Vaginal and Cervical PAP Smear

Collection Container

Frosted end, clean glass slide

Special Patient Preparation Requirements

1. The patient should not have applied any intravaginal douches or therapy during the 24 hours prior to the examination.
2. Materials needed:
   1. A clean glass slide labeled with the patient's name (patient's name should be written with a pencil).
   2. Ayre spatula.
   3. Cervical brush (or "broom") as necessary.
   4. Non-aerosol (pump) spray fixative.

Obtaining Specimen

• Place the patient in the lithotomy position.
  
• Insert the speculum without lubricants (just warm tap water).
  
• The posterior vaginal fornix (pool) and the ectocervix are typically sampled with a wooden tongue depressor or Ayre spatula. Insert the spatula into the cervix. Using the rounded end of the instrument, a scraping is obtained from the posterior vaginal fornix with the material kept on the instrument .
  
  Then a scraping with the second spatula is made from the ectocervix by rotating the spatula 360 degrees in an effort to obtain thorough sampling of the transformation zone. Again the material is kept on the instrument.
  
  Finally the endocervical sample is obtained using a commercially available endocervical brush. The latter is not necessarily utilized in the pregnant patient.
  
  All of the samples must then be swiftly transferred to a labeled slide.  Immediately fix the smear by spraying fixative held 10-12 inches away from the slide. This must be done as quickly as possible to avoid air drying, which will hinder the cytologic interpretation.
  
• "Broom": Another collection instrument for Pap smears is a plastic "broom-like" brush which simultaneously samples the endocervix and ectocervix.
  
  To use the broom, the long central bristles are inserted into the cervical os until the lateral bristles bend against the ectocervix. Rotate 3-5 times in clockwise and counter-clockwise directions. To transfer material, both sides of the "broom" are brushed across the glass slide.
  
  Use of a cotton-tip applicator is not recommended; it provides less cellular samples due to material being trapped in the fibers.

Fixation

As indicated above, immediately fix the smears by spraying with fixative, held 10-12 inches away from the slide. Any air-drying will hinder the cytologic interpretation.