Health Library Pap Test: Should I Have Colposcopy If My Pap Test Shows Minor Cell Changes?From Healthwise
Pap Test: Should I Have Colposcopy if My Pap Test Shows Minor Cell Changes?
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Pap Test: Should I Have Colposcopy if My Pap Test Shows Minor Cell Changes?
Get the facts
Your options
- Have colposcopy.
- Don't have colposcopy. Instead, have a follow-up Pap test in about 6 months or get an HPV (human papillomavirus) test to see if you have a type of HPV that can increase your risk of getting cervical cancer.
Key points to remember
- Most minor cell changes go away on their own and don't cause problems. And they are not usually cancer.
- You may decide to wait and have another Pap test in about 6 months to see if the changes have gone away. More severe changes aren't likely to occur during a short period of watchful waiting.
- If you're not comfortable waiting, you may decide to have colposcopy. This test allows your doctor to take a closer look at the abnormal cells and find out if treatment is needed.
- Minor cell changes may be caused by HPV infection. You can get an HPV test—if you haven't already had one—to find out if you have a type of HPV that can increase your risk of getting cervical cancer. If you have one of these types, colposcopy is recommended.
What is colposcopy?
Colposcopy is a test that can find abnormal cells on your cervix, vulva, and vagina.
During the exam, your doctor uses a magnifying device called a colposcope. This device allows your doctor to see problems that might be missed by the naked eye. If a problem is seen during the exam, your doctor may take a small piece of tissue (biopsy) from your cervix to take a closer look at the cells.
Colposcopy may be done after a Pap test shows that you have minor cell changes on your cervix. An abnormal Pap test means that the test found some cells on your cervix that don't look normal. It doesn't mean that you have cancer. In fact, the chances that you have cancer are very small.
What are your choices after a Pap test shows minor cell changes?
All abnormal Pap tests require some kind of follow-up to be sure that the cell changes haven't gotten worse or have returned to normal.
If you have atypical squamous cells of undetermined significance (ASC-US) cell changes, there are several follow-up options you can choose from. Most of the time, ASC-US cell changes stay the same or return to normal on their own. Women with ASC-US changes are not likely to get cervical cancer.
Your choices of what to do next include:
- Watchful waiting with a follow-up Pap test in about 6 months or as often as your doctor suggests. More severe cell changes aren't likely to occur during this time. More than half of all minor cell changes return to normal on their own.
- AnHPV test—if you haven't already
had one—to find out if you have a type of HPV that can increase your risk of
getting cervical cancer. If you already had this test during your initial Pap
test, your doctor can tell you the results. If you don't have a high-risk type
of HPV, no further testing is recommended. But if you have a high-risk type of
HPV:
- Colposcopy is recommended to see how severe the cell changes are.
- It doesn't mean that minor cell changes will progress to cancer, because HPV infections can go away on their own.
- Colposcopy if you:
- Are not comfortable waiting and want to know right away if you may need treatment.
- Have certain risk factors, such as a high-risk type of HPV infection or a weakened immune system.
- Are not able to return for a follow-up Pap test.
If you're pregnant and have ASC-US cell changes, your choices are the same as those for women who aren't pregnant.
Who may not need colposcopy?
Most of the time, colposcopy is not advised for:
- Women who have gone through menopause, because a natural decrease in estrogen levels is likely to cause minor cell changes.
- Teenage girls, because minor cell changes and HPV infection are more likely to go away on their own. And it's very rare that girls this age get cervical cancer.
Instead, a period of watchful waiting and repeat Pap tests are tried first.
What are the side effects or risks of colposcopy?
Colposcopy is usually not painful, but it may cause some mild cramping. The tool (speculum) used to spread open your vagina is in place longer than during a routine pelvic exam. This may cause some discomfort.
A biopsy may be done at the time of colposcopy. You may feel a brief, sharp pain or have some cramping while this is done.
After the test you may:
- Have vaginal bleeding and discharge.
- Be sore.
- Get an infection. But this is very rare.
Why might your doctor recommend colposcopy?
Your doctor may recommend colposcopy if:
- You have had two abnormal Pap tests in a row that show atypical squamous cells of undetermined significance (ASC-US) cell changes.1
- You have ASC-US cell changes and certain risk factors, such as a high-risk type of HPV infection or a weakened immune system.1
- You're not comfortable waiting and want to know right away if you may need treatment.
Compare your options
Compare
What is usually involved? | ||
What are the benefits? | ||
What are the risks and side effects? |
- You lie on your back with your feet raised and supported by footrests while your doctor uses a magnifying device called a colposcope to look at your vulva, vagina, and cervix.
- Photos or videos of your vagina and cervix may be taken.
- If your doctor sees a problem, he or she will take a small piece of tissue (biopsy) from your cervix to check for problems.
- You may feel some discomfort and mild cramping, but colposcopy usually isn't painful.
- During a biopsy, you may feel a brief, sharp pain or have some cramping.
- Colposcopy and a cervical biopsy can be done in your doctor's office.
- Colposcopy and a cervical biopsy
can:
- Let you know right away if there is a more serious problem and whether you may need treatment.
- Show abnormal cells that can't be seen by the naked eye.
- Detect cervical cancer.
- Help rule out cervical cancer.
- Possible side
effects after a cervical biopsy include:
- Vaginal bleeding and discharge.
- Soreness.
- Infection. But this is very rare.
- You have a follow-up Pap test in about 6 months or as often as your doctor suggests to see if the abnormal cells have returned to normal.
- You may have an HPV test to see if minor cell changes are caused by a type of HPV that can cause more severe cell changes and cervical cancer.
- You avoid the cost of colposcopy.
- You avoid the risks of having colposcopy and a cervical biopsy.
- The abnormal cells may return to normal on their own.
- If you start to worry and don't want to wait any longer, you can decide later to have colposcopy.
- Minor cell changes may become more severe.
- If you don't have colposcopy, you won't know right away if the cell changes may be the kind that are more likely to turn into cancer and that need to be treated.
Personal stories
Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.
Personal stories about treating minor cervical cell changes
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
I was finishing school, starting a new job, and planning a wedding when the women's clinic called and said my Pap test was abnormal, with minor cervical cell changes called atypical squamous cells of undetermined significance (ASC-US). She says I do not have any high-risk factors for cervical cancer and that waiting 4 to 6 months to follow up would be fine. I feel comfortable with her recommendation and have so much to do right now that watchful waiting feels okay.
Indira, age 34
I started worrying as soon as my doctor called and said my Pap test was abnormal. She said the results showed only minor cervical cell changes called atypical squamous cells of undetermined significance (ASC-US). I could follow up with another Pap test in 4 to 6 months. But I had just heard about a woman at my health club who was diagnosed with cervical cancer and is now undergoing treatment. With that fresh on my mind, I knew I couldn't wait 4 to 6 months to see if everything was okay. So I asked my doctor what else we could do. She said we could schedule a colposcopy examination as follow-up rather than waiting.
April, age 29
I had an abnormal Pap test in my early 20s. My health professional at the time explained that an abnormal Pap is common in young, sexually active women. My tests have all been normal now for several years. I recently changed jobs and moved, so I didn't have a routine examination for almost 2 years. Now I have another abnormal Pap test, and the results classify the cell changes as ASC-US (atypical squamous cells of undetermined significance). My new health professional explained that further testing for high-risk human papillomavirus (HPV) types may determine how serious these cell changes are and help me decide what to do next. Because of my past health, it sounded reasonable to find out more. The HPV test was negative, which made me feel better. Now I only need follow-up Pap tests to monitor the cell changes.
Margaret, age 32
I'm studying overseas for 3 months, so I had my regular gynecologic examination and Pap test at the student health clinic before leaving. The results showed minor cervical cell changes called atypical squamous cells of undetermined significance (ASC-US). The health clinic nurse said that these changes are not usually treated and that follow-up Pap tests are usually all they recommend to monitor the minor cell changes. She reassured me that watchful waiting would be appropriate and told me to come back for a follow-up Pap test after I return home in 4 to 6 months.
Aisha, age 22
My health professional just called with the results of my routine Pap test. I have some minor cervical cell changes classified as atypical squamous cells of undetermined significance (ASC-US). I've had sexually transmitted infections before, so I knew I might be at risk for an abnormal Pap test. He recommended that I have testing for the human papillomavirus (HPV) to determine if I have a high-risk HPV type. Further testing, such as repeat Pap tests or a colposcopy, will depend on the HPV test result. Since my husband and I want to start a family soon, it will be best to follow up now so we know what we're dealing with.
Connie, age 32
I just had my first Pap test and found out I have cervical cell changes called low-grade squamous intraepithelial lesions (LSIL). My doctor says most women with these cell changes should have a procedure called a colposcopy to take a closer look at the cells. But since I'm still a teenager, the abnormal cells will probably not get worse. Instead of a colposcopy, I will have another Pap test in 4 to 6 months.
Paola, age 16
What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have colposcopy
Reasons not to have colposcopy
I'm worried that the abnormal cells may turn into cancer.
I want to wait and see if the abnormal cells return to normal on their own.
I'm not afraid to have a biopsy if my doctor sees a problem during the colposcopy.
I don't want to have a colposcopy or biopsy if I don't need to.
I'm not worried about how much colposcopy costs.
I don't have insurance, and I can't afford to pay for the test myself.
My other important reasons:
My other important reasons:
Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Having colposcopy
NOT having colposcopy
What else do you need to make your decision?
Check the facts
Do most minor cell changes go away on their own?
- YesThat's right. Most minor cell changes go away on their own and don't cause problems. And they are not usually cancer.
- NoSorry, that's not right. Most minor cell changes go away on their own and don't cause problems. And they are not usually cancer.
- I'm not sureIt may help to go back and read "Key points to remember." Most minor cell changes go away on their own and don't cause problems. And they are not usually cancer.
Is it okay to wait a while to see if the abnormal cells return to normal on their own?
- YesThat's right. More severe changes aren't likely to occur during a short period of watchful waiting.
- NoSorry, that's not right. More severe changes aren't likely to occur during a short period of watchful waiting.
- I'm not sureIt may help to go back and read "Get the Facts." More severe changes aren't likely to occur during a short period of watchful waiting.
Can HPV infection cause minor cell changes to get worse?
- YesThat's right. Some types of HPV can increase your risk of getting cervical cancer.
- NoSorry, that's not right. Some types of HPV can increase your risk of getting cervical cancer.
- I'm not sureIt may help to go back and read "Get the Facts." Some types of HPV can increase your risk of getting cervical cancer.
Decide what's next
Do you understand the options available to you?
Are you clear about which benefits and side effects matter most to you?
Do you have enough support and advice from others to make a choice?
Certainty
How sure do you feel right now about your decision?
Check what you need to do before you make this decision.
Use the following space to list questions, concerns, and next steps.
Your Summary
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
Your decision
Next steps
Which way you're leaning
How sure you are
Your comments
Your knowledge of the facts
Key concepts that you understood
Key concepts that may need review
Getting ready to act
Patient choices
Credits and References
| Credits | Healthwise Staff |
|---|---|
| Primary Medical Reviewer | Sarah Marshall, MD - Family Medicine |
| Specialist Medical Reviewer | Kirtly Jones, MD - Obstetrics and Gynecology |
Pap Test: Should I Have Colposcopy if My Pap Test Shows Minor Cell Changes?
- Get the facts
- Compare your options
- What matters most to you?
- Where are you leaning now?
- What else do you need to make your decision?
1. Get the facts
Your options
- Have colposcopy.
- Don't have colposcopy. Instead, have a follow-up Pap test in about 6 months or get an HPV (human papillomavirus) test to see if you have a type of HPV that can increase your risk of getting cervical cancer.
Key points to remember
- Most minor cell changes go away on their own and don't cause problems. And they are not usually cancer.
- You may decide to wait and have another Pap test in about 6 months to see if the changes have gone away. More severe changes aren't likely to occur during a short period of watchful waiting.
- If you're not comfortable waiting, you may decide to have colposcopy. This test allows your doctor to take a closer look at the abnormal cells and find out if treatment is needed.
- Minor cell changes may be caused by HPV infection. You can get an HPV test—if you haven't already had one—to find out if you have a type of HPV that can increase your risk of getting cervical cancer. If you have one of these types, colposcopy is recommended.
What is colposcopy?
Colposcopy is a test that can find abnormal cells on your cervix, vulva, and vagina.
During the exam, your doctor uses a magnifying device called a colposcope. This device allows your doctor to see problems that might be missed by the naked eye. If a problem is seen during the exam, your doctor may take a small piece of tissue (biopsy) from your cervix to take a closer look at the cells.
Colposcopy may be done after a Pap test shows that you have minor cell changes on your cervix. An abnormal Pap test means that the test found some cells on your cervix that don't look normal. It doesn't mean that you have cancer. In fact, the chances that you have cancer are very small.
What are your choices after a Pap test shows minor cell changes?
All abnormal Pap tests require some kind of follow-up to be sure that the cell changes haven't gotten worse or have returned to normal.
If you have atypical squamous cells of undetermined significance (ASC-US) cell changes, there are several follow-up options you can choose from. Most of the time, ASC-US cell changes stay the same or return to normal on their own. Women with ASC-US changes are not likely to get cervical cancer.
Your choices of what to do next include:
- Watchful waiting with a follow-up Pap test in about 6 months or as often as your doctor suggests. More severe cell changes aren't likely to occur during this time. More than half of all minor cell changes return to normal on their own.
- AnHPV test—if you haven't already
had one—to find out if you have a type of HPV that can increase your risk of
getting cervical cancer. If you already had this test during your initial Pap
test, your doctor can tell you the results. If you don't have a high-risk type
of HPV, no further testing is recommended. But if you have a high-risk type of
HPV:
- Colposcopy is recommended to see how severe the cell changes are.
- It doesn't mean that minor cell changes will progress to cancer, because HPV infections can go away on their own.
- Colposcopy if you:
- Are not comfortable waiting and want to know right away if you may need treatment.
- Have certain risk factors, such as a high-risk type of HPV infection or a weakened immune system.
- Are not able to return for a follow-up Pap test.
If you're pregnant and have ASC-US cell changes, your choices are the same as those for women who aren't pregnant.
Who may not need colposcopy?
Most of the time, colposcopy is not advised for:
- Women who have gone through menopause, because a natural decrease in estrogen levels is likely to cause minor cell changes.
- Teenage girls, because minor cell changes and HPV infection are more likely to go away on their own. And it's very rare that girls this age get cervical cancer.
Instead, a period of watchful waiting and repeat Pap tests are tried first.
What are the side effects or risks of colposcopy?
Colposcopy is usually not painful, but it may cause some mild cramping. The tool (speculum) used to spread open your vagina is in place longer than during a routine pelvic exam. This may cause some discomfort.
A biopsy may be done at the time of colposcopy. You may feel a brief, sharp pain or have some cramping while this is done.
After the test you may:
- Have vaginal bleeding and discharge.
- Be sore.
- Get an infection. But this is very rare.
Why might your doctor recommend colposcopy?
Your doctor may recommend colposcopy if:
- You have had two abnormal Pap tests in a row that show atypical squamous cells of undetermined significance (ASC-US) cell changes.1
- You have ASC-US cell changes and certain risk factors, such as a high-risk type of HPV infection or a weakened immune system.1
- You're not comfortable waiting and want to know right away if you may need treatment.
2. Compare your options
| Have colposcopy | Don't have colposcopy | |
|---|---|---|
| What is usually involved? |
|
|
| What are the benefits? |
|
|
| What are the risks and side effects? |
|
|
Personal stories
Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.
Personal stories about treating minor cervical cell changes
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
"I was finishing school, starting a new job, and planning a wedding when the women's clinic called and said my Pap test was abnormal, with minor cervical cell changes called atypical squamous cells of undetermined significance (ASC-US). She says I do not have any high-risk factors for cervical cancer and that waiting 4 to 6 months to follow up would be fine. I feel comfortable with her recommendation and have so much to do right now that watchful waiting feels okay."
— Indira, age 34
"I started worrying as soon as my doctor called and said my Pap test was abnormal. She said the results showed only minor cervical cell changes called atypical squamous cells of undetermined significance (ASC-US). I could follow up with another Pap test in 4 to 6 months. But I had just heard about a woman at my health club who was diagnosed with cervical cancer and is now undergoing treatment. With that fresh on my mind, I knew I couldn't wait 4 to 6 months to see if everything was okay. So I asked my doctor what else we could do. She said we could schedule a colposcopy examination as follow-up rather than waiting."
— April, age 29
"I had an abnormal Pap test in my early 20s. My health professional at the time explained that an abnormal Pap is common in young, sexually active women. My tests have all been normal now for several years. I recently changed jobs and moved, so I didn't have a routine examination for almost 2 years. Now I have another abnormal Pap test, and the results classify the cell changes as ASC-US (atypical squamous cells of undetermined significance). My new health professional explained that further testing for high-risk human papillomavirus (HPV) types may determine how serious these cell changes are and help me decide what to do next. Because of my past health, it sounded reasonable to find out more. The HPV test was negative, which made me feel better. Now I only need follow-up Pap tests to monitor the cell changes."
— Margaret, age 32
"I'm studying overseas for 3 months, so I had my regular gynecologic examination and Pap test at the student health clinic before leaving. The results showed minor cervical cell changes called atypical squamous cells of undetermined significance (ASC-US). The health clinic nurse said that these changes are not usually treated and that follow-up Pap tests are usually all they recommend to monitor the minor cell changes. She reassured me that watchful waiting would be appropriate and told me to come back for a follow-up Pap test after I return home in 4 to 6 months."
— Aisha, age 22
"My health professional just called with the results of my routine Pap test. I have some minor cervical cell changes classified as atypical squamous cells of undetermined significance (ASC-US). I've had sexually transmitted infections before, so I knew I might be at risk for an abnormal Pap test. He recommended that I have testing for the human papillomavirus (HPV) to determine if I have a high-risk HPV type. Further testing, such as repeat Pap tests or a colposcopy, will depend on the HPV test result. Since my husband and I want to start a family soon, it will be best to follow up now so we know what we're dealing with."
— Connie, age 32
"I just had my first Pap test and found out I have cervical cell changes called low-grade squamous intraepithelial lesions (LSIL). My doctor says most women with these cell changes should have a procedure called a colposcopy to take a closer look at the cells. But since I'm still a teenager, the abnormal cells will probably not get worse. Instead of a colposcopy, I will have another Pap test in 4 to 6 months."
— Paola, age 16
3. What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have colposcopy
Reasons not to have colposcopy
I'm worried that the abnormal cells may turn into cancer.
I want to wait and see if the abnormal cells return to normal on their own.
I'm not afraid to have a biopsy if my doctor sees a problem during the colposcopy.
I don't want to have a colposcopy or biopsy if I don't need to.
I'm not worried about how much colposcopy costs.
I don't have insurance, and I can't afford to pay for the test myself.
My other important reasons:
My other important reasons:
4. Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Having colposcopy
NOT having colposcopy
5. What else do you need to make your decision?
Check the facts
1. Do most minor cell changes go away on their own?
- Yes
- No
- I'm not sure
2. Is it okay to wait a while to see if the abnormal cells return to normal on their own?
- Yes
- No
- I'm not sure
3. Can HPV infection cause minor cell changes to get worse?
- Yes
- No
- I'm not sure
Decide what's next
1. Do you understand the options available to you?
2. Are you clear about which benefits and side effects matter most to you?
3. Do you have enough support and advice from others to make a choice?
Certainty
1. How sure do you feel right now about your decision?
2. Check what you need to do before you make this decision.
- I'm ready to take action.
- I want to discuss the options with others.
- I want to learn more about my options.
3. Use the following space to list questions, concerns, and next steps.
| By | Healthwise Staff |
|---|---|
| Primary Medical Reviewer | Sarah Marshall, MD - Family Medicine |
| Specialist Medical Reviewer | Kirtly Jones, MD - Obstetrics and Gynecology |
Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.
Last Revised: December 28, 2010
Author: Healthwise Staff
Medical Review: Sarah Marshall, MD - Family Medicine & Kirtly Jones, MD - Obstetrics and Gynecology
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