Aim: This study aimed to analyze the patterns of cervical Pap smear cytology among women attending a tertiary care hospital and evaluate the associations between cytological findings and demographic, clinical, and behavioral factors.

Material and Methods: The study included 120 women attending the gynecology outpatient department for routine cervical cancer screening or presenting with symptoms such as vaginal discharge, postcoital bleeding, pelvic pain, or menstrual irregularities. Demographic and clinical data, including age, parity, contraceptive use, and smoking, were collected using a pre-structured proforma. Cervical smears were obtained and evaluated using the Papanicolaou staining technique, and findings were categorized according to the 2014 Bethesda System.

Results: The majority of participants (37.50%) were aged 30–39 years, followed by 40–49 years (25.00%). A significant relationship was observed between cytological patterns and age (p = 0.045). Half of the participants (50.00%) had 1–2 children, while 25.00% were nulliparous and 25.00% had parity ≥3, with parity significantly associated with abnormal findings (p = 0.032). Vaginal discharge (41.67%) was the most common clinical presentation, followed by asymptomatic cases (33.33%), with symptoms significantly influencing cytological outcomes (p = 0.021). NILM was the most prevalent finding (66.67%), followed by LSIL (12.50%), ASC-US (8.33%) and HSIL (8.33%). Cytological abnormalities were significantly associated with smoking, contraceptive use, and higher parity (p < 0.05). Infections such as bacterial vaginosis (12.50%) and HPV-related changes (8.33%) were also identified.

Conclusion: Pap smear cytology effectively identified cervical abnormalities and infections, with significant associations observed between cytological patterns and demographic and clinical factors. These findings emphasize the importance of comprehensive screening programs to improve early detection and reduce the burden of cervical cancer, particularly in resource-constrained settings.