Planned Parenthood of Central New Jersey

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Service Descriptions

Abnormal Pap Test Results

What Are "Abnormal" Pap Test Results?
A Pap test is a scraping of cells from the surface and canal of the cervix. These cells are examined under a microscope for signs of infection or early changes that might indicate cancer.

An abnormal Pap test can mean that there are harmless cell changes due to infection, or that there are precancerous changes which if ignored may become cancer. Early treatment of precancerous growths usually due to the wart virus, HPV (human papilloma virus) can prevent cancer from developing. If suspicious cells are found then a more thorough examination of your cervix using a colposcope which magnifies the surface is recommended. Your clinician may obtain small tissue samples for the pathologist to study.

A Pap test also may detect infections such as bacteria, yeast, or viruses. One kind of sexually transmitted virus is important to detect because of its link to cervical cancer. This virus is the human papilloma virus (HPV) and also is the cause of genital warts.

Pap test results are divided into six major groups:

A finding of inflammation on a Pap test sometimes means that there is a viral or bacterial infection of the cervix. Sometimes inflammation is present on Pap test because of a cervical injury and later repair and no infection can be found. Since a cervical infection may be present, it is suggested that you return to Planned Parenthood for an examination of your cervix. If the examination or tests reveals the presence of infection, you will be treated. If the tests are negative, no further treatment will be necessary.

Atypical Cells of Undetermined Significance (ASCUS):
ASCUS is a Pap test result that is in-between normal and abnormal. It is frequently the result of an injury to the cervix from an infection or other cause and in many cases the abnormality goes away without any treatment. A small percentage of women with ASCUS on Pap test will actually have Cervical Intraepithelial Neoplasia (CIN), which is a pre-cancerous condition. Since there is no way to tell from an ASCUS Pap test who has a serious abnormality, you should have your Pap test repeated in 4-6 months. If that Pap test is normal, it should be repeated every 6 months for another two times. If any of the repeat Pap tests are abnormal, you will be advised to have a special evaluation called a colposcopy (a procedure which allows your clinician to visualize your cervix under magnification). If all your repeat Pap tests are normal, you can return to Pap tests at yearly intervals.

Atypical Glandular Cells of Undetermined Significance (AGCUS):
AGCUS is a Pap test finding that shows abnormal glandular cells. It is similar to ASCUS in that the abnormality may or may not be significant. Because glandular cells are found in the canal of the cervix, abnormalities are more difficult to diagnose. Therefore, it is considered necessary to evaluate the condition further by a procedure called colposcopy (visualization of your cervix under magnification), without waiting.

Low Grade Squamous Intraepithelial Lesion (Low grade SIL):
The cells in the cervix show an abnormality which frequently means you have a viral condition called Cervical Intraepithelial Neoplasia (CIN). CIN is sometimes called Dysplasia of the cervix. Mild forms of CIN often go away without treatment. More severe forms are considered pre-cancerous and can even progress to cancer if untreated. Occasionally, if a Pap test is reported as Low Grade SIL, the abnormalities are caused by simple problems like infection or healing from a minor injury or, rarely, there is no problem at all. To find out which form of CIN you have or if you even have a significant abnormality, you will be advised to have a colposcopy (a procedure that allows your clinician to visualize your cervix under magnification).

High Grade Squamous Intraepithelial Lesion (High Grade SIL):
The cells in the cervix show an abnormality which usually means you have a more severe form of Cervical Intraepithelial Neoplasia (CIN),a pre-cancerous condition which sometimes can progress to cancer if untreated. Rarely you may even have an actual cancer. If your Pap test shows High Grade SIL, you should be evaluated by a procedure called colposcopy. This technique allows the clinician to examine the cervix with a magnifying telescope, which helps to show where the areas of abnormality are located. It is done as an office procedure and takes about 1/2 hour. During colposcopy, the clinician usually will perform a biopsy, in which a small amount of tissue is taken from the cervix and sent to a lab to be evaluated by a pathologist. A biopsy is the only way to establish the diagnosis suggested by the Pap test.

Obvious cancer cells are found on the Pap test, indicating that it is very likely that cervical cancer is present. This must be evaluated and treated immediately. We will refer you to a specialist in cervical cancer.

The clinical staff at Planned Parenthood is happy to answer any questions that you have about Pap tests or cervical problems.


Colposcopy and Cervical Biopsy

What is colposcopy?
Colposcopy is a painless examination of the cervix and vagina with a colposcope. This exam usually is done between menstrual periods and generally takes less than thirty minutes. A woman lies down in the position used to take a Pap test and a speculum is inserted into the vagina to give a view of the cervix and vagina. After cleansing the cervix with a special solution, most of the time is spent just looking at the cervix and vagina through the colposcope.

What is a colposcope?
A colposcope is a low power telescope mounted on a stand, used to look at the cervix and vagina under magnification. The colposcope may have a camera attachment so that pictures of the cervix may be taken and kept to check for change at a later exam.

Why are some women advised to have colposcopy?
If your Pap test indicates the presence of abnormal cells or if the cervix looks abnormal, colposcopy may help in diagnosis and in planning of treatment. It is impossible to diagnose diseases or other problems simply by looking at the cervix with the naked eye. A magnified view is necessary to find any abnormalities or to show that cervical changes are not cause for concern. When abnormal areas are found, biopsies will be taken to confirm the abnormality.

What is a biopsy of the cervix?
Biopsy is the removal of a small piece of tissue from the cervix using a specially designed instrument. One or more biopsies may be necessary during your colposcopy. This tissue then is sent to a laboratory where it is examined under a microscope by a doctor and the diagnosis is forwarded to Planned Parenthood Golden Gate. We will contact you regarding the results.

Is biopsy painful?
Most women describe the procedure as feeling like a sharp pinch. Some experience a menstrual-type cramp. There may be slight spotting or bleeding for a few days after a cervical biopsy, especially if more than one biopsy is done.

What should I do after a colposcopy?
There are only a few special instructions you should follow after a colposcopy:
   If a biopsy is taken, you should wait one week before having vaginal intercourse to allow the cervix to heal.
   If a biopsy is not taken, you can resume sexual activity whenever you want to.
   If you take birth control pills or other medications, you should take them as usual.
   You may shower or bathe as soon as you want.
   You may use tampons, unless you are told something different at the time of the colposcopy.
   Call the clinic if you have: bleeding (heavier than spotting) at a time you are not having your period; severe pain in the lower abdomen; fever or chills; and/or heavy, yellow-colored, or bad-smelling vaginal discharge.

What further treatment will I need?
Sometimes the examination shows that no immediate treatment is necessary and that you need further follow-up only. In the event your condition requires more specialized evaluation or treatment than Planned Parenthood can provide, we will refer you to a physician consultant for further management.


What Is Cryotherapy?

Cryotherapy is used to treat an area of abnormal tissue on the cervix. It is performed after the colposcopy visit, once the result of the cervical biopsies has been received.

How is cryotherapy performed?
Cryotherapy is done with the client in the same position used for taking a Pap test. A speculum is inserted and the cervix is touched with an instrument, called a cryoprobe, that rapidly freezes the abnormal tissue. The procedure takes several minutes.

Is it painful?
Most women describe pelvic pressure and some have menstrual-like cramps during cryotherapy. A few women notice no discomfort at all.

What can I expect after cryotherapy?
All women will have a watery discharge that can last from a few days to several weeks. This discharge may be extremely heavy and can be blood-tinged. Your clinician may advise you not to have intercourse and not to use tampons for approximately two weeks. Because of the heavy loss of water from the freezing of tissue, you should be sure to drink lots of fluids. Orange juice is especially good for you as the cells are repairing. Call the clinic if you have: heavy bleeding; severe abdominal pain; fever, chills or other discomforts that concern you

What are the risks of cryotherapy?
Most women do not have any serious side effects after cryotherapy. Rarely, however, complications can occur and include fainting, flare-up of pelvic infection, freeze burns of the vaginal wall and excessive bleeding. No treatment is one hundred percent effective and no guarantee can be made by Planned Parenthood regarding the success of the treatment. The risk that this treatment will fail to cure the cervical problem is about 10 - 15%. If the condition is left untreated, it may progress to cancer. For this reason, it is essential that you keep your return appointments for follow-up care.


What Is Loop Electrosurgical Excision Procedure (LEEP)?

What is Loop Electrosurgical Excision?
"Loop Electrosurgical Excision" is a treatment in which an electrical wire loop is used to remove an abnormal piece of tissue on the cervix.

When is this performed?
If CIN (also called dysplasia), an area of abnormal cervical cells, is found after a colposcopic viewing and biopsy of the cervix, the LEEP treatment may be performed in our clinic.

How is the procedure performed?
It is done with the patient in the same position used for taking a Pap test, and takes about 30 minutes.

Is it painful?
All patients are given a small amount of numbing medication (local anesthetic) injected into the cervix. Some patients experience mild discomfort or cramping, but most do not feel anything.

What can I expect after LEEP?
After treatment, you may experience mild cramping for up to 24 hours. You probably will have a watery vaginal discharge for several weeks. This discharge may be heavy for a few days or may be mixed with a little blood. There may be some odor to the discharge. If this happens, wash the labia (vaginal lips) off with plain water several times a day for a few days.

What are the risks of this procedure?
Most women do not experience serious side effects from this procedure. However, very rarely, serious complications can occur. These include damage to other pelvic organs or the vaginal walls, pelvic infection (particularly if you have sex before the cervix heals), or excessive bleeding (about 1 in 100 women has bleeding that may require a return visit to the office). Very rarely the procedure can weaken the cervix and cause problems with future pregnancies. The risk that this treatment will fail to cure the problem is about 10%. If the condition is left untreated, it may progress to cancer. For this reason, it is essential that you keep your appointments for follow-up care.

Some things to remember after you have had LEEP
To speed healing and prevent infection, you should follow these instructions:
   Sanitary pads, rather than tampons, are recommended, if needed, for three weeks.
   You should not have intercourse for three weeks unless the doctor recommends otherwise.
   You should not douche your vagina for at least three weeks.
   Oral pain relievers, such as Tylenol or Advil, may be used for cramps.
   Call the Planned Parenthood clinic if you have any questions or any unusual or unexpected symptoms, such as: unusual vaginal bleeding, or bleeding heavier than the heaviest day of your period; foul smelling vaginal discharge; fever or chills; abdominal pain.

It is very important to have follow-up Pap tests at Planned Parenthood at 4 months, 8 months, and 12 months and every 6 months for the 2nd year after having loop electrosurgical excision done.


Adoption Referrals

Adoption is one option available to pregnant women. Planned Parenthood of Central New Jersey provides referrals to state licensed adoption agencies.


School/Work Physicals

General school physicals for athletics and pre-employment physicals necessary for working papers are available at all of our health centers.