How to Perform a Pap Smear in Detail

A Pap smear, also called a Papanicolaou test, is a screening procedure for cervical cancer. It involves collecting cells from the cervix and examining them under a microscope for abnormalities.

Step-by-Step Guide to Performing a Pap Smear

1. Preparation

• Ensure patient comfort and privacy:

  • Explain the procedure and obtain informed consent.

  • Ask the patient to empty their bladder to reduce discomfort.

  • Position the patient in the lithotomy position (lying on their back with feet in stirrups).

• Required equipment:

  • Sterile gloves

  • Speculum (correct size)

  • Lubricant (water-based)

  • Cervical cytobrush and spatula or broom device

  • Slide and fixative (if conventional smear)

  • Liquid-based cytology vial (if using ThinPrep or SurePath)

  • Labeling materials and request form

  • Light source
    

2. Inspection of the External Genitalia

• Inspect for lesions, discharge, ulcerations, or signs of infection.

• If abnormalities are present, document findings before proceeding.
  

3. Insertion of the Speculum

• Warm the speculum if necessary.

• Apply a small amount of water-based lubricant to the speculum.

• Gently insert the speculum at a 45-degree angle, directing it posteriorly to avoid urethral trauma.

• Once inserted, open the speculum slowly until the cervix is clearly visible.

• Adjust the light source for better visualization.
  

4. Collection of the Cervical Cells

• Identify the transformation zone (area where squamous and columnar cells meet).

• Use the correct collection device:

  • Spatula: Rotate 360° around the ectocervix (outer part of the cervix).

  • Endocervical brush: Insert into the endocervical canal and rotate 180°.

  • Broom device (for liquid-based cytology): Rotate 5 times in one direction.
    

5. Transferring the Sample

• Conventional Smear (Glass Slide Method):

  • Spread the collected cells evenly on a glass slide.

  • Immediately fix the slide with a cytology fixative spray to prevent air drying.

• Liquid-Based Cytology (ThinPrep or SurePath)

  • Rinse the collection device into a vial containing liquid preservative.

  • Ensure the brush or spatula is thoroughly agitated in the vial.
    

6. Speculum Removal and Completion

• Gently remove the speculum while inspecting for any abnormal vaginal or cervical findings.

• Allow the patient to dress and discuss any findings.

• Label and send the sample to the lab with a properly filled request form.

• Advise on follow-up, typically within 1-3 weeks depending on lab processing.
  

  
  

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What Solution to Use for Fixation?

• If using a conventional smear, the slide should be fixed immediately using:

  • 95% ethanol solution or

  • Commercial cytology fixative spray

• If using liquid-based cytology, the sample should be placed in a preservative solution like:

  • ThinPrep (PreservCyt)

  • SurePath (BD Preservative Fluid)
    

Key Notes

• Avoid collecting during menstruation.

• Do not use too much lubricant, as it may interfere with cytology results.

• Patients should avoid douching, intercourse, or using vaginal medications for 24–48 hours before the test.