Gynecological examination: concept, importance and method

Cervicovaginal cytology is mainly used to detect changes in the cells of the cervix. The Pap test (also known as cervical cytopathology, Pap test, cytopathology) is a gynecological exam and it is a simple and relatively economical method that provides valuable clinical information about women throughout much of their life.

A small sample of cells is collected from the surface of the cervix. Then the sample is spread on a glass slide and sent to a laboratory for analysis. The cells are examined for abnormalities that may point to vaginal or uterine infections and also cervical cancer.

PAP SMEAR HISTORY

In 1924, George Papanicolau , a researcher interested in the endocrinology of the menstrual cycle, observed that neoplastic cells derived from the cervix could be seen in a vaginal smear. In 1941, he published the first results of detection of neoplastic cells in vaginal smears in a group of patients with malignant tumors of the cervix and endometrium, some of which were without clinical suspicion. In 1947, a Canadian gynecologist, J. Ernest Ayre, documented that a sample taken directly from the cervix with a wooden spatula on a gynecological examination was more efficient and easier to examine than a vaginal smear. Shortly after the introduction of the test, it is observed that the neoplastic changes confined to the epithelium could be identified in the cytological samples.

Based on the assumption that the treatment of these pre-cancerous lesions could prevent the development of invasive cancer, the gynecological exam for Pap smear was considered the fundamental tool in the detection and prevention of cervical cancer.

What problems are identified by the Pap smear?

This test is done to identify changes in the cells of the cervix. Finding these changes and treating them will greatly reduce the chances of developing cervical cancer. It is worth mentioning that the test is not done to detect cervical cancer, but to detect precancerous lesions. When abnormal cells are identified, the doctor can take steps to discover the cause of these changes and treat the disease before it develops into cancer.

Is there any preparation before the Gynecological Exam ?

Some guidelines must be followed so that there is no interference in the result:

  • Do not use showers or vaginal medications for 48 hours before collection;
  • Avoid sexual intercourse for 48 hours before collection;
  • Do not do the test in the menstrual period – the presence of blood can impair the cytological diagnosis. Wait for the 5th day after the end.

How should the gynecological exam be performed for the Pap test?

The cervical-vaginal cytology exam consists of several steps, including the collection of the cytological sample, the fixation of the biological material, the identification of the material and the referral to the laboratory for technical processing, microscopic evaluation, diagnostic conclusion and issuing of the report .

Materials required for collection:

  • Ayres spatula;
  • Cervical brush;
  • Vaginal speculum;
  • Glass slides;
  • Cell fixative (spray or 95% alcohol);
  • Suitable container for transporting the blades.

In the first stage of the gynecological examination, the speculum should be placed to the bottom of the vaginal cavity. Once inserted and opened, the cervix is ​​identified, folding and vaginal mucosa, secretions and other changes that may occur are evaluated.

Shave the side wall of the vagina in its upper third with the rounded part of the Ayre spatula. The collected material must be spread over the entire length of the glass slide evenly and immediately fixed.

For collection in the ectocervix, fit the longest tip of the Ayre spatula into the external orifice of the neck, supporting it firmly, scraping the ectocervical mucosa in a 360 ° rotational movement.

For endocervical collection, insert the cervical brush into the cervical orifice and collect the material, gently rotating it 360 °. Perform cell fixation immediately after the smear is made.

Store the slide in a suitable transport container identified with the patient’s full name and date of collection.

Reference: Lopes, CONSOLARO, Márcia Edilaine, and MARIA-ENGLER, Silvya Stuchi (orgs.). Clinical Cervico-Vaginal Cytology – Text and Atlas. Roca, 2012.

Representative scheme of cervical-vaginal collection.

  • APositioning the elongated arm of the Ayre spatula in the external orifice of the neck and 360 ° rotation.
  • BIntroduction of the brush in the endocervical canal and 360 ° rotation.
  • CScraping the bottom of the bag with the rounded end of the Ayre spatula.
  • DScraping the upper third of the lateral wall of the vagina with the rounded end of the Ayre spatula.

Sample collection

The collection in the gynecological exam, although simple, must be systematized, as it directly influences the effectiveness of tracking cellular changes.

Processing and tracking

After collecting the cervical-vaginal sample, the processing steps that occur within the cytology laboratory can be didactically divided into three phases: pre-analytical , analytical and post-analytical.

Pre-Analytical Phase

It includes the steps for receiving the material, checking the sample identifications, registration and technical processing. Any non-conformity in the data will result in errors that will make it difficult or impossible for the next steps.

Analytical Phase

It consists of microscopy for reading the slide, interpretation of cytological pictures, discussion, case review and diagnosis.

Post-Analytical Phase

Characterized by actions performed after the interpretation of the slide, typing the report, checking and referring patients or offices. The legal requirement for archiving slides is 5 years for negative exams, being undetermined for positive and suspicious exams.

 

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