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excellent communication and practical skills. This guide provides a step-by-step approach to performing cervical screening
in an OSCE setting, with an included video demonstration.
Gather equipment
Gather the appropriate equipment: Gloves, Lubricant, Speculum, A light source for the speculum, Endocervical brush,
Sample pot (liquid-based cytology), Paper towels
Introduction
Wash your hands and don PPE if appropriate.
Introduce yourself to the patient including your name and role.
Confirm the patient’s name and date of birth.
Explain what the procedure will involve using patient-friendly language: “Today I need to perform a cervical screening test.
The procedure will involve me inserting a small plastic device called a speculum into the vagina. This will allow me to
visualise the neck of the womb. I will then place a very small brush into the vagina and take a sample of cells from the neck
of the womb. It shouldn’t be painful, but it will feel a little uncomfortable. You can ask me to stop at any point. You may
experience some light vaginal bleeding after the procedure.”
Explain the need for a chaperone: “One of the female ward staff members will be present throughout the examination,
acting as a chaperone, would that be ok?”
Gain consent to proceed with the examination: “Do you understand everything I’ve said? Do you have any questions? Are
you happy for me to carry out the procedure?”
Ask the patient if they have any pain or if they think they may be pregnant before proceeding with the clinical examination.
Provide the patient with the opportunity to pass urine before the examination.
Explain to the patient that they’ll need to remove their underwear and lie on the clinical examination couch, covering
themselves with the sheet provided. Provide the patient with privacy to undress and check it is ok to re-enter the room
before doing so.
Inspection
Position
1. Don a pair of non-sterile gloves.
2. Position the patient in the modified lithotomy position: “Bring your heels towards your bottom and then let your knees
fall to the sides.”
Bartholin’s cyst
Bartholin’s glands are responsible for producing secretions which maintain vaginal moisture and are typically located at 4
and 8 o’clock in relation to the vaginal introitus. These glands can become blocked and/or infected, resulting in cyst
formation. Typical findings on clinical examination include a unilateral, fluctuant mass, which may or may not be tender.
Lichen sclerosus
Lichen sclerosus is a chronic inflammatory dermatological condition that can affect the anogenital region in women. It
presents with pruritis and clinical examination typically reveals white thickened patches. Destructive scarring and adhesions
develop causing distortion of the normal vaginal architecture (shrinking of the labia, narrowing of the introitus, obscuration
of the clitoris).
Cervical ectropion
Cervical ectropion is a condition in which the columnar epithelial cells which are normally located inside the cervical canal
are present on the outside of the vaginal cervix (normally the only cells on the outside of the vaginal cervix are squamous
epithelial cells). The areas of columnar epithelial cells appear red against the normal pink colour of the cervix and are often
located around the external os. They are more prone to bleeding, due to the presence of a network of delicate fine blood
vessels, and as a result, patients often present with post-coital bleeding.
Cervical cancer
Cervical cancer is caused by persistent infection with human papillomavirus (HPV). Prior to the development of cervical
cancer, the cells of the cervix can become dysplastic, a condition that is known as cervical intraepithelial neoplasia (CIN).
Cervical screening can identify patients infected with HPV who have CIN, allowing early treatment to prevent progression
to invasive cervical cancer. Many women do not have symptoms in the early stages of cervical cancer, but symptoms can
include vaginal bleeding (intermenstrual, post-coital), increased vaginal discharge and vaginal discomfort. Clinical
examination typically reveals white or red patches on the cervix in early disease or the presence of a cervical ulcer or
tumour in more advanced disease.
Example summary
“Today I examined Mrs Smith, a 28-year-old female. On general inspection, the patient appeared comfortable at rest. There
were no objects or medical equipment around the bed of relevance.“
“There were no abnormalities noted on inspection of the vulva and speculum examination revealed a healthy cervix with a
closed external os. I was able to obtain an adequate sample for cervical screening.”
“In summary, these findings are consistent with a normal speculum examination.”
“For completeness, I would like to perform the following further assessments and investigations.”