What does my ASC-H pap smear signify?

Question

Hi doctor,

I received an abnormal Pap smear result last week, specifically asc-h. I am scheduled for a colposcopy in three weeks. However, the Pap smear results took eight weeks.

I am getting concerned because I have had consistent lower back pain and also abdominal pain. A bit of uncomfortable pain, but not too unbearable. It was my first PAP smear test.

I had tested negative for an hpv test two years ago. I am worried about the worst-case scenario.

Can you please explain me what to expect?

Answer 1

Hi,

Welcome to icliniq.com

I saw your report and understand why you are anxious. The Papanicolaou test (Pap smear) shows ASC-H (Atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion), which means some cells look abnormal, not clearly cancerous, but concerning enough that we need a closer look under colposcopy.

It also shows high-risk human papillomavirus HPV (types 16 and 18/45), which are the strains linked to cervical precancer. It does not mean cancer, but it does mean we cannot ignore it.

The delay in getting results does not usually change the disease process much because these cell changes develop slowly over months to years, not days. The back and abdominal discomfort could be due to anxiety or pelvic muscle strain; they are not typical early symptoms of cervical disease. Still, we will rule out any local inflammation or infection when you come for the colposcopy.

In your case, the probable cause is cervical epithelial changes possibly related to persistent high-risk HPV infection.

I would recommend the following investigations to be done:

Colposcopy (as scheduled) with directed biopsy if any abnormal areas are seen.
If the biopsy confirms CIN (cervical intraepithelial neoplasia), further management is based on the grade.
Pelvic ultrasound if pain continues.

The differential diagnosis will include:

HPV-related cervical dysplasia
Cervical inflammation or reactive changes
Endocervical glandular atypia (less likely)

Your case looks like high-grade cervical epithelial changes (ASC-H).

Right now, the best is to wait for a colposcopy and biopsy before jumping to conclusions. Avoid vaginal intercourse or douching till then. Take an anti-inflammatory (like Paracetamol 500 mg) if pain persists. No supplements or herbal cleanses needed. Maintain hydration and rest well.

As a preventive measure, you must:

Quit smoking if applicable.
Use barrier protection till further advice.
Continue with HPV vaccination if not completed.
Regular follow-up Pap and HPV testing as per protocol.

Once the biopsy report is available, please update me here. If the pain increases, or you notice postcoital bleeding or unusual discharge, get a pelvic exam earlier. Also, continue with your scheduled colposcopy; it is the key next step.

I hope this answers your query.

Thank you.