“Your Pap test results are abnormal.” If your doctor’s
office gives you this news, you can’t help but worry that somewhere along the way
you’ve she’s been exposed to one or more of the high-risk human papilloma viruses
(HPV). And often it’s a big surprise to women who’ve both consistently used condoms
and had a limited number of partners over the course of their lives.
Even women who have been in monogamous relationships for decades can end up with
an abnormal Pap smear. But how does this happen and — why now?
Human papilloma virus, or HPV, is the name of a group of viruses with more than
100 different strains discovered to date, 30–40 of which affect the reproductive
tract. Transmitted through sexual contact, these strains can infect the genital
areas of men and women, including the vulva (area outside the vagina), penis and
anus, as well as the linings of the cervix, vagina and the rectum.
HPV: Widespread and stealthy
Human papilloma virus is so widespread that most men and women carry some form of
HPV, but don’t know it. That’s because a well-functioning immune system effectively
keeps the virus in check until something later in life triggers an outbreak, often
many years later.
One estimate is that by the age of 50, approximately 80% of women have some strain
of the HPV virus. Some of these various HPV strains can lead to genital warts, or
condylomata, and some can lead to abnormal Pap test results. Most HPV strains carry
low risk, but highrisk strains may trigger cellular changes that can lead to cervical,
vulvar or anal cancer.
To help you stay healthy, your first step is to determine if you’ve been exposed
to a high-risk strain. Then you can identify any preventive measures you can take
to stop a dormant virus from becoming active.
Pap smears: a discovery that saves lives
Both traditional and alternative practitioners generally advocate for women to get
an annual pelvic examination and Pap smear because these are the best preventive
steps to protect health and longevity. Different health organizations have individual
age-related recommendations and suggestions for intervals between tests but the
Pap smear is still the only way to know if you’ve been exposed to HPV. To decide
yourself, check out the basic parameters for Pap testing set by the Center for Disease
Control and Prevention.
The Pap smear test has saved many women’s lives. It was developed by and named after
Dr. George Papanicolaou for early identification of cervical cancer. Cervical cancer
was once the top cause of cancer-related death for women in the US, but because
of of Pap smear screening, it has dropped to fifteenth over the past 60 years.
Cervical cancer still kills around 270,000 women per year worldwide, 3700 in the
US alone. And since the Pap smear is an easy and mostly reliable test, we recommend
that women get regular testing.
(See our page on routine Pap test
and pelvic exam for an explanation of what happens during these procedures,
along with a description of the new ThinPrep Pap.)
The Human Papilloma Virus (HPV)
The human papilloma virus is contracted through skin-to-skin contact during vaginal,
anal, or oral sex. It is passed by the cells of the entire genital region. Even
though condoms help prevent many sexually-transmitted infections, they are less
likely to prevent HPV infection.
So far, there are around 100 different identified strains of HPV identified with
each strain assigned a number. Some are considered “high-risk,” such as strain numbers
16 (most prevalent worldwide), 18, 31, 33, and 45, because they are closely associated
with cancer risks. Other strains are “low-risk,” such as those that cause genital
warts. New information about HPV continues to be released frequently.
Like the cold sores of herpes simplex, HPV can lurk in a woman’s body for months,
even years, with no signs or symptoms because her immune system is keeping it in
check. HPV can hide or pop up when we least expect it, especially when we are run
down, under emotional stress, or the immune system is otherwise weakened. Sometimes
the virus can lie dormant for decades. Even if you test negative for HPV, you could
still be harboring the virus.
You had an abnormal Pap test. Now what?
If you’re told your latest Pap smear is abnormal, it is quite possible that your
initial exposure to the HPV virus occurred long ago. An abnormal Pap at this point,
is actually reflecting your current state of stress and emotional health and there
is plenty you can do to improve both.
Many HPV strains are not cancerous and the strain affecting you may be the low-risk
variety, making it inconvenient but not life-threatening. And while several high-risk
strains do carry cancer risk, early detection by routine Pap smears can ensure that
these strains are not the life threat they once were.
It is possible to be exposed to several strains during the course of your life,
so you may test positive for more than one type of HPV. The earlier a woman begins
having sex and the more male sexual partners she has, the higher her risk of contracting
various strains of the HPV virus. Both women and men can transmit HPV to partners
of either sex through direct genital skin-to-skin contact . High–risk strains need
to be dealt with differently from low–risk strains.
Preventing HPV: start early
Delaying first sexual activity and limiting the number of partners are the top two
HPV preventive measures for young women to consider. A young woman’s developing
cervix is at its most vulnerable to all STDs so it’s very important to talk to girls
about safe-sex strategies before they begin having sex.
We recommend that all safe-sex strategies include an annual exam and Pap test. Young
women should be prepared for the experience of an annual pelvic exam in their teens
especially if they’re sexually active, or by age 21. Every woman should have
STD testing with each new sexual partner, and Pap smear testing within 1–2
years of her first sexual experience.
A young woman’s first talk with a doctor before she becomes sexually active is the
best time to consider the HPV vaccine when indicated (see below for more information).
Good nutrition is another key component of early prevention. A diet high in folic
acid, antioxidants, and essential fatty acids is great support for the immune system.
high-quality nutritional supplement with a complete selection of key vitamins
and minerals helps reinforce cervical health.
HPV vaccine protection
The HPV vaccines currently on the market target only 2 to 4 of the higher-risk strains
most frequently seen in developed countries. These vaccines include Gardasil by
Merck and Cervarix by Glaxo.
The primary goal is to vaccinate young women before their first sexual activity,
i.e. prior to HPV exposure. The best age and intervals for the vaccine and boosters
have yet to be determined and their overall success will need to be judged over
time. Early findings suggest there is potential for preventing the cervical and
vulvar cancers associated with the specific HPV virus strains for which the vaccination
Since the vaccines target only a limited number of the known high-risk strains,
HPV protection is not complete. The politics and economics surrounding the vaccines
are evolving and remain somewhat controversial. Women will still need to get regular
GYN exams and Pap testing.
There are some limitations to these vaccines for women already exposed to high-risk
HPV strains. While women in this category won’t be fully protected, clinical trials
seem to indicate that they may still get enough protection from the vaccine to warrant
their use as both a preventive and therapeutic measure.
These vaccines represent a major medical breakthrough and may lead to vaccines for
other virus-related cancers, though we don’t know the long-term effects yet.
How often should you get Pap testing?
The American College of Obstetricians and Gynecologists (ACOG) recommends Pap screening
annually until age 30, and then every 2-3 years if you’ve had 3 sequential years
of normal results and don’t fall into a high-risk category. If a woman is on hormones,
she should be checked annually and her prescription monitored. The recommended age
to discontinue Pap screening varies so this decision is best made by a woman and
At Women's Health Network, we suggest having a Pap smear just about every year for
routine screening of sexually-active adult women. Since every woman’s HPV risk status
can change over time, sometimes they need Pap testing more often:
- after any minor abnormal cells have been found on previous Pap smear tests.
- when women change sexual partners.
- when monogamous women might have been exposed via their partners.
- because changes in stress levels and immune response can lead a previously normal–testing
woman to suddenly test abnormal.
The Pap test is a good warning system for your overall health because abnormal cervical
cells are a sign of weakened immune system function. Delayed testing can place you
at greater risk by reducing the probability of detecting abnormal cell changes early
— the key to preventing cervical cancer.
There are also some special considerations to discuss with your healthcare provider.
If you’ve had a hysterectomy with complete removal of the cervix and no prior abnormal
Pap, it may be fine to discontinue Pap testing. If hysterectomy surgery leaves the
cervix intact, Pap testing should continue.
So what happens if you’ve had annual screenings, and then one day you get an abnormal
Pap smear reading?
Abnormal Pap test results
Ideally you have a GYN practitioner you trust with whom you can discuss your next
Here’s what’s likely to happen: you’ll be contacted if anything is detected on your
Pap test beyond a “satisfactory” sample with visibly normal cells. If the clinician
was unable to obtain an adequate cell sample, the results will be “insufficient”
and you may be called back. For a low-risk woman or if you’re in menopause, re-sampling
can often wait until the next pelvic exam in a year.
Occasionally a Pap report can indicate
infection with yeast or bacteria, and possibly even atrophic (tissue-thinning,
etc.) vaginal changes from low estrogen in menopause. These findings are unrelated
to HPV and cervical cancer.
The scale of abnormal Pap test results ranges from slightly atypical to major cellular
changes. If needed, HPV testing/typing can be added to the Pap test analysis. Some
women ask for this with their Pap test before anything abnormal is found, but the
guidelines are still evolving.
Click here for a listing and brief overview of the
most common abnormal Pap results using the Bethesda system. If your test
yields any of these results, remember it is showing your practitioner the path toward
further testing, a more accurate diagnosis, and — if necessary — a care management
Next steps — follow up with your practitioner
Pap testing is a screening tool and there is a margin of error each time it is performed.
A false reading can be more favorable or worse than it should be. This is another
reason for those at risk to have yearly Pap testing, and why repeat testing is done
at shorter intervals after any abnormal findings.
If you have an abnormal Pap, your practitioner will likely repeat the Pap test or
move on to one or more other diagnostic measures, such as
colposcopy or endometrial biopsy. The results of colposcopy drive decisions
about what is needed next and when. The colposcopy may also be repeated within a
reasonable time-frame to ensure healing or for early intervention if precancerous
changes are found. Repeat testing is routine and ensures that nothing was missed.
If you have any confusion about your follow-up plan after an abnormal Pap smear
or colposcopy, call your practitioner’s office to clarify what to do next and when.
Sometimes women have abnormal readings that return to normal once stress is reduced
and the immune system is back on track! Close monitoring is always warranted to
ensure this. (Here for some frequently asked
questions about Pap smear results.)
There are a number of advanced treatment procedures available, if necessary, all
geared toward removing any suspicious tissue that persists on the cervix. For persistent
abnormal biopsy results or ongoing presence of abnormal cells (cervical dysplasia),
these procedures may be warranted. Most decisions are made by you and your practitioner,
based on well-established guidelines. The goal is to intervene before the dysplasia
worsens and spreads into the tissue of the cervix or uterus, and to prevent true
Keep HPV in a dormant state — 7 ways to boost immune system function and protect
Try these steps to help care for yourself while supporting your body’s natural healing
1. Good nutrition with a balanced diet and basic nutritional
See our Nutritional and
Lifestyle Guidelines for more specific information. Consider a rich multivitamin
high in folic acid and antioxidants, along with essential fatty acids to help with
inflammation. With abnormal Paps, supplementing with extra folic acid, indole–3
carbinol (I3C), and/or DiM can help keep the immune system healthy, minimize cellular
changes, and promote healing. Talk to qualified a healthcare provider about these.
2. Be honest about the facts.
If you have been sexually active at any point, you may have been exposed to HPV.
Get regular pelvic exams and Pap tests to help ensure any cellular changes are caught
early and treated, before cancer can develop.
3. Avoid cigarette smoke.
Many studies have shown a measurable link between smoking and increased cervical
cancer risk, as nicotine actually concentrates in the cervix. Avoid second-hand
smoke whenever possible because smoking weakens the immune system.
4. Help your system detoxify.
Good digestive habits and regular bowel movements with ample water and fiber intake,
along with good sleep, all encourage proper detoxification and elimination — more
key factors for a strong immune system.
5. Minimize stress.
Stress can wreak havoc on your immune system. Some physicians note more abnormal
Paps toward the end of the year, perhaps due to holiday stress. Addressing emotional
issues is important because our physical bodies often can’t tell the difference
between daily stress and life-threatening emergencies. Choose stress relief that
works for you.
6. Follow good guidelines.
If you do get an atypical Pap reading, follow your doctor’s guidelines and remember
to go back for repeat testing. Don’t let fear get the best of you because it’s likely
that further testing will relieve your anxiety.
You can make a difference in the outcome
It can be scary to get an abnormal Pap smear but having the facts is calming and
With so much new and existing technology to identify and treat abnormalities, we
have the power to change the outcome. But don’t delay testing. Yes, if abnormal
tissue poses a risk, more advanced procedures may be necessary but surgery is not
always involved, and monitoring the situation may be all that’s required.
Your Pap test is one piece of your health story and you hold the power to set the
stage for a positive outcome.
1 Vachani, C. 2005. HPV and cervical cancer. OncoLink (Abramson Cancer
Center of the University of Pennsylvania) URL: http://www.oncolink.com/types/article.cfm?c=6&s=17&ss=131&id=9531
2 White, W., et al. 1998. In vitro infection and type-restricted
antibody-mediated neutralization of authentic human papillomavirus Type 16. J. Virol.,
72 (2), URL: http://www.pubmedcentral.gov/articlerender.fcgi?artid=124566
3 American College of Obstetricians and Gynecologists Office of Communications.
05.09.2006. Press Release: ACOG recommends first ob-gyn visit in early teens. http://www.acog.org/from_home/publications/press_releases/nr05-09-06-2.cfm
The American College of Obstetrics & Gynecologists Committee on Adolescent Health.
2006. ACOG Committee Opinion No. 335: The initial reproductive health visit. Ob.
& Gyn. 107 (5), 1215–1219.
American Society for Colposcopy and Cervical Pathology (ASCCP): http://www.asccp.org/
American College of Gynecology (ACOG):
Hudson, T. 2001. Preventing and treating cervical dysplasia: a natural medicine
perspective. Alt. Comp. Therapies, 7 (1), 15–20.
National Cancer Institute. 2005. Vaccine protects against virus linked to
half of all cervical cancers. URL: http://www.cancer.gov/clinicaltrials/results/cervical-cancer-vaccine1102
Sattler, C. 2005. Efficacy of a prophylactic quadrivalent human papillomavirus (HPV)
(Types 6, 11, 16, 18) L1 virus-like particle (VLP) vaccine for prevention of cervical
dysplasia and external genital lesions (EGL). 45th Annual Interscience Conference
on Antimicrobial Agents and Chemotherapy (ICAAC), Washington, DC.
Wright, T., et alia. Revised 2003. 2001 Concensus guidelines for the management
of women with cervical intraepithelial neoplasia. Am. J. Ob. Gyn. 189 (1),
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