The Pap test is a simple procedure- one that takes little time but may save your life. Your recent Pap test may have included the following steps.
• An instrument called a speculum holds the vagina open, so your health care professional can see your cervix.
• Cells may be taken from several areas of the cervix.
• Cells are smeared on a slide or placed in a vial of liquid and sent to a lab to be studied under a microscope.

What Your Pap Test Shows
After looking at your cell samples on a slide under a microscope, the lab reports any changes in cell shape or color. Your health care professional may discuss these changes with you. In many cases, an abnormal Pap test is due to inflammation caused by a vaginal infection or low hormones. More serious cell changes range from dysplasia (pre-cancer) to cancer (malignancy).

The Range of Results
If your Pap test results are negative, all the cells viewed in your sample were normal.
Abnormal results may be categorized in the following ways:
• ASCUS – atypical cells of undetermined significance. These are usually not precancerous cells and are a normal finding in 5% of pap smears. The cells look atypical. We run an HPV test to help decide what to do next.. repeat the pap in a year or look with a colposcope (discussed below). In some clinics or communities, HPV tests are not easily available and sometimes we just repeat the pap in a few months.
• SIL (squamous intraepithelial lesion), where abnormal cells replace mature ones, resulting in dysplasia.
• LGSIL =low- or
• HGSIL = high-grade (more worrisome)
• AGUS – atypical glandular cells (much less common, glandular cells, may come from the cervix canal or from up inside the uterus (the lining.)

HPV testing
Beginning in 2006, recommendations changed and it has been suggested that we add an HPV test to the pap on women over 30. If both tests are normal, your next pap/HPV would be in 3 years. (you still get checkups and pelvic exams more often than 3 years, just not the pap). If the pap is normal but the HPV is positive, we repeat your tests in a year. If the pap test is abnormal we proceed as discussed below.

Diagnosis and Treatment
After talking with you about your Pap test results, your doctor may suggest procedures to diagnose and treat the problem. If your cells are inflamed because of a vaginal infection, you may be given medication. To learn the extent of an abnormality, your doctor may view the cervix through a magnifying instrument (colposcope) and remove some tissue (biopsy). Depending on the severity of your problem, you may need no further treatment.

Colposcopy: a Visual Aid to Diagnosis.
Using a colposcope, your health care professional can see changes on the surface of the cervix. Once pinpointed, abnormal-looking areas can be studied further. Your doctor may also use colposcopy to monitor your condition over time. The colposcope's magnifying lens makes the cervix easier to see. You may want to take Advil or Aleve a couple of hours before your colposcopy. You will be able to drive and possibly choose to return to work after your colposcopy.

How to Treat Your Problem
Medication to Treat Mild Inflammation
To reverse less severe cell changes caused by some vaginal infections, your doctor may prescribe medication. The Pap test may be repeated after treatment to be sure the cervix is once again healthy.
Biopsy to Diagnose Disease
During biopsy, tissue suspected of change is removed and studied under a microscope for signs of cancer. Several areas of the cervix may be biopsied.
Endocervical Curettage to Study Canal Cells
To detect problems in the cervical canal, your doctor may perform endocervical curettage. With this procedure, cells are scraped from the canal wall and studied under a microscope for signs of cancer. Endocervical curettage is often performed along with biopsy.
Treatments to Destroy Abnormalities

Your Experience
Many doctors perform diagnostic and treatment procedures in the office. Most of these take no more than 15 to 30 minutes. You should feel little discomfort during most procedures, but you may have some cramping or light spotting for several days afterward. Aspirin or ibuprofen should help relieve any pain.
Treatments to Remove Abnormalities
To remove most or all abnormal cervical cells, your doctor may use a cutting laser, electric loop, or other surgical instrument, or may use very low temperatures to freeze the cells (cryosurgery).
In some cases, a cone-shaped piece of tissue, extending from the center of the cervix into the canal, is cut away during a procedure called a cone biopsy.