based on your age and the degree of abnormalities. These recommendations may include:

Frequent Pap Smears

Individuals may need a repeat Pap screening every three months until their findings return to normal. 

It is common when the changes observed in the cervical cells are minimal and will likely resolve without therapy. 

HPV Infection Testing

In cases of HPV infection, an HPV test may be required for further evaluation to detect the HPV type.


A colposcopy can look for more evident changes. During this procedure, the cervix is examined under magnification to distinguish between areas with normal and abnormal tissue. 


Your doctor may recommend a biopsy if the colposcopy reveals areas of concern that are considered precancerous or cancerous. 

Removing the Abnormal Cells

In particular cases of precancerous cells, medical professionals might advise the excision of abnormal cervical cells as a preventive measure against their progression to cancer. 

It is frequently achieved through loop electrosurgical excision (LEEP) and cryosurgery. The tissue removed undergoes a lab evaluation to confirm the complete removal of the abnormal area. 


An abnormal Pap smear is not a final diagnosis but a sign for further investigation. There are many things that can cause an abnormal Pap smear.

It is advisable to seek guidance and follow-up examinations from your healthcare provider to treat the cause of an abnormal Pap smear. 

Taking proactive measures, such as routine checkups, self-education, and open discussions with your healthcare provider, can contribute to your well-being.

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  1. Maraqa B, Lataifeh I, Otay L, Badran O, Qutaiba Nouri Y, Issam I, Al Hussaini M. Prevalence of Abnormal Pap Smears: A Descriptive Study from a Cancer Center in a Low-Prevalence Community. Asian Pac J Cancer Prev. 2017 Nov 26;18(11):3117-3121. doi: 10.22034/APJCP.2017.18.11.3117. PMID: 29172288; PMCID: PMC5773800.
  2. Braaten KP, Laufer MR. Human Papillomavirus (HPV), HPV-Related Disease, and the HPV Vaccine. Rev Obstet Gynecol. 2008 Winter;1(1):2-10. PMID: 18701931; PMCID: PMC2492590.
  3. Chesson HW, Dunne EF, Hariri S, Markowitz LE. The estimated lifetime probability of acquiring human papillomavirus in the United States. Sex Transm Dis. 2014 Nov;41(11):660-4. doi: 10.1097/OLQ.0000000000000193. PMID: 25299412; PMCID: PMC6745688.
  4. Jayapalan S, Bindu RS. Papanicolaou smear: A diagnostic aid in sexually transmitted infections. Indian J Sex Transm Dis AIDS. 2020 Jul-Dec;41(2):143-148. doi: 10.4103/ijstd.IJSTD_114_16. Epub 2020 Jul 31. PMID: 33817585; PMCID: PMC8000682.
  5. Mishra, Renuka. (2021). Clinico-pathological Analysis of Cervical Pap Smear in Patients Attending Gynecology OPD of a Medical Colleg. Europasian Journal of Medical Sciences. 3. 12-17. 10.46405/ejms.v3i1.288. 
  6. CDC. Cervical Cancer is Preventable.
  7. ACOG. Updated Cervical Cancer Screening Guidelines.

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