Granular Tissue on Pap Smear: Causes and What It Means

Granulation tissue (granular tissue) is vascular, fibrous connective tissue formed during wound healing. On Pap smear, it appears as clusters of fibroblasts, capillaries, and inflammatory cells.

Common Causes

• Post-procedural healing: Cervical biopsy, LEEP, cone, cryotherapy, D&C.
• Trauma: Childbirth laceration, IUD insertion, vigorous intercourse.
• Inflammation/Infection: Cervicitis (chlamydia, gonorrhea, HSV, trichomonas), vaginitis.
• Hormonal: Pregnancy (cervical eversion/ectropion), atrophy (postmenopausal).
• Foreign body reaction: Retained suture, IUD strings.

Clinical Significance

• Usually benign, reflects healing or inflammation.
• Not dysplasia/cancer, but can obscure interpretation.
• May require repeat Pap in 3–6 months if inadequate sampling.
• Colposcopy if persistent, atypical cells, or high-risk HPV+.

Management

• Treat underlying infection (STI panel).
• Topical estrogen for atrophy.
• Reassurance if post-procedural and asymptomatic.

Granulation tissue on Pap is a common, usually benign finding reflecting cervical response to injury or inflammation.