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Cervical ( Pap) Smear

Info : All women who are registered with the GP are invited for cervical screening:
Aged : 25 to 49 – every 3 years.
Aged 50 to 64 – every 5 years
Over 65 – only women who have recently had abnormal cells.

Before proceeding rule out any contraindications like:

1. Pregnancy
2. Active menstruation
3. Active Vaginal bleeding
4. Recent Sexual intercourse
5. Recent use of spermicidal gel

Question:

You are FY2 doctor in the GP clinic.

43 year old lady is invited to the clinic for routine pap smear.
Her last smear was 3 years ago and findings / result was normal.
Take relevant history, assess the patient and do the necessary procedure.

Dr: Hello... I’m Dr......... one of the junior doctors in the GP clinic. How are you doing?
Pt: I’m fine doctor.
Dr: How may I call you? Pt: ..........
Dr: Okay Mrs..... how can I help you?
Pt: I got a letter from the clinic. They told me to book an appointment for cervical sampling.

Dr: I’m glad that you came here for the check-up. And of course, it’s a good practice to have
the pap smear examination in appropriate time intervals. Thanks for coming in. Pt: ...........
Dr: May I ask you a little bit about you before the procedure, if that’s okay with you?
Pt: sure doctor.!
Dr: Mrs....... can you please confirm your age for me? Pt: I’m 43 doctor
Dr: Alright! When was the last time you had the smear sampling?
Pt: It was 3 years ago. Doctor said that my smear was normal, and advised me to undergo
sampling every 3 years.
Dr: I’m glad to hear that the last smear was normal and yes! We do perform cervical smear
every 3 years even if the results are normal. The main purpose of this examination is to check
whether if there is any abnormal cells in the smear which can later develop into cancer. Are
you following me? yes

Dr: Mrs...... may I ask when was your last menstrual period ( C. I) ? Pt: it was 3 weeks ago
doctor!
Dr: Is your periods normal ? Yes.
Dr: Do you have any bleeding from the vagina in between your periods or during intercourse
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( symptoms of cervical cancer)? No

Dr: Alright. Do you have children?
Pt: Yes doctor I got two children. Elder one is 13 and the other one is 10.
Dr: So your last child birth was 10 years back .is that right? Pt: yes!
Dr: Were both of the deliveries were normal? Pt: yes.

Dr: Do you have any bleeding? Any discharge? From your front passage Pt: no doctor!
Dr: Dr: Are you using any contraceptives now? (ask about IUD) Pt: no
Dr: are you sexually active now? Do you practice safe sex? Pt: ......................
Dr: when was the recent sexual intercourse ( C.I) ? ....
Dr: Have used any spermicidal for contraception recently ( C. I) ? No
Dr: Okay Mrs.... was there any surgery or any instrumentation done to your tummy or your
front passage recently? Pt: no doctor.
Pt: do you have any medical conditions ? No
Dr: Are you on any medications now? no

Thank you Mrs........ now I would like to perform the smear sampling.
Could you please empty your urine bladder first and then please undress from below your
chest to mid thigh. I will have a chaperone with me and will provide you adequate privacy.
Pt: okay doctor

SMEAR SAMPLING
COMMENT ON THE POSITION (MODIFIED LITHOTOMY):
Position the patient correctly: she should be lying on her back, heels drawn up towards her
bottom and knees gently relaxing open.

CHECK FOR THE EQUIPMENTS IN THE TRAY. PROCEED TO THE MANNEQUIN.

Check the trolley for:

1. Pair of gloves
2. Cusco’s speculum
3. Cervical brush
4. Sure Path
5. Few wipes
6. Lubricating Jelly
7. Clinical waste bin
8. Good source light

Wear Gloves
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Perform a quick inspection of the abdomen and genital area and comment on the findings.
Abdomen is normal, no distension, no scars, no visible pulsations, no dilated veins, no
visible peristalsis.
No vaginal bleeding, discharge, no obvious masses or visible swellings in the groin. Hair
patterns looks normal.

Tell the patient about the procedure before we begin.

1. Warm the speculum and add lubricating jelly to it.
2. Warn the patient that before introducing the speculum – part the labia and insert the
speculum closed position ( blades vertical), rotate ( blades horizontal) and open the
blades and when you visualize the cervix retain the speculum and fix it.
3. Insert the brush deep enough to allow full contact with the cervix
4. Verbalise: “I can see the cervix, the os is closed and there is no cervical erosion, no
bleeding, discharge or any growth
5. Push gently the brush and rotate 5 times in a clock wise direction
6. Gently remove the brush and dip it 10 times in the Thin Prep Bottle, and then shake it
well.
7. Inspect for any remaining cells then discard the brush in the clinical waste bin.

8. Tighten the cap of the bottle and send it to the lab after recording patient’s details on
it.
9. If the bottle is sure path, drop the brush in the container.

warn the patient that “ I am going to remove the speculum”: release the screw, unlock the
blades, and remove it little outside (to make the cervix free), de-rotate the speculum.

look for any bleeding or any discharge, and then send it for sterilization.( DOSPOSABLE
SPECULUM- DISCARD, METTALIC speculum - SEND FOR STERILISATION)
Thank the patient. Give wipes for cleaning and ask her to dress up.
Dr: Once again, I would like to appreciate for coming in today. My seniors will get in touch
with you soon after we get the result.
Pt: thank you doctor

The results of your screening test will be sent to you in the post in about 2 to 3 weeks
time, with a copy sent to your GP.
Any concerns ? No Thank you.
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Talk about the below only if the patient ask any thing :
The types of screening result you may get depends on how your screening sample was tested.
The first test carried out on the cell sample is either:
 to look for abnormal cells (cytology) or
 to test for human papilloma virus (HPV) – this is called HPV primary screening
Test results for abnormal cells
If the first test carried out on your sample is to look for abnormal cells (cytology), you should
receive one of the following results.
Normal
A normal test result means no abnormal cell changes have been found. No action is needed
and you don't need another cervical screening test until it's routinely due.
Inadequate
You may be told you need to have a repeat test because the first one couldn't be read
properly.
This may be because:
 not enough cells were collected
 the cells couldn't be seen clearly enough
 an infection was present
You'll be asked to go back so another sample of cells can be taken, usually after about 3
months.

Abnormal :
If you have abnormal results, you may be told you have:
 borderline or low-grade changes (dyskaryosis)
 moderate or severe (high-grade) dyskaryosis
If your result is low-grade, it means that although there are some abnormal cell changes,
they're very close to being normal and may disappear without treatment.
In this case, your sample will be tested for HPV. If HPV isn't found, you're at very low risk of
developing cervical cancer before your next screening test.
You'll be invited back for routine screening in 3 to 5 years (depending on your age).
If HPV is found, you'll be offered an examination called colposcopy, which looks at the
cervix more closely.
If your result is high-grade dyskaryosis, your sample won't be tested for HPV, but you'll be
offered colposcopy to check the changes in your cervical cells.
All these results show you have abnormal cell changes. This doesn't mean you have cancer or
will get cancer.
It just means that some of your cells are abnormal, and if they're not treated they may develop
into cervical cancer.
A colposcopy is a simpke procedure used to look at cervix, the lower part of the wombat the
top of the vagina. It is often done if cervical screening finds abnormal cells in your cervix.