A cervical smear test involves scraping cells from the cervix and examining them under a microscope. The cervix is the entrance to the uterus from the vagina. A smear aims to collect cells from the transformation zone where changes may occur. It is best done mid-cycle for accuracy, not during pregnancy or immediately after giving birth. Screening is recommended annually for women 25-64 to check for any abnormal cell changes, though it does not diagnose cancer. Equipment used includes a speculum to hold the vagina open, wooden spatulas or brooms to scrape the cervix, and sometimes an endocervical brush.

1. Cervical uterine smear (pap
smear)

3. Definition
• The cervical smear is a test in which a specimen of cellular material is
scraped from the cervix. The specimen is then stained and examined
under a microscope by a cytologist to identify early cellular changes.

4. Anatomy and physiology
• The cervix is the narrow neck of the uterus and is located between
the vagina and the uterus. It projects into the vagina and the cavity of
the cervix is known as the cervical canal. The cervical canal’s glands
secrete a mucus that blocks the entry of sperm except in the midcycle
when a reduction in viscosity allows sperm to pass.

6. • The intention of a smear test is to collect squamous epithelial cells
and some endocervical cells from the transformation zone and
squamocolumnar junction of the cervix.
• The sampling technique must take into consideration that the
position of the squamocolumnar junction changes with age,
contraception and parity .

7. • The ideal time for obtaining a cervical smear is midcycle if the woman is
premenopausal; this prevents contamination from menstrual fl ow and
allows for accuracy of results . It
• Is not ideal to take a cervical smear if a woman is pregnant or immediately
post-partum as results obtained can be misleading. The WHO suggests that
if a woman is in the target age group and there are concerns about access
to screening postpartum, then a cervical smear should be taken following
childbirth after consent is obtained.
• Screening is recommended for all women between the ages of 25 and 64
years and is an investigation to confirm that the cervix is healthy and there
are no abnormal changes to the cells; it is not a test for diagnosing cervical
cancer .

8. Indications
• Women between the age of 25 and 64.

9. Contraindications
• During pregnancy. • Immediately post-partum

10. Equipment:
There are several devices which are used in sampling the uterine cervix

11. • Vaginal speculum: this is an instrument used during gynaecological
examination to facilitate the visualization of the vagina and cervix. The
speculum is introduced via the vagina and its cylinder with a rounded end
shape allows easy passage. Once in situ, the speculum is opened, holding
the vagina open and allowing the health professional to have access to the
cervix and perform the cervical smear. Most speculums are now made of
plastic and are single use, replacing those formerly made of metal,
requiring sterilization after use. There are two categories of speculum:
virgin and non-virgin. The latter is available in four sizes: small, medium,
large and long. Special attention should be paid when selecting a speculum
for use in women previously treated with pelvic radiotherapy or who are
postmenopausal .

12. • Wooden spatula (Aylesbury spatula): a wooden instrument used in
smear screening to obtain a cervical sample, i.e. to take a
representative cell sample from the cervix. It comes in diff erent
widths and should be chosen depending upon the condition of the os.
Wooden spatulas are very popular due to their easy and cost-eff
ective use.

13. Cervical broom:
• These are plastic broom-shaped tools with a pyramidal arrangement
of flexible fl at ‘teeth’. The longer ‘central’ tuft fi ts into the cervical os
and must be rotated clockwise through a full circle fi ve times. When
used to take a conventional smear, this brush is an adequate and eff
ective sampling device

14. • Endocervical brush: a plastic instrument used to sample the
endocervical canal which should never be used alone but always in
conjunction with the spatula. The endocervical brush should be used
after the spatula and its use is restricted to: – where there is difficulty
in inserting the spatula into the external os (if the os is narrow or
stenosed) – when the woman is being followed up for previous
borderline nuclear changes in endocervical cells – for follow-up in
previously treated endocervical glandular abnormality.
• The brush should be inserted into the cervical os with the lower
bristles remaining visible, and rotated between half and a whole turn
to reduce trauma.