Understanding Pap Test Results

A visit to the gynecologist to get your pap smear is an important part of your health routine. And it’s a unique opportunity to understand and ask questions about your sexual health - from painful sex to menopause.

The main purpose of the pap smear is to screen for cancer risk. So your doctor will follow up after your pap smear and let you know if everything is normal or if further testing is needed. After that, you may receive a copy of your actual pap smear results.

Even if your pap results are normal, when you understand common phrases that appear on your pap results, you can know your body better and ask better questions with your doctor. Certain pap results might point to infections or hormonal changes like menopause, and this is an opportunity to get any additional care you need.

Pap results that indicate if the pap smear was complete

Endocervical cells present

This means cells from the inside of your cervix or “cervical canal” were sampled. This is something your gynecologist is trying to accomplish during the pap smear, so this indicates a complete pap!

Endocervical cells absent

This means that cells from the inside of your cervix were NOT picked up during the pap smear. You’ll most likely need another pap smear.

Transformation zone component present

The pap smear picked up cells in the “transformation zone” where the outside and inside of your cervix meet. This is something your gynecologist is trying to accomplish during the pap smear, so this indicates a complete pap!

Transformation zone component absent or scant

The pap smear did NOT pick up the cells that exist where the outside and inside of your cervix meet. Consider asking your doctor if you should have another pap smear.

Pap results that mean everything is normal

Atrophic change (or atrophic pattern)

This pap result means that the pathologist reviewing your test could see cells that showed atrophy due to a lack of estrogen. This is normal in menopause. But it can lead to pain or discomfort. If you are experiencing bothersome symptoms like vaginal dryness, painful sex, or urgency, this is a very common condition called vaginal atrophy or the genitourinary syndrome of menopause (GSM). Your gynecologist can recommend many safe and effective treatment options.

Parabasal cells present

This means your pap smear showed cells that indicate a lack of estrogen. This is a normal finding if you are experiencing hormonal changes due to menopause, menstruation, postpartum, or taking certain medications. But if you are experiencing symptoms like vaginal dryness, painful sex, or urgency, then you may have vaginal atrophy or the genitourinary syndrome of menopause.

Acute inflammation

This pap result means the pathologist reviewing your pap could see some white blood cells. This could be a sign of normal hormonal changes, like menopause, menstruation, postpartum, or taking certain medications. Also, if you are experiencing unusual vaginal odor, discharge, or itching, then you may have a vaginal infection that requires treatment.

Endometrial cells present

This means your pap smear picked up some cells from the inside of your uterus. It’s normal to see these cells if your pap smear was done anytime between day 1 and day 12 of your menstrual cycle, when your body sheds these cells. But if you’re post-menopause and not getting periods, there could be abnormal thickening in your uterus and your gynecologist will order further testing.

Squamous metaplastic cells present

The pathologist could see cells that were growing or repairing themselves. This is a normal process of tissue growth and repair.

Obscuring inflammatory exudate

Your pap picked up other cells that partially obscure or completely obscure the sample.

Negative for intraepithelial lesion or malignancy (or NILM)

This means that the pathologist did not see any abnormal or cancerous cells. Similar phrases include “normal pap result” or “negative pap result”.

Pap results that mean you need further testing

Atypical squamous cells (or ASC)

The pathologist could see abnormal cells. But the reason is unclear. It could be a simple vaginal infection, or it could be an abnormality. Your gynecologist will order further testing.

Atypical glandular cells (or AGC)

The pathologist identified cells from other organs in your reproductive tract or abdomen. It could be normal if you were approaching your period at the time of your pap smear. But it could also mean an abnormal presence of cells in your cervix or uterus. Your gynecologist will probably order a colposcopy, a detailed cervical exam that uses a lighted microscope. Your gynecologist may also want to do a biopsy of the tissues that line the uterus.

Cannot rule out high-grade abnormality (or SIL)

The pathologist analyzing your pap smear could not determine if your cells looked normal. Your gynecologist will order a colposcopy and may want to do biopsies.

Low grade or high-grade squamous intraepithelial lesion (LSIL or HSIL)

Indicates that abnormal cells were seen, and your gynecologist will order a colposcopy.

Next steps

Although the main purpose of a pap smear is to screen for cancer risk, your pap smear results might point to opportunities to improve your sexual health and well-being. And if you have a question or medical concern about your pap results, you should always discuss it with your doctor.