PAP Smear Report (Liquid Based Cytology) - Summary

Patient Details

• Name: Mrs. Sheetal Kute | Age: 38 years | Female
• Collected: 09 Aug 2026 | Reported: 11 Aug 2026
• Lab: Lupin Diagnostics, NRL Mumbai

What Test Was Done?

Key Findings

What Does This Mean?

• No cancer or pre-cancerous changes were detected - this is a normal/reassuring result.
• The result shows reactive cellular changes due to inflammation, which means the cervical cells are reacting to some irritation or infection, but are not abnormal or malignant.
• This type of change is common and often caused by bacterial, fungal, or other minor infections.

Recommendation

• Repeat PAP smear after treatment of the inflammation. The inflammation should be treated first (usually with antibiotics or antifungals as advised by the doctor), and then a follow-up smear is recommended to confirm the result is clear.

Bottom Line

Causes of Cervical Inflammation (Cervicitis)

1. Infectious Causes (Most Common)

A. Sexually Transmitted Infections (STIs) - Primary Causes

Important: In nearly half of women with cervicitis, no specific organism is identified even with modern testing. - Harrison's Principles of Internal Medicine, 22nd Ed.

B. Non-STI Infectious Causes

• Normal vaginal flora overgrowth - bacteria that normally live in the vagina (Staphylococci, Streptococci, E. coli, Candida) can cause inflammation when the vaginal ecosystem is disrupted.
• Bacterial Vaginosis (BV) caused by Gardnerella vaginalis - produces a thin, fishy-smelling discharge and can trigger cervical inflammation.
• Candida (yeast infection) - especially in women with diabetes, pregnancy, antibiotic use, or immune compromise.
• Ureaplasma urealyticum / Mycoplasma hominis - account for a subset of cervicitis cases.

2. Non-Infectious Causes

• Mechanical irritation - from IUDs (intrauterine devices), tampons, diaphragms, or cervical caps
• Chemical irritation - from douches, spermicides, latex condoms (allergy), or hygiene products
• Radiation - radiation therapy to the pelvic area
• Hormonal changes - low estrogen (as in menopause) can make cervical tissue more vulnerable to irritation

How It Relates to Sheetal's Report

• Normal flora imbalance / bacterial vaginosis, or
• A mild yeast/fungal infection, or
• Non-specific irritation

Heavy Periods + Severe Abdominal Pain in a 38-Year-Old Woman with Cervical Inflammation

1. Pelvic Inflammatory Disease (PID) - HIGH PRIORITY

• PID occurs when infection ascends from the cervix upward into the uterus (endometritis) and fallopian tubes (salpingitis)
• Common organisms: Chlamydia trachomatis, N. gonorrhoeae, Mycoplasma genitalium, and vaginal anaerobes
• Symptoms: Pelvic pain (constant or intermittent, worse with periods and intercourse), adnexal tenderness, fever, and abnormal bleeding
• The heavy/irregular bleeding occurs because the uterine lining gets inflamed (endometritis)
• If untreated, PID can lead to tubo-ovarian abscess or chronic pelvic pain

"Women with PID often complain of pelvic pain which is typically exacerbated by menses and coitus." - Goldman-Cecil Medicine

2. Endometriosis - STRONG POSSIBILITY

• Uterine lining tissue (endometrium) grows outside the uterus - on ovaries, fallopian tubes, bladder, bowel
• This tissue bleeds cyclically with every period, causing internal bleeding, adhesions, and inflammation
• Classic symptoms: Severe painful periods (dysmenorrhea), deep pelvic pain, pain during intercourse, heavy/irregular bleeding, and infertility in 30-40% of cases
• Can cause "chocolate cysts" (endometriomas) on ovaries filled with old blood
• Endometriosis also triggers inflammation in the pelvic area, which can secondarily affect the cervix

"Clinical signs usually include severe dysmenorrhea, dyspareunia, and pelvic pain due to intrapelvic bleeding and periuterine adhesions. Menstrual irregularities are common." - Robbins, Cotran & Kumar Pathologic Basis of Disease

3. Adenomyosis - COMMON AT AGE 38

• Very common in women in their late 30s-40s
• Causes the uterus to enlarge and become "boggy"
• Symptoms: Heavy periods (menorrhagia), severe cramping/colicky pain especially just before menstruation, pelvic pressure
• Can coexist with endometriosis

"Extensive adenomyosis may cause menorrhagia, dysmenorrhea, and pelvic pain, particularly just prior to menstruation." - Robbins & Kumar Basic Pathology

4. Uterine Fibroids (Leiomyomas)

• Benign muscle tumors of the uterus, very common in women aged 30-45
• Depending on location, can cause heavy, prolonged periods and pelvic pressure/pain
• Fibroids distort the uterine cavity causing increased bleeding surface area
• Submucosal fibroids (inside the uterine cavity) are most likely to cause heavy bleeding

Summary Table

What Should Be Done Next for Sheetal

1. Pelvic ultrasound - to check for fibroids, ovarian cysts, endometriomas, or thickened uterine lining
2. STI swabs (Chlamydia, Gonorrhea, Mycoplasma) - to rule out PID-causing organisms
3. Blood tests - CBC (to check for anaemia from heavy bleeding), ESR/CRP (inflammation markers)
4. Laparoscopy - gold standard if endometriosis is suspected and imaging is inconclusive
5. Treat the cervical inflammation first as recommended in her PAP report, then repeat the smear

Important: This is a clinical assessment based on the reported symptoms. Only her treating doctor can make a definitive diagnosis after a proper examination and investigations.