Reasons for an Abnormal Pap Smear
I know the worry that comes from being told a test at the doctor’s office is abnormal, especially your Pap smear. It’s an entirely normal reaction to be alarmed. I don’t want you to worry, however. It’s important to keep your results in perspective should you have an abnormal Pap smear. Just because your results are abnormal doesn’t mean you have cancer. An abnormal test simply means further testing is needed.
Women, you’re encouraged to get a Pap smear every year beginning at 21 or within 3 years of becoming sexually active. These tests are crucial in the early detection of human papillomavirus (HPV), cervical cancer, and the prevalence of sexually transmitted diseases. HPV is the most common reason for an abnormal Pap smear.
While that may seem frightening, the good news is the majority of Pap smear tests are normal. Only 2 to 5% of the women with annual Pap smears come back with an abnormal test result. 1
I will tell you the reasons you may have an abnormal Pap smear, who should get one, and functional medicine’s approach to an abnormal Pap smear. First, let’s talk about why you need a Pap smear.
Why You Need a Pap Smear
My patients and members of my community ask me why they need a Pap smear, it seems like a yearly nuisance to some. I find that most women know they need to have a Pap smear as part of their regular health screenings, yet many don’t know what the results mean.
The Pap smear, also known as the Papanicolaou test, was developed by George Nicholas Papanicolaou. He was a pioneer in understanding the physiology and biology of the female reproductive system.2
As I mentioned, a Pap smear tests for cervical cancer, HPV, and STDs. It’s performed by opening the vagina with a speculum and collecting cells at the outer opening of the cervix. A Pap smear is the best method for early detection of cervical cancer, which increases the chances of a cure.
Who Should Get a Pap Smear
Women should begin getting a Pap smear starting at the age of 21. The American College of Obstetrics and Gynecology says no one under the age of 21 should have a Pap smear regardless of sexual activity. The American College of Obstetrics and Gynecology’s guidelines for who should get a Pap smear are:3
- No screening under 21 years of age, regardless of sexual activity
- Once every three years for ages 21-29, as long as results are normal
- Every five years for ages 30-65, combined with an HPV test
- You do not need screening after age 65 with a history of negative screening results.
- No screening is necessary if you have had a hysterectomy (with cervix removal) and with no history of precancerous lesions or cervical cancer.
If you have a family history of cervical cancer or have had abnormal Pap test results in the past, you may need more frequent testing. Genetics can increase your risk of cervical cancer.4 I’ll discuss the HPV-autoimmune connection in just a minute. First, I’m going to tell you about the common reasons you have an abnormal Pap smear.
What Causes an Abnormal Pap Smear?
There are many reasons for an abnormal Pap smear. Abnormal Pap smear results range in severity. Again, it’s important to remember an abnormal Pap smear does not mean you have cancer, and it just means you need further testing.
It could mean nothing at all. Recent sexual activity, taking a bath before a Pap smear, a recent or current period, and using feminine hygiene products could cause your results to be abnormal. Here are a few more serious reasons you had an abnormal Pap smear.
Human Papillomavirus (HPV)
HPV is the most common reason for an abnormal Pap smear and accounts for more than 95% of cervical cancers.5
HPV is transmitted by skin-to-skin contact, causing it to spread quickly. There are more than 100 varieties of HPV; 40 of them infect the genitals, the anus, and the mouth. HPV also causes Palmer warts (found on the hands) and plantar warts (located on the feet).
There are two types of HPV: low-risk and high-risk. The low-risk types, even sexually transmitted, are usually completely harmless.
High-risk strains of HPV in women can lead to cervical cancer and cancer of the vulva, vagina, anus, mouth, and throat. In fact, HPV types 16 and 18 are responsible for up to 80% of all cervical cancers, the third most frequent cancer type in women. Men can also get HPV. If they get high-risk HPV, it can lead to cancers of the anus, mouth, and throat.
How HPV Spreads
All forms of HPV transmit by skin-to-skin contact. Sexually transmitted HPV can result from vaginal, anal, or oral sexual contact. Most people with HPV show no symptoms which makes it even easier to spread since people aren’t aware and not seeking treatment. However, genital warts are common in people with HPV.
If your immune system is in optimal shape, your body can typically fight off the virus without even knowing you had it. That’s one of the reasons that HPV is the most common sexually transmitted infection. According to the Centers for Disease Control, about 79 million Americans have it.6
The other reason is that nearly all other STDS, such as gonorrhea and syphilis, are transferred by body fluid. Because HPV transmits through skin-to-skin contact, it’s much easier to contract.
The HPV-Autoimmune Connection
There is a connection between HPV infections and lupus and other autoimmune diseases.
It’s believed that the immune cells involved in certain autoimmune diseases may be the same as those activated during an immune response to certain types of HPV. So when you have HPV, your body unwittingly learns to attack healthy tissue, too, causing autoimmunity.
For example, research shows that HPV infection is directly associated with the onset of several oral autoimmune diseases, including:
- oral lichen planus (OLP)
- mucous membrane pemphigoid (MMP)
- pemphigus vulgaris (PV)
- epidermolysis bullosa acquisita (EBA)
You may be more likely to get infected with HPV if you already have autoimmunity. In addition, those with lupus are more likely to contract the HPV virus and have cervical cancer than the general population of women.
Some immune system disorders cause abnormally low activity of the immune system, decreasing the body’s ability to fight invaders and therefore increasing vulnerability to infections.
If you are diagnosed with cervical dysplasia, your abnormal Pap Smear may be due to a change in the cells on the surface of your cervix. While this is not cancer, it can lead to cervical cancer.
Cervical dysplasia can develop at any age and is commonly caused by HPV. Just as with HPV, cervical dysplasia does not have symptoms. You might be more at risk of cervical dysplasia if you:
- Had sex before you were 18
- Had a baby at a very young age
- Have multiple sexual partners
- Have tuberculosis or HIV
- Take medications that suppress the immune system
- If you smoke
Treatment for cervical dysplasia includes freezing the abnormal cells, laser surgery to burn away the abnormal tissue, or in rare cases, a hysterectomy.7
Cervical cancer is the most severe reason for an abnormal Pap smear. However, cervical cancer is often slow-growing and happens in stages. There may be little to no symptoms in the early stages, so frequent testing is essential. Early detection is key to treatment and a possible cure.
Symptoms of early-stage cervical cancer may include:
- Irregular vaginal bleeding (After intercourse, between periods, or post-menopause)
- Abnormal vaginal discharge (heavy or with a foul odor)
- Pain during intercourse
Symptoms of advanced-stage cervical cancer may include:
- Back, leg, or pelvic pain
- Swelling in one or both of your legs
- Unexplained weight loss
- Decreased appetite
Early-stage cervical cancer is treated with surgery to remove the cancer cells, cervix (trachelectomy), or a hysterectomy. Having a hysterectomy makes it impossible to get pregnant. Advanced-stage cervical cancer is treated with radiation and chemotherapy, which has really awful side effects.
You can reduce your risk of cervical cancer by practicing safe sex, having regular Pap smears, and not smoking.
Sexually Transmitted Diseases (STDs)
STDs other than HPV and genetial warts may also cause an abnormal Pap smear. As you know, STDs are transmitted through body fluides from sexual contact. Some of the most common ones include herpes, chlamydia, and gonorrhea, which are caused by bacteria.
These STDs are treated with antibiotics, Antibiotics have one job: kill bacteria and stop them from multiplying. However, this simple task is what leads to a disruption in your gut microbiome. Antibiotics cannot tell the difference between good bacteria and bad bacteria, and they don’t discriminate between the good and bad.
If you must take antibiotics, I recommend taking 100 Billion Probiotics at the same time or immediately after a cycle of antibiotics to restore the good bacteria in your gut. If you have SIBO, I recommend taking a soil-based probiotic that’s free from the lactic acid that can make your SIBO symptoms worse.
A yeast infection can also cause an abnormal Pap smear. A yeast infection is a fungal infection caused by Candida overgrowth, which causes bloating, constipation, rashes, fungal infections, fatigue, brain fog, mood swings, and autoimmune disease.
I’ve worked with thousands of clients to gain control over Candida overgrowth in their bodies. It starts by removing the foods that feed it from your diet, cutting all sugar and alcohol, and limiting carbohydrates such as fruit, starchy vegetables, grains, and legumes.
Next, you’ll want to attack the Candida by taking supplements that help break down the cell wall of yeast cells. I use Candifense® as well as Caprylic Acid. Candifense® supports microbe balance in the GI tract and discourages yeast growth. At the same time, Caprylic Acid helps penetrate intestinal mucosal cells to exert the effect of yeast. Both Candifense® and Caprylic Acid are excellent at helping break down Candida cells’ walls.
Finally, you will repopulate your gut with good bacteria using a high-potency probiotic to keep Candida under control. While battling Candida overgrowth, I recommend a probiotic supplement containing 100 billion colony-forming units (CFUs) to restore your gut’s healthy microbial balance.
There are many harmless reasons for an abnormal Pap smear, including a lab error. If you’ve had sex recently, this can affect the cells of the cervix, as can being close to the start of your period or recently having your period. Using tampons or even taking a bath can cause an abnormal Pap smear.
It’s good to avoid the activities I mentioned above for at least 24 hours before getting a Pap smear. I also recommend not scheduling your exam right before or after your period. Now, let me tell you how you can support your reproductive health.
Support Your Reproductive Health
There are several reasons for an abnormal Pap smear. If you have an abnormal Pap smear, talk to your doctor to determine what to do next.
As I mentioned earlier, the best step to support your reproductive health is to practice safe sex. If you smoke, stop smoking. Steer clear of secondhand smoke or be outside if you are around smokers.
Remember, HPV is the leading cause of an abnormal Pap smear. If your immune system is functioning optimally, it can fight off the virus. Methylation is a biochemical process that, among many other critical functions, transforms toxins, including viruses, into safer substances that will not harm your body.
Methylation depends on several vitamins and cofactors, including folate, vitamin B12, and vitamin B6. Those who have a heavy viral load and those with MTHFR gene mutations need support in their methylation process. The more MTHFR mutations one has in this gene, the less able one is to make this conversion.
MTHFR lab testing to check for mutations used to be costly, and required a prescription and a blood sample. However, genetic MTHFR mutation testing is now much more affordable, accessible, and convenient. Talk to your functional medicine doctor about ordering you a MTHFR mutation test.
If you do have MTHF mutation, I recommend taking Methylation Support®. I formulated Methylation Support® to include the perfect blend of the B vitamins in their methylated forms to facilitate a healthy methylation process.
I know it can be frightening to find out you had an abnormal Pap smear, yet it is not a cause for panic. A Pap smear, while uncomfortable, is a tool that could save your life. The empowering part is that you can support your reproductive health using these functional medicine based tools.
- Abnormal Pap Smears. All Women's Care. 2021.
- George Papanicolaou (1883–1962): Discoverer of the Pap smear. Siang Yong Tan, MD, JD and Yvonne Tatsumura, MA, MD. Singapore Medical Journal, vl 56. 2015.
- Updated Cervical Cancer Screening Guidelines. The American College of Obstetrics and Gynecology. 2021.
- Increased risk of cervical dysplasia in females with autoimmune conditions—Results from an Australia database linkage study. Emma Foster, et al. PloS One, vol 15. 2020.
- Cervical cancer: Key Facts. World Health Organization. 2022.
- Cervical cancer: Key Facts. World Health Organization. 2022.
- Cervical dysplasia. Mount Sinai. 2021.
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