Per Speculum Examination

You are SHO on the Obstetrics and Gynaecology department and sitting chatting on the nursing station with your nurse colleagues. There you meet a very enthusiastic medical student Mr David who want to learn Per Speculum Examination. Please teach him Per Speculum examination.
You assume that you are wearing head lamp and you are gloved.

Cervical Screening and Per Speculum Examination

Cervical screening is a preventive health measure that involves testing for abnormal cervical cells in women. It is also known as a Pap smear or Pap test. The purpose of cervical screening is to detect changes in the cells of the cervix that may lead to cervical cancer or a precancerous condition.

During a cervical screening, a healthcare provider collects a sample of cells from the cervix using a small brush or spatula. The sample is then sent to a laboratory for analysis to determine if there are any abnormal cells present. If abnormal cells are detected, further testing or treatment may be needed to prevent the development of cervical cancer.

Cervical screening is important because cervical cancer is a preventable disease. If detected early, cervical cancer is highly treatable, with a 5-year survival rate of up to 92%. However, if left untreated, cervical cancer can spread to other parts of the body and become more difficult to treat.

Cervical screening is recommended for most women between the ages of 21 and 65, or as recommended by their healthcare provider. The frequency of screening may depend on the woman's age, medical history, and other factors. Women who have had a hysterectomy, which means their cervix has been removed, may not need to undergo cervical screening.

Overall, cervical screening is an important preventive health measure that can help detect and prevent cervical cancer. Women should discuss with their healthcare provider when to begin cervical screening and how often they should be screened.

Note the steps involved in a per speculum examination and how to collect a pap smear.

Step 1: Preparing the patient. Before starting the examination, it's important to explain the procedure to the patient and ensure that they are comfortable and in a position that allows access to the genitals. Ask them to empty their bladder to reduce discomfort during the exam.

Step 2: Positioning the patient. Ask the patient to lie down on the examination table with their feet placed in stirrups. The buttocks should be at the edge of the table, allowing easy access to the genitals. Provide a sheet or blanket for the patient to cover their torso and provide some privacy.

Step 3: Inspection of the external genitalia. Start by inspecting the external genitalia for any abnormalities such as swelling, lesions, or discharge. Use a gloved hand to separate the labia and inspect the clitoris, labia minora, and vaginal opening.

Step 4: Insertion of the speculum. Apply a water-soluble lubricant to the tip of the speculum to ease insertion. With one hand, gently spread the labia apart, and using the other hand, insert the closed speculum into the vaginal opening. Angle the speculum downwards towards the patient's sacrum and then rotate the instrument horizontally to open the blades.

Step 5: Visualization of the cervix. Use the speculum to visualize the cervix. Check for any abnormalities such as lesions, ulcers, or growths. Use a swab or brush to collect cells from the cervix for a Pap smear if necessary.

Step 6: Collection of a Pap smear. Use a spatula or brush to collect cells from the cervix. Gently scrape the cells from the transformation zone of the cervix, which is where the squamous cells meet the columnar cells. Transfer the collected cells to a glass slide or a liquid-based cytology collection medium.

Step 7: Removal of the speculum. Once the Pap smear has been collected, remove the speculum gently by reversing the insertion steps. Close the blades and rotate the instrument towards the pubic bone before removing it from the vaginal opening.

Step 8: End of the examination. Dispose of any used instruments and gloves in a proper manner. Ensure the patient is comfortable and has had any questions answered before ending the examination.

It's important to note that the specific steps involved in a per speculum examination and Pap smear collection may vary depending on the individual patient and the physician's preferences.

Techniques to collect pap smear

There are two main techniques for collecting a Pap smear: the conventional Pap smear and the liquid-based Pap smear.

1. Conventional Pap smear: In this technique, a healthcare provider uses a spatula and a small brush to collect cells from the cervix. The spatula is used to scrape the surface of the cervix, while the brush is used to collect cells from the endocervical canal. The collected cells are then transferred onto a glass slide and sent to a laboratory for analysis.
2. Liquid-based Pap smear: In this technique, a healthcare provider uses a small brush to collect cells from the cervix. The brush is inserted into the endocervical canal, rotated a few times, and then withdrawn. The collected cells are then rinsed in a liquid-based medium that preserves them and removes mucus and blood. The preserved cells are then sent to a laboratory for analysis.

The liquid-based Pap smear has several advantages over the conventional Pap smear. It produces clearer and more uniform cell samples, which reduces the likelihood of false negative results. It also allows for additional tests to be performed on the same sample, such as testing for the human papillomavirus (HPV). However, it can be more expensive than the conventional Pap smear and may not be widely available in all healthcare settings.

Both techniques are effective in detecting abnormal cervical cells, which may indicate the presence of cervical cancer or a precancerous condition. Women should discuss with their healthcare provider which technique is best for them based on their medical history and individual circumstances.

What is the difference between thin pre and sure path technique?

ThinPrep and SurePath are two different types of liquid-based cytology techniques used to collect and prepare cervical samples for Pap smear testing. The main differences between the two techniques are in the way the samples are collected, the type of preservative used, and the method of sample preparation.

1. Collection method: The collection method for both techniques is similar. A healthcare provider uses a small brush to collect cells from the cervix. However, in the ThinPrep technique, the brush is placed in a vial containing a liquid preservative solution. In the SurePath technique, the brush is rinsed in a vial containing a liquid preservative solution.
2. Preservative: The preservative solutions used in the two techniques are different. The ThinPrep technique uses a preservative solution that contains ethanol and methanol, which helps to fix and preserve the cells. The SurePath technique uses a proprietary preservative solution that contains a surfactant to remove mucus and other debris from the sample.
3. Sample preparation: The preparation of the cervical sample is different between the two techniques. In the ThinPrep technique, the sample is filtered to remove mucus and other debris, and the remaining cells are placed onto a glass slide for examination. In the SurePath technique, the sample is spread onto a thin, single-layer slide using a proprietary process. The slide is then stained and examined under a microscope.

Overall, the main differences between ThinPrep and SurePath techniques are in the type of preservative used and the method of sample preparation. Both techniques are effective in detecting abnormal cervical cells and have similar sensitivity and specificity rates. The choice of technique may depend on factors such as cost, availability, and the preferences of the healthcare provider and patient.