Nobody loves getting a Pap test, also known as a Pap smear. The stirrups, the cold speculum, that feeling of total exposure — it ranks right up there with bathing suit shopping and root canals. Still, it’s essential. A regular Pap smear at your gynecologist’s office can detect abnormal cells that could lead to cervical cancer. 

“The good news is that we can actually prevent people from getting cancer because these cellular changes happen over several years. With a Pap test, we can treat abnormal cells before they progress to cancer,” says Jenell Coleman, M.D., M.P.H., medical director of the Women’s Health Center, Johns Hopkins Outpatient Center and co-director of the Johns Hopkins Colposcopy Clinic.

The American College of Obstetricians and Gynecologists (ACOG) recommends the following:

• Women ages 21 to 29 should get a Pap test every three years
• Women ages 30 to 65 should have a Pap test combined with an HPV test every five years. 
• Some women with certain conditions may need more frequent testing, including women with a history of cervical cancer, HIV/AIDS or a weakened immune system. 

What Happens After an Abnormal Pap Test?

If your Pap test results are abnormal, your doctor may recommend a colposcopy. If you’re told that you need a colposcopy, don’t panic, says Coleman. 

“Women come to me saying, ‘Oh, my gosh. I could have cancer!’ But most women do not have cancer when they come in for a colposcopy. I’ve done hundreds of colposcopies, and I’ve diagnosed less than a handful of cervical cancers,” she adds. 

The routine is similar to a Pap smear. But this time, your doctor will use a magnifying lens to look at your cervix in order to see abnormal cells. This is done by swiping the area with acetic acid, which turns abnormal areas white. At Johns Hopkins, doctors also use a digital colposcopy system called DYSIS to further pinpoint the exact location of changing cells. This makes diagnosis even more precise. 

Once abnormal cells are identified, your doctor performs a biopsy, taking a small amount of tissue for testing. You’ll feel a pinch, nothing more. Then, your cells are off to the lab for analysis. You might experience some mild cramping after colposcopy, but that’s it. “Most women tell me, ‘That wasn’t as bad as I thought!’” says Coleman. 

Treatment Options After an Abnormal Pap Test

When your colposcopy is complete and your biopsy results are finalized, your doctor will explain the changes in your tissue sample. Sometimes, those changes are low-grade. This means you can watch and wait. Low-grade cervical changes are unlikely to become cervical cancer. If the changes are moderate- to high-grade, your doctor will evaluate more options. These changes create a higher risk of cervical cancer.

If there are moderate to severe changes in your cervix, your doctor may want to remove the cervical tissue. Typically, your doctor will use the Loop Electrosurgical Excision Procedure (LEEP), or perform a cold knife cone biopsy as a minor surgical procedure. 

Be sure to always bring up any questions you may about you Pap test with your gynecologist.