What Does an LSIL Pap Smear Result Mean?

An LSIL Pap smear result means the laboratory saw low-grade (mild) changes in cells from the surface of the cervix. LSIL stands for low-grade squamous intraepithelial lesion. The US National Cancer Institute (NCI) says these changes are usually caused by an HPV infection.

Cleveland Clinic describes LSIL as a mild form of dysplasia and states that a squamous intraepithelial lesion does not mean you have cancer. It is a reason for follow-up, so that any changes that do not settle can be found and managed early. This guide explains general pathways; it cannot interpret your own result.

An LSIL result on its own is not a reason for emergency care. Symptoms are a separate matter. The NHS advises seeing a doctor if you notice any of the following, even if your next screening test is months away. These symptoms have many possible causes and most are not cancer, but they should be checked.

• Vaginal bleeding that is unusual for you, such as during or after sex, between periods or after menopause.
• Periods that are heavier than usual, or changes in vaginal discharge.
• Pain during sex, or pain in the lower back, pelvis or lower abdomen.
• After a colposcopy, biopsy or treatment: bleeding heavier than a heavy period, smelly discharge, or stomach pain that does not improve with pain relief or keeps coming back. The NHS advises contacting a doctor or urgent advice line for these.

HPV (human papillomavirus) is a very common virus, and certain types can cause changes in cervical cells. NCI describes LSIL as low-grade changes usually caused by HPV. That is why an HPV test is often part of the follow-up: it helps estimate how likely the changes are to need closer attention.

HPV is common, and an HPV-related result is not a judgement about you. Your clinician can explain what your HPV result means for follow-up and answer questions about HPV in a private conversation.

Often, yes. Cleveland Clinic states that most low-grade lesions go away on their own. NCI says that CIN 1, the low-grade grade sometimes found on a biopsy, usually goes away without treatment.

The NHS colposcopy guide says that if a biopsy shows CIN1, no immediate treatment is needed and you may be offered a follow-up screening test or colposcopy. Monitoring exists because a small number of changes do not clear, and follow-up is how those are picked up.

In the United States, follow-up is guided by the 2019 ASCCP risk-based management guidelines, which weigh your current result together with past screening history. A CDC summary of these guidelines describes these general pathways for people aged 25 and over:

• LSIL with a positive HPV test, and previous results unknown or HPV-positive: colposcopy is recommended.
• LSIL with a negative HPV test, and previous results unknown or HPV-negative: repeat HPV testing, with or without a Pap test, in 1 year.
• LSIL that follows a negative HPV test or co-test within the past 5 years: the CDC summary says follow-up in 1 year is recommended instead of colposcopy.
• Under 25: the CDC notes that HPV testing is not part of routine screening at this age and that HPV-related changes in young people are more likely to clear, so the approach can differ.

If you have a colposcopy, the clinician looks closely at the cervix and may take a small biopsy. NCI explains that a colposcopy usually includes a biopsy so the tissue can be checked under a microscope. The NHS says that if no abnormal cells are seen you are usually told straight away, while biopsy results can take 4 to 8 weeks.

The NHS colposcopy guide describes biopsy grades from low to high. These grades come from tissue, not from the Pap sample, so they can differ from the original LSIL report. Your clinician will explain which applies to you.

• Normal biopsy: a return to routine screening, with the interval depending on age.
• CIN1 (low grade): no immediate treatment; a follow-up screening test or colposcopy may be offered.
• CIN2 (medium grade): follow-up colposcopy or treatment to remove the cells may be offered.
• CIN3 (high grade): treatment to remove the cells is offered.

In England, screening starts with an HPV test and cells are only examined if high-risk HPV is found. UK reports may use the term "low-grade dyskaryosis" rather than LSIL. UK colposcopy guidance states that anyone who is HPV-positive with abnormal cells must be referred for colposcopy, and that at least 99% of people referred with low-grade changes should be offered an appointment within 6 weeks.

The NHS reassures that cell changes will not get worse while you wait for a colposcopy appointment. A colposcopy usually takes 15 to 20 minutes, may be uncomfortable, and you can ask to stop at any time. Other countries have their own pathways, so ask how your local programme applies.

Bring your report, including the HPV result and the sample date, and any earlier screening results. These questions can help you leave with a clear plan.

• Was an HPV test done, and what did it show?
• Does my previous screening history change what you recommend?
• Am I being offered colposcopy or a repeat test, and why?
• When is my next test due, and who will contact me?
• If I have a biopsy and it shows CIN1, what does monitoring involve?
• Which symptoms should make me contact you before my next test?
• If a biopsy is taken, how and when will I get the result?
• I am pregnant or planning a pregnancy. Does that change the timing?

On SameCase, patients and verified doctors share de-identified cases. Reading how others with an LSIL result discussed HPV testing, colposcopy or repeat tests can help you spot questions to bring to your own appointment.

Someone else's outcome cannot predict yours, and SameCase does not diagnose. Use similar cases to prepare, and rely on your own clinician for decisions about follow-up.