Nabothian Cysts and Pap Smear Results
Nabothian cysts do not cause abnormal Pap smear results. These are benign mucous retention cysts of the cervix that represent blocked cervical glands and have no relationship to cellular abnormalities detected by cytology 1, 2, 3.
Understanding Nabothian Cysts
Nabothian cysts are common benign cervical lesions found in women of reproductive age, formed when cervical mucous glands become obstructed, typically following childbirth, minor trauma, or chronic cervicitis 1, 4, 2.
These cysts are usually small (2-10 mm) and asymptomatic, though rare giant variants exceeding 4 cm can occur and may mimic malignancy on imaging 1, 2, 5.
Nabothian cysts are structural/anatomic findings, not cellular abnormalities, and therefore cannot produce the atypical cells that define an abnormal Pap smear 1, 3.
What Actually Causes Abnormal Pap Smears
The Bethesda System classifies cervical cytology abnormalities ranging from ASC-US (atypical squamous cells of undetermined significance) to HSIL (high-grade squamous intraepithelial lesion), with these abnormalities representing cellular changes, not structural lesions 6, 7.
High-risk HPV infection is the primary cause of true cervical dysplasia and abnormal cytology, with HPV-positive women having significantly higher rates of progression to CIN 2 or worse 6, 7.
Non-HPV causes of abnormal Pap smears include severe inflammation from infections (trichomoniasis, bacterial vaginosis, candidiasis, chlamydia, gonorrhea), which can produce reactive cellular changes that appear abnormal on cytology 7.
HIV-infected women have 10-11 times higher rates of abnormal cervical cytology compared to the general population due to immune dysfunction, independent of HPV status 8, 7.
Critical Clinical Distinction
If a woman with nabothian cysts has an abnormal Pap smear, the abnormality is caused by cellular changes (HPV, infection, inflammation, or immune dysfunction) that are coincidentally present alongside the cysts, not caused by them 7.
Large nabothian cysts may be mistaken for malignancy on physical examination or imaging, but histopathology confirms their benign nature, and they do not produce the atypical squamous or glandular cells detected by Pap testing 1, 2, 3.
Management Implications
Women with nabothian cysts should follow standard cervical cancer screening guidelines based on age: cytology alone every 3 years for ages 21-29, or cotesting (cytology plus HPV) every 5 years for ages 30-65 8, 6.
Any abnormal Pap smear result requires appropriate follow-up according to established algorithms (reflex HPV testing for ASC-US, colposcopy for LSIL/HSIL), regardless of whether nabothian cysts are present 6, 7.
Specimens reported as unsatisfactory for evaluation should be repeated, as inadequate sampling—not the presence of nabothian cysts—is the issue 8, 7.