BACKGROUND: Cervical intraepithelial neoplasia and cervical cancer remain chief health complications for women globally. Cervical cytology by Papanicolaou (Pap)-stained smears is an effective means of screening for cervical premalignant and malignant situations. This study was designed to determine and assess the prevalence and characteristics of abnormal Pap smears in this region of Sikkim, India. MATERIALS AND METHODS: This retrospective study was conducted in the Departments of Pathology at Multi-Specialty Hospital in Gangtok, Sikkim. All Pap smears screened during 2018 and 2020 were included in this study. Approximately 1256 Pap smears were reported based on Bethesda III System (2001). All abnormal smears patients' data were collected and evaluated accordingly. RESULTS: Most of the patients screened during the 2 years belonged to the ethnic group of Bhutias (15.45%), followed by Rai (12.90%), and the majority were aged 31–40 years (43.78%). Epithelial abnormalities categorized as atypical squamous cells of undetermined significance, atypical squamous cells-high-grade lesions, low grade squamous intraepithelial lesion, and high grade squamous intraepithelial lesion were found in 18.07%, 15.04%, 7.25%, and 4.77% of the women, respectively. The majority of the women with abnormal Pap smear were associated with inflammatory response, with moderate inflammation (33.07%), followed by severe (30.75%) and mild (24.36%) inflammation. The most common pattern was inflammatory which includes neutrophilic infiltration and reactive cellular changes with 66.6% of the case having irregular uterine bleeding (P = 0.002) followed by abnormal vaginal discharge (P = 0.3) and lower abdominal pain (P = 0.005). CONCLUSION: Prevalence of abnormal Pap smears in Sikkim, India is relatively low compared with other states of India. In contrast, the prevalence of progressive glandular anomalies with inflammation was observed to be high.