If the Pap smear results are abnormal, the next step usually involves 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 located 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 found to be normal, which indicates that the cells reverted back to a normal growth pattern. Occasionally, abnormal cells are still present, but are located high up in the cervical canal, beyond the view of the colposcope, which is why a follow-up short interval Pap smear is always the next step.

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 sexually-transmitted HPV virus. When discovering you have been exposed to HPV, keep in mind that this could have occurred years before dysplasia shows up, and may have nothing to do with your current partner.

This is an important distinction: Almost all women with cancer have HPV, but most women with HPV never develop 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 your gynecologist may diagnose you with HPV and then reassure you that it's not a big deal and you really shouldn't have to worry about it.

Next: Who needs pap smears and when


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