Management of patients whose Papanicolaou smears show atypical squamous cells of undetermined significance (ASCUS) is a complex challenge for the family physician. It is critical that patients with the ASCUS smear be properly evaluated and triaged, as the ASCUS smear may be a manifestation of high-grade disease in 20% or more of cases. Several options for triage exist. Colposcopy is considered by many the option of choice. However, alternative options include cervicography, speculoscopy, and human papillomavirus subtyping. For proper management of the patient with the ASCUS smear, the clinician must consider the patient's Pap test history, risk factors for cervical cancer, and the cytopathologist's interpretation/recommendation.