Pap Smear Technique

Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 1

Pap Smear Technique

Positioning

• Privacy• Buttocks just off table• Good Lighting• Drape• Standby

Padded Stirrups

• Soft, padded stirrups• Oven mitts• Socks• Battle dressings

Inspect

• Spread labia• Discharge• Ulcers• Growths

Anatomy

Vaginal Speculum

Warm Speculum• Warm water• Not too hot• Lubricates speculum• Don’t use K-Y,

Surgilube or Vaseline to lubricate speculum

Insert Speculum• Spread labia• Keep labia apart• Blades remain closed

until fully inserted

Squamo-Columnar Junction• Junction of pink cervical skin

and red endocervical canal• Inherently unstable • Key portion of the cervix to

sample• Most likely site of dysplasia

Ayers Spatula• Concave end to fit the

cervix• Convex end for vaginal

wall and vaginal pool scrapings

Sample Cervix• Use concave end • Rotate 360 degrees• Don’t use too much force

(bleeding, pain)• Don’t use too little force

(inadequate sample)

Cytobrush• Insert ~ 2 cm (until brush

is fully inside canal)• Rotate only 180 degrees

(otherwise will cause bleeding)

Make Pap Smear• As thin as possible• Properly labeled

Spray with Fixative• Within 10-15 seconds• Allow to fully dry

before packaging• Cytologic Fixative

(hairspray works acceptably also)

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