What Does an HSIL Pap Smear Result Mean, and What Happens Next?

An HSIL Pap smear result means the cervical screening sample showed high-grade squamous intraepithelial lesion: cells that look moderately or severely abnormal. HSIL is not cancer. The US National Cancer Institute (NCI) explains that these cells could become cancer in the future if not treated, which is why HSIL is followed up promptly, usually with colposcopy.

In the UK and some other countries, the same finding may be called high-grade dyskaryosis. Cancer Research UK stresses that cell changes do not mean you have cancer, and that it is very rare for an abnormal result to show a cancer has already developed.

This guide is for adults who have an HSIL result and want to understand the usual pathway. It cannot interpret your sample or decide your care; your screening programme or clinician does that.

Most people with HSIL feel completely well, and the result was found through routine screening. You do not need to wait for a colposcopy date if you notice new symptoms. The NHS advises seeing a GP or local clinician about:

• Vaginal bleeding that is unusual for you, including during or after sex, between periods or after the menopause.
• Changes in vaginal discharge.
• Pain or discomfort during sex.
• Pain in the lower back, pelvis or lower tummy that does not settle.
• After a biopsy or treatment: heavy bleeding, discharge that smells unpleasant, or tummy pain not eased by ordinary painkillers. Contact the clinic, a GP or urgent services.

No. HSIL describes precancerous changes in the surface cells of the cervix. Most of these changes are linked to a persistent infection with high-risk human papillomavirus (HPV). The point of finding HSIL is to remove or monitor abnormal cells before they ever have the chance to become cancer.

A Pap or cytology result is a screening result, not a final diagnosis. When a biopsy is taken, the tissue result is usually reported using a different scale called CIN (cervical intraepithelial neoplasia). NCI notes that HSIL on a Pap test usually corresponds to CIN 2, CIN 2/3 or CIN 3 on biopsy. Your clinician will explain how the two results fit together.

Colposcopy is a closer look at the cervix. It feels similar to a screening test and usually takes around 15 to 20 minutes, according to the NHS. A speculum is used, and a magnifying instrument with a light (the colposcope) stays outside the body. A liquid is applied to the cervix to show abnormal areas, which may tingle slightly.

A small biopsy may be taken from any area that looks abnormal. This can feel like a brief pinch. Mild period-like pain and light bleeding or discharge for a few days afterwards are common. You can ask for a chaperone or interpreter, and you can ask to stop at any time.

The NHS says any cell changes will not get worse while you are waiting for your appointment. It is safe to have a colposcopy during pregnancy, but tell the clinic beforehand if you are or might be pregnant.

Treatment is commonly offered for high-grade changes. The most common method is LEEP (loop electrosurgical excision procedure), called LLETZ (large loop excision of the transformation zone) in the UK. A thin heated wire loop removes the affected area under local anaesthetic. The NHS describes it as taking about 15 minutes, often at the same appointment, with most people going home the same day.

Other options exist. A cone biopsy removes a larger cone-shaped piece of tissue, usually under general anaesthetic. Laser therapy, cold coagulation and cryotherapy are used in some clinics. The removed tissue is sent to the laboratory, which also confirms the grade of the changes.

In some situations, clinicians offer treatment without waiting for biopsy results. US guidelines from the American Society for Colposcopy and Cervical Pathology (ASCCP) describe this "expedited treatment" for some non-pregnant adults with HSIL, and recommend shared decision-making, especially for people who are planning a future pregnancy. Pregnancy changes the plan, and treatment is often delayed until after the birth. Your team will advise on what applies to you.

After treatment, bleeding and discharge can last for up to about four weeks. Clinics usually advise avoiding sex, tampons and menstrual cups for a period, and using pads instead. Follow the written instructions from your own clinic.

A follow-up test is arranged to check that the treatment worked. Cancer Research UK describes a follow-up screening test about six months after treatment in the UK; other countries use different schedules. Going to this appointment matters even if you feel well.

Cancer Research UK states that treatment for abnormal cervical cells should not affect the ability to get pregnant. Repeated treatment or removal of a larger amount of tissue may slightly raise the chance of premature birth in a later pregnancy, so mention any past treatment to your maternity team.

Bring a copy of the screening report if you can, and write down the answers.

• Does my report say HSIL, high-grade dyskaryosis, or something else, and was HPV also tested?
• Is the plan colposcopy with biopsy, or might treatment be offered at the same visit?
• Which treatment would be used, and what anaesthetic does it need?
• I may want a pregnancy in future, or I am pregnant now. How does that change the plan?
• How and when will I get the biopsy or treatment results?
• When is my follow-up test, and who will send the invitation?
• Which symptoms after the procedure should make me call the clinic, and what number do I use?

On SameCase, patients and verified doctors share de-identified cases. Reading how others with an HSIL result moved through colposcopy and follow-up can help you notice questions you had not thought of, such as how results were communicated or how future pregnancy plans were discussed.

Other people's cases are not a guide to your own result or outcome. Use them to prepare for the conversation with your clinician, not to replace it.