Q&A: What Does An Abnormal Pap Smear Mean?

QUESTION: My most recent pap smear came back abnormal. I had a colposcopy and my doctor said that it looked like I had only mild cervical changes. He checked for warts but did not find any. Can I still have sex with my boyfriend (vaginal and oral)? What safer sex practices should we use, and for how long?

I am sorry to hear about your diagnosis. While difficult, it may be reassuring to know that about 60-80% of sexually active adults have had or will have the human papillomavirus. Many never know it. This is particularly true for men, since we currently have no way of testing men for HPV.

In other words, your boyfriend may have HPV but neither of you would know it unless he had visible warts diagnosed by a healthcare provider. It is even possible that you got HPV from him, but there is no way to know.

More Than 100 Strains of HPV

There are more than 100 strains of HPV. Some are linked to genital warts; others may cause cervical changes which would show up on a Pap test. Most people’s bodies appear to “get over” their HPV infection without it ever causing symptoms like warts or cervical changes.

Most women who have an abnormal Pap test result have a normal Pap test result again within one year. It is important, however, to follow your healthcare provider’s recommendations regarding repeat Pap testing and colposcopy testing. Good for you for doing so!

Skin-To-Skin HPV Transmission

It is a personal choice to have sex after a sexually transmissible infection diagnosis so we cannot advise you on what to do. Since you have been together for a year and have likely been sexually active together for a while, it is possible that your boyfriend already has HPV (whether you gave it to him or he gave it to you).

As HPV is transmitted skin-to-skin, condoms (which do not cover all of one’s genital skin) cannot eliminate the risk of HPV transmission although some research suggests that they may reduce the risk. HPV is unlikely to be transmitted to oral sex. It does happen, but it is uncommon as the virus is said to “prefer” the genital.

HPV and Genital Warts

An HPV diagnosis does not mean that you will get warts. You may not have a wart-related strain. Even if you do, you may never get warts or you may only get a few warts from time to time. Treatments are available for warts should you ever get them.

Both you and your boyfriend can examine your genitals for changes in appearance, keeping in mind that there are many normal lumps and bumps on one’s genitals that have nothing to do with HPV or other problems. You can learn more about HPV, abnormal Paps, warts, and normal lumps and bumps in The V Book: A Doctor’s Guide to Complete Vulvovaginal Health.

HPV and Smoking

If you smoke cigarettes, quitting smoking is a major step toward improving your cervical health. A great deal of research has connected cigarette smoking with HPV-related problems including cervical changes and genital warts.

Smoking cessation classes are available through many campus health centers and community groups. In addition, anything that helps your immune system (e.g., good sleep, relaxation, healthy lifestyle) may be helpful.