Pap Smears

Performing a Pap Smear, Step-by-step guide:

1. Have an organized way of setting up (ie. The number of gloves you will need, the

tools by your side, proper draping)

2. Select appropriately sized speculum, lubricate with warm water

3. You may insert one or two fingers to push down on the vaginal wall before

introducing the speculum, or insert the speculum sideways, turning it flat once you

have entered the introitus

4. Insert the closed speculum at an angle pointing downward (toward the patient’s

sacrum), making sure to exert downward pressure on the vaginal floor, rather than

tilting the speculum (which might press up on the urethra causing pain)

5. Keep the speculum closed (with your index finger on the top bill) while inserting it as

far as it will go

6. Open the speculum and the cervix should fall into place. If it does not, gently rotate

and adjust the speculum angle until the cervix is visualized between the bills

7. Once the speculum is in place around the cervix, tighten (with screw or clicks); you

should be able to let go of it without it moving

8. Inspect cervix and os for color, position, ulcerations, nodules, masses, bleeding,

discharge, etc.

9. If there is visible discharge, wipe it with a clean cotton swab.

10. Obtain specimen using a and b or c alone:

a. Cervical Scrape

--place the longer end of the scraper in the os, press and scrape in a full

circle, being sure to include the transformation zone and

squamocolumnar junction; stir the scraper into the thin-prep jar

b. Endocervical Brush

--place the brush into the os, roll it between your fingers clockwise and

counterclockwise, stir it into the thin-prep jar

c. Cervical Broom

--rotate the tip of the brush in the os, in a full clockwise direction, stir

into thin-prep jar

11. Pull the speculum out until you have cleared the cervix WITHOUT closing it (closing

it on the cervix will hurt); once you have cleared it, close the speculum as you pull it

out, being sure that it is not still open as you reach this introitus as this will push up

on the urethra, causing pain

Tips:

• With a retroverted uterus, the cervix will point more anteriorly than usual

• Avoid pap smears during menses

• Avoid tampons and intercourse for 48 hours prior

• If testing for gonorrhea/Chlamydia, get these samples BEFORE pap to avoid contaminating sample with blood that might be caused by the pap

• In pregnant women, place the brush only 50% of the way into the os

References:

Bickley, Lynn S. (2003). Bates’ Guide to Physical Examination and History Taking. 8^th

Ed. Philadephia: Lippincott Williams & Wilkins.

FamilyPracticeNotebook.com

Category: Gynecology Notes