The Pap Smear: Why You Might Need It, Why You Might Not

If a Pap smear is abnormal, the next step is usually colposcopy, which is nothing more than a microscopic examination of the cervix done in the office. While a Pap smear samples random cells, colposcopy allows the gynecologist to inspect the surface of the cervix under magnification so that the area where the abnormality is can be targeted and biopsied. The small sample of tissue removed is then sent to a pathologist who will report one of the following:

Normal tissue
Frequently, the cervical cells are normal, which indicates that the cells reverted back to a normal growth pattern. Occasionally, abnormal cells are present, but are high up in the cervical canal, beyond the view of the colposcope, which is why a follow-up short interval Pap smear is always done.

HPV changes
Human Papilloma Virus (HPV) is responsible for dysplasia and cervical cancers. Sometimes, cellular changes indicate the presence of the virus, but there are still no actual pre-cancerous cells.

CIN I (mild dysplasia or low grade squamous intraepithelial lesions)

CIN II (moderate dysplasia or high grade squamous intraepithelial lesions)

CIN III (severe dysplasia, or high grade squamous intraepithelial lesions, also known as carcinoma in situ)

Invasive Cancer (true cancer which has infiltrated surrounding tissue and has the ability to spread)

Dysplasia is the result of infection with the HPV virus, which is sexually transmitted. Before you plot your boyfriend or husband’s murder when discovering you have been exposed to HPV, keep in mind that that exposure could have occurred years before dysplasia shows up and may have nothing to do with a current partner. 

An important distinction: Almost all women with cancer have HPV, but most women with HPV never get dysplasia or cancer. HPV is extremely common; some studies show that it is present in the cervixes of almost 80% of sexually active women. There are over 100 subtypes of HPV, but it is the high-risk subtypes that are most likely to progress to cancer. This is why if you have HPV and your gynecologist says it is no big deal, you really shouldn’t worry about it. Really.