Interview with Dr. Thais Aliabadi, OB/GYN and Women’s Health Expert

We sat down with Dr. Thais Aliabadi to unpack everything about Pap smears, HPV testing, and what happens after an abnormal result. This conversation strips away the confusion and fear and gives clear, practical guidance you can use at your next appointment. Below you’ll find our questions and Dr. A’s answers, plus step-by-step next steps, treatment options, pregnancy considerations, and common myths we hear all the time.

Table of Contents

• Understanding the basics
• HPV explained
• Who should be screened and when
• Reading Pap results: what the terminology means
• When to expect a colposcopy and what it involves
• Biopsy results and CIN staging
• When treatment is needed: LEEP and cold knife cone
• HPV behavior and relationship questions
• HPV vaccine: what we recommend
• Common myths and important clarifications
• Practical questions to ask your clinician
• After treatment: follow-up and recovery
• FAQ
• Final practical takeaways

Understanding the basics

What exactly is a Pap smear, and what are we testing for when we get one?

We use the Pap smear as a screening test for cervical cancer. The cervix is the mouth of the uterus, a cylinder-shaped structure at the end of the vagina. During the exam, the clinician opens the vagina with a speculum, visualizes the cervix, and collects cells from the transformation zone and the endocervical canal. Those cells are sent to the lab and evaluated for two primary things: precancerous or cancerous changes in the cells, and human papillomavirus, HPV. That’s it. A Pap smear does not evaluate your ovaries, your uterine lining, or test for every sexually transmitted infection.

How do the Pap smear and HPV test relate to each other?

The swab we collect from the cervix is typically used for both tests. On the lab side, cytology (the Pap) looks for atypical or precancerous cells, while the HPV test looks for viral DNA from high-risk HPV types. In practice, you usually have one specimen taken, and the lab runs both analyses.

HPV explained

What is HPV, and why is it important?

HPV stands for human papillomavirus. It is one of the most common sexually transmitted infections. By age 50, more than 80 to 85 percent of women have been exposed to some form of HPV. There are many types—around 100 total—with roughly 30 that affect the genital area. Of those genital types, about 15 are considered high risk for causing cervical cancer. Two high-risk types, HPV 16 and HPV 18, are responsible for about 75 percent of cervical cancers. Low-risk types such as HPV 6 and 11 most often cause genital warts.

Does HPV always cause symptoms?

Not usually. Low-risk HPV types can cause visible genital warts, which look like small cauliflower-like growths on the labia or around the genital skin. High-risk HPV is often silent; it causes cellular changes on the cervix that only show up on a Pap smear or on colposcopy. Most HPV infections do not cause symptoms and clear on their own, thanks to the immune system.

Who should be screened and when

When should we start Pap tests, and how often should people be screened?

Guideline-based screening starts at age 21 or three years after first intercourse, whichever comes first. Between ages 21 and 29, cytology (Pap) alone is generally recommended. At age 30 and above, we recommend co-testing: Pap plus HPV. For people with consistently normal results, routine Pap (or co-test) intervals can be every three years. Screening typically stops around age 65 if prior testing has been consistently negative and there are no new risk factors. If a person becomes newly sexually active or is otherwise high risk, the clinician may choose to continue screening beyond those standard cutoffs.

Why add HPV testing at age 30?

The Pap by itself has limited sensitivity—meaning a single Pap can miss abnormal cells. HPV testing identifies individuals who carry the virus that drives most cervical cancers. Co-testing increases the ability to detect risk earlier. If you have three negative Pap smears or a negative co-test series, you can be reassured and lengthen the interval between screening visits.

Reading Pap results: what the terminology means

My Pap came back abnormal. What do the commonly used terms mean?

Lab terminology can feel like a foreign language. Here are the common categories and what they imply:

• Negative — no abnormal cells found.
• ASC-US (atypical squamous cells of undetermined significance) — the pathologist sees some atypical cells but can’t be sure if they are reactive or HPV-related.
• LSIL or Low-grade SIL — low-grade squamous intraepithelial lesion; suggests mild precancerous changes often associated with HPV and commonly clears on its own.
• HSIL or High-grade SIL — more concerning precancerous changes that usually require treatment.
• ASC-H — atypical squamous cells, cannot exclude high-grade lesion; this needs prompt follow-up.
• AGC or AGUS (atypical glandular cells) — these cells arise from glandular tissue either in the cervix or possibly from the uterine lining. This result has a special workflow, especially in patients over age 40.

What’s special about atypical glandular cells (AGC/AGUS)?

When your Pap shows AGC, it may be from the endocervical glands or the endometrial lining of the uterus. For patients age 40 and older, AGC usually triggers both a colposcopy and an endometrial biopsy to make sure the abnormal cells didn’t originate in the uterine lining. Younger patients may get a colposcopy and targeted evaluation based on risk factors and symptoms.

When to expect a colposcopy and what it involves

What should I ask my doctor when they call with abnormal results?

When you get that call, ask two things: what is my Pap result and what is my HPV status? If HPV is detected, ask whether it is one of the high-risk types 16 or 18. Those numbers change the next steps. The main decision points are:

• Negative Pap and HPV negative — resume routine screening as recommended.
• Negative Pap, HPV positive but not 16/18 — repeat co-testing at six months and again at one year. Most HPV infections clear on their own (about 75 percent clear within a year, 90 percent within two years).
• Negative Pap, HPV 16 or 18 positive — proceed directly to colposcopy because these types are particularly aggressive and can be missed on cytology.
• LSIL, HSIL, ASC-H, or AGC at any age — usually proceed to colposcopy for diagnostic evaluation and targeted biopsies.

What is a colposcopy, and what happens during it?

Colposcopy is a diagnostic office procedure that uses a special light and camera to examine the cervix at high magnification. The cervix is visualized with the speculum, and the clinician applies acetic acid (vinegar), which causes precancerous areas to turn white under magnification. If areas light up or look suspicious, the clinician takes small punch biopsies of those spots and may sample the endocervical canal with curettage.

Colposcopy is short, generally under five minutes for the exam and targeted biopsies. It should be as comfortable as possible. We numb the cervix with a local anesthetic in our practice; many clinicians still perform biopsies without numbing, so it’s reasonable to ask for anesthesia. After biopsies, patients typically experience light, brownish discharge for a few days and are advised pelvic rest (no intercourse) until bleeding subsides.

Biopsy results and CIN staging

What will the biopsy results tell me?

Pathology reports generally fall into a few categories:

• Benign or reactive changes — no precancerous cells identified. We will usually repeat cytology and HPV testing at short intervals until we have documented stability.
• CIN 1 (mild dysplasia) — low-grade precancer. Often observed because many of these lesions regress with time.
• CIN 2 (moderate dysplasia) — higher-grade precancer that may require treatment depending on age, pregnancy status, and other factors.
• CIN 3 (severe dysplasia or carcinoma in situ) — high-grade precancer that usually requires treatment to prevent progression to invasive cancer.
• Invasive cervical cancer — rare in modern screening programs but treated according to oncologic guidelines.

Two important points: first, sample quality and the clinician’s experience matter. A pathologist’s diagnosis is the gold standard, but if a clinician’s visual impression suggests more significant disease and the pathology appears benign, most experienced clinicians will discuss the specimen with the pathologist and request re-evaluation. Second, how much tissue is sampled and from which clock positions on the cervix affects accuracy—targeted sampling of the suspicious area is key.

What if the biopsy is CIN 1? What are the treatment options?

CIN 1 is often detected on repeat Pap and HPV testing because your immune system often clears the infection. In some cases, if there are multiple persistent lesions or other risk factors, clinicians may offer in-office treatments such as cryotherapy, which freezes the abnormal tissue so it sloughs off and healthy tissue replaces it. Cryotherapy is quick and generally well-tolerated.

When treatment is needed: LEEP and cold knife cone

What is a LEEP, and when is it done?

LEEP stands for loop electrosurgical excision procedure. The clinician uses a thin wire loop heated by electric current to shave off the abnormal portion of the cervix, usually a surface area roughly the size of a dime or nicke,l depending on cervical size. LEEP is commonly performed in the office under local anesthesia and sometimes with additional laughing gas for patient comfort. Healing typically takes about four weeks, and patients are advised to avoid intercourse and tampon use during that time. It is effective at removing CIN 2 and CIN 3 lesions.

What is a cold knife cone, and when do we use it?

A cold knife cone is a surgical procedure performed in an operating room where a cone-shaped piece of the cervix is removed with a scalpel. Because tissue is not thermally cauterized, pathology can better evaluate margins. Cold knife cones are used when there is concern for carcinoma in situ or when margin status is particularly important. This is a more invasive procedure and typically requires general anesthesia.

How can treatment affect future pregnancy?

Removing cervical tissue can increase the risk of cervical insufficiency or preterm birth, especially if a large portion of the cervix is removed. That’s why it’s critical that clinicians remove the minimal effective amount of tissue. Ask your provider how much they plan to remove and how often they’ve performed LEEPs. If you become pregnant after a LEEP, we monitor cervical length with transvaginal ultrasounds at intervals (for example, 16, 18, 20, 22 weeks) and place a cerclage if cervical shortening suggests risk of preterm birth. Choosing an experienced clinician lowers the risk of overtreatment and unnecessary removal of cervical tissue.

HPV behavior and relationship questions

Can HPV remain dormant and then resurface years later?

Yes. HPV can be latent in the body for many years. A person can acquire HPV in their early sexually active years and clear it or suppress it to undetectable levels. Later, during periods of immune suppression, stress, pregnancy, or illness, the virus can reactivate and be detectable again. Because of that dormancy, a new positive HPV test is not proof of recent infidelity. It is biologically plausible that an older infection has re-emerged.

How do we manage HPV while it’s present?

There is no direct antiviral cure for HPV. Management focuses on surveillance and treating precancerous lesions when they appear. Your immune system clears most infections—about 75 percent within a year and 90 percent within two years. During the clearance window, some clinicians recommend condom use to reduce viral exposure, especially if the person is being followed after treatment for high-grade disease. General immune health—sleep, nutrition, exercise, stress reduction—supports viral clearance.

HPV vaccine: what we recommend

Should people get the HPV vaccine even if they have a normal Pap?

Yes. The HPV vaccine is safe and highly effective. We recommend vaccination for all children, boys and girls, ideally between the ages of 9 and 11. If vaccination is started before age 15, a two-dose schedule is usually sufficient. If started after age 15, a three-dose schedule is required; vaccination is approved up to age 45 in many guidelines, and some clinicians vaccinate up to age 46 depending on risk and previous exposure. Widespread vaccination has the potential to dramatically reduce and potentially eliminate cervical cancer.

Does the HPV vaccine prevent ovarian cancer?

No. The vaccine targets human papillomavirus and prevents cervical and other HPV-related cancers. Ovarian cancer has different causes, and a Pap smear does not screen for ovarian cancer. It’s important to separate these misconceptions: Pap and HPV tests protect against cervical cancer; HPV vaccination prevents infections that can lead to cervical cancer.

Common myths and important clarifications

Can a Pap smear explain pelvic pain or heavy periods?

No. A Pap smear samples superficial cervical cells and the endocervical canal. It is not an evaluation of the uterine lining, ovaries, or fallopian tubes. Pelvic pain, heavy periods, or other gynecologic symptoms require a full clinical evaluation that can include ultrasound, lab studies, and targeted tests. Do not confuse the Pap test with a complete well-woman exam.

Does a normal Pap mean my whole well-woman exam is fine for three years?

Absolutely not. A Pap is one component of a well-woman visit. Routine preventive care includes discussion of contraception and fertility goals, screening for STIs as indicated, breast health, bone and cardiovascular risk assessments, immunizations, mental health screening, and age-appropriate testing such as mammography, lipid panels, and colon cancer screening. Even if your Pap interval moves to every three years, maintain annual well-woman visits for comprehensive preventive care.

Practical questions to ask your clinician

What should I ask if my Pap or HPV test comes back abnormal?

Here’s a quick checklist to bring to your clinician or keep handy when you get a call:

• What exactly is my Pap result? (ask for the lab wording)
• What is my HPV result? If positive, is it HPV-16 or HPV-18?
• Do I need a colposcopy now, or should we repeat co-testing in 6–12 months?
• If colposcopy is recommended, will you numb the cervix for biopsies?
• If treatment is recommended, how much tissue will be removed, and how experienced are you with LEEP or cones?
• If I become pregnant later, how will this affect monitoring or pregnancy care?

Can I ask how many LEEPs or colposcopies a clinician has done?

Yes. It is entirely reasonable to ask about experience. Ask your clinician how many LEEPs, cones, and colposcopies they have performed and how comfortable they are managing women who want future pregnancies. A surgeon who understands how much tissue to remove and how to preserve cervical competence is essential.

After treatment: follow-up and recovery

What happens after we treat a precancerous lesion?

Follow-up generally includes Pap and HPV testing at recommended intervals. If you have a LEEP or cone, many clinicians recheck cytology and HPV at around four months and then at regular intervals until there are three consecutive normal results, including negative HPV, before returning to routine screening. During the initial months after treatment, avoid sexual intercourse until your clinician says it is safe, and expect some irregular bleeding or brown discharge for a short time.

FAQs

Can I get a Pap smear while I’m on my period?

Ideally not. Blood can interfere with the quality of the specimen. Modern liquid-based Pap tests tolerate some bleeding better than older slide methods, so it may still be possible, but rescheduling for a time when you are not menstruating often improves sample adequacy.

If my Pap is normal, do I still need the HPV vaccine?

Yes. A normal Pap does not mean you haven’t been exposed to HPV or that vaccination won’t be beneficial. The vaccine prevents infections with the most dangerous HPV types and is recommended for boys and girls starting at ages 9 to 11, and still beneficial up to age 45 in many cases.

Does the Pap test check for STIs like chlamydia or gonorrhea?

Not automatically. Chlamydia and gonorrhea testing are separate but can sometimes be performed from the same swab if ordered. Blood tests are needed for HIV, syphilis, and hepatitis screening. If you want STI testing, request it specifically.

How often does HPV clear on its own?

Most people clear HPV: approximately 75 percent within one year and 90 percent within two years. Clearance depends on immune health and other factors. Persistent infection with high-risk types is what increases the risk of precancerous changes.

Are colposcopy biopsies painful?

Biopsies can be uncomfortable if local anesthesia is not used. Many clinicians numb the cervix with a local anesthetic before taking biopsies. It is appropriate to ask your provider to numb the area; doing so typically makes the procedure tolerable with minimal pain.

When can I resume normal activity after a colposcopy or LEEP?

After colposcopy with punch biopsies, most people can return to normal activities the same day, but should avoid intercourse and tampons until bleeding stops—typically a few days. After a LEEP, pelvic rest is usually advised for about four weeks, and heavy bleeding can occur in the first week. Follow your clinician’s specific instructions.

Will removing tissue from my cervix prevent me from getting pregnant?

Most people who have a small LEEP or localized treatment can conceive normally. The key risk is when a large amount of cervical tissue is removed, which can weaken the cervix and increase the risk of second-trimester miscarriage or preterm birth. Experienced clinicians aim to remove only what is necessary and counsel patients on pregnancy monitoring and cerclage options if needed.

Final practical takeaways

We want to leave you with the core messages we return to again and again:

1. Get screened. Regular Pap and HPV testing dramatically reduces the risk of dying from cervical cancer. With routine screening and appropriate follow-up, cervical cancer is highly preventable.
2. Know what your results mean. Ask for your Pap wording and your HPV status, and ask whether a positive HPV is type 16 or 18.
3. Ask for what matters to you. If you need a colposcopy, ask whether the clinician will numb the cervix and how experienced they are with diagnostic and therapeutic procedures.
4. Distinguish a Pap smear from a well-woman visit. A Pap is one test among many in preventive care. Keep annual visits for comprehensive health maintenance even if your Pap interval is extended.
5. Vaccinate. The HPV vaccine is safe, effective, and a powerful tool in preventing cervical cancer in the next generation.

If you have more questions about screening, colposcopy, or treatment options, bring this checklist to your appointment and ask for clear explanations of next steps. We want you to feel confident and informed about your cervical health so you can make choices that align with your life and goals.

Thank you to Dr. Thais Aliabadi for sharing clinical clarity and practical advice.

This article was created from the video Ask Dr. A: Pap Smear vs HPV Test… What’s the Difference? | SHE MD for Dr. Thais Aliabadi’s website.