11/13/24, 6\:58 PM Guide | Cervical screening

Cervical screening

Table of contents
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Gather equipment

Gather the appropriate equipment\:
Gloves
Speculum
A light source
Endocervical brush
Sample pot (liquid-based cytology)
Paper towels
Lubricant*
* U s e o f l u b r i c a n t s h o u l d b e a v o i d e d w h e n t a k i n g a c e r v i c a l s m e a r s a m p l e d u e t o t h e r i s k o f c o n t a m i n a t i o n . H o w e v e r , i f l u b r i c a n t
i s r e q u i r e d , o n l y a c a r b o m e r-f r e e p r o d u c t t h a t i s r e c o m m e n d e d b y t h e m a n u f a c t u r e r o f t h e c e r v i c a l s c r e e n i n g k i t s h o u l d b e
u s e d ( e .g . O p t i L u b e Z e r o a .k .a . C e r v i L u b e f o r H o l o gi c T h i n P r e p ) .
1 0
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Gather equipment

Introduction

Wash your hands and don PPE if appropriate.
Introduce yourself to the patient including your name and role.
Con
Explain what the procedure will involve using patient-friendly language\: " T o d a y I n e e d t o p e r f o r m a c e r v i c a l s c r e e n i n g t e s t .
T h i s l o o k s f o r t h e p r e s e n c e o f a v i r u s c a l l e d H P V ( h u m a n p a p i l l o m a v i r u s ) . I f H P V i s f o u n d , t h e l a b w i l l p e r f o r m a n o t h e r t e s t o n
t h e s a m p l e ( c y t o l o g y ) t o l o o k f o r a n y a b n o r m a l c e l l s c a u s e d b y t h e v i r u s . I f a b n o r m a l c e l l s a r e s e e n , y o u m a y n e e d f u r t h e r
i n v e s t i g a t i o n s .
T h e p r o c e d u r e w i l l i n v o l v e m e i n s e r t i n g a s m a l l p l a s t i c d e v i c e c a l l e d a s p e c u l u m i n t o t h e v a gi n a . T h i s w i l l a l l o w m e t o v i s u a l i s e
t h e n e c k o f t h e w o m b ( y o u r c e r v i x ) . I w i l l t h e n p l a c e a v e r y s m a l l b r u s h i n t o t h e v a gi n a a n d t a k e a s a m p l e o f c e l l s f r o m t h e n e c k
o f t h e w o m b . I t s h o u l d n’ t b e p a i n f u l , b u t i t w i l l f e e l a l i t t l e u n c o m f o r t a b l e . Y o u c a n a s k m e t o s t o p a t a n y p o i n t . Y o u m a y
e x p e r i e n c e s o m e l i g h t v a g i n a l b l e e d i n g a f t e r t h e p r o c e d u r e .
"
Explain the need for a chaperone\:
a s a c h a p e r o n e , w o u l d t h a t b e o k ?”
“ O n e o f t h e f e m a l e w a r d s t a
Gain consent to proceed with the examination\:
h a p p y f o r m e t o c a r r y o u t t h e p r o c e d u r e ?"
" D o y o u u n d e r s t a n d e v e r y t h i n g I' v e s a i d ? D o y o u h a v e a n y q u e s t i o n s ? A r e y o u
Ask the patient if they have any pain or if they think they may be pregnant before proceeding with the clinical examination.
Establish their last menstrual period (cervical screening is not recommended during menstruation).
Provide the patient with the opportunity to pass urine before the examination.
Explain to the patient that they'll need to remove their underwear and lie on the clinical examination couch, covering
themselves with the sheet provided.
Provide the patient with privacy to undress and check whether it is okay to re-enter the room before doing so.
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Preparation

1. Wash your hands
2. Open the speculum packaging whilst avoiding touching the speculum or the inner surface of the packaging
3. Open the lubricant (if being used) onto the inner surface of the speculum packaging
Wash your hands

Position the patient

1. Re-check consent and that the patient is happy to proceed with the procedure\:
g e n i t a l s . A r e y o u h a p p y f o r m e t o d o t h i s ?”
“ I’ m g o i n g t o m o v e o n a n d e x a m i n e y o u r
2. Position the patient in the modi
t h e b e d , a n d t h e n l e t y o u r l e g s f a l l o p e n”
“ D r a w y o u r a n k l e s u p t o w a r d s y o u r b u t t o c k s , k e e p y o u r f e e t
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Position the patient in the modi

Vulval inspection

It is good practice to inspect the vulva for any abnormalities
1. Don a pair of non-sterile gloves and an apron
2. Expose the patient’s external genitalia and ensure there is adequate lighting
Don apron and gloves

Inspect the vulva

Inspect the vulva for abnormalities\:
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Ulcers\: typically associated with genital herpes
Abnormal vaginal discharge\: causes include candidiasis, bacterial vaginosis, chlamydia and gonorrhoea
Scarring\: may relate to previous surgery (e.g. episiotomy) or lichen sclerosus (scarring with associated abnormal
architecture)
Vulvovaginal atrophy\: most commonly occurs in postmenopausal women
White lesions (leukoplakia)\: may be patchy or in a
lichen sclerosus
Other lesions\: causes include folliculitis, molluscum, genital warts and vulval malignancy
Masses\: causes include Bartholin’s cyst and vulval malignancy
Varicosities\: varicose veins secondary to chronic venous disease or obstruction in the pelvis (e.g. pelvic malignancy)
Female genital mutilation\: total or partial removal of the clitoris and/or labia and/or narrowing of the vaginal introitus
Inspect the vulva and perineum
Female genital mutilation
The WHO de
f e m a l e g e n i t a l i a , o r o t h e r i n j u r y t o t h e f e m a l e ge n i t a l o r g a n s f o r n o n-m e d i c a l r e a s o n s”
5
.
Over 200 million girls and women worldwide have undergone FGM. 5
Women attending maternity, family planning,
gynaecology, and urology clinics (among others) should be asked routinely about the practice of FGM. 6
In the UK,
healthcare professionals must report cases of FGM in girls under the age of 18 to the police.
7
Bartholin's cyst
Bartholin's glands are responsible for producing secretions which maintain vaginal moisture and are typically located at
4 and 8 o'clock in relation to the vaginal introitus. These glands can become blocked and/or infected, resulting in cyst
formation. Typical
Lichen sclerosus
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Lichen sclerosus is a chronic in
presents with pruritis and clinical examination typically reveals white thickened patches. Destructive scarring and
adhesions develop causing distortion of the normal vaginal architecture (shrinking of the labia, narrowing of the introitus,
obscuration of the clitoris).
Abnormal vaginal discharge
There are several causes of abnormal vaginal discharge including\:
Bacterial vaginosis\: a thin, profuse
Candidiasis\: a curd-like, non-o
Chlamydia and gonorrhoea (symptomatic)\: a purulent vaginal discharge with or without associated in
Trichomoniasis\: an o

Inserting the speculum

Warn the patient that you are going to insert the speculum and ask if it is still okay for you to do so.
If the patient consents to continuing the procedure, prepare to insert the speculum. If using an approved lubricant (see
equipment section for details), apply a small amount of product over the exterior sides of the speculum only, taking care to
avoid the tip. This is to avoid contaminating and invalidating the sample.
Then, proceed to insert the speculum\:
1. Carefully separate the labia using the thumb and index
2. With the blades closed, gently insert the speculum. Usually, the speculum is inserted with the handle pointing sideways (at 9
or 3 o’clock)
3. Once inserted, rotate the speculum so that the handle is facing upwards
4. Open the speculum blades until an optimal view of the cervix is achieved
5. Tighten the locking nut to
Lubricate the speculum
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Inspection of the cervix and vaginal walls

Inspect the cervix for\:
The cervical os\: if open and the patient is pregnant, this may indicate an inevitable or incomplete miscarriage
Erosions around the os\: most commonly associated with ectropion; however, early cervical cancer can have similar
appearances
Cervical masses\: typically associated with cervical malignancy
Scarring\: from a previous colposcopy procedure (e.g. LLETZ)
Inspect the cervix and vagina for\:
Ulceration\: most commonly associated with genital herpes
Atrophy\: in post-menopausal patients
Foreign body\: for example, a retained tampon or condom
Abnormal discharge\: several possible causes, including bacterial vaginosis, vaginal candidiasis, trichomonas, chlamydia and
gonorrhoea
Inspect the cervix
Cervical ectropion
Cervical ectropion is a condition in which columnar epithelial cells (usually only located inside the cervical canal) are
present on the outside of the vaginal cervix. Normally, the only cells on the outside of the vaginal cervix are squamous
epithelial cells.
The areas of columnar epithelial cells appear red against the normal pink colour of the cervix and are often located
around the external os. They are more prone to bleeding due to the presence of a network of delicate
vessels, and patients often present with post-coital bleeding.
Cervical cancer
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Cervical cancer is caused by persistent infection with human papillomavirus (HPV). Before the development of cervical
cancer, the cells of the cervix can become dysplastic, a condition that is known as cervical intraepithelial neoplasia
(CIN).
Cervical screening can identify patients infected with HPV and those who have gone on to develop CIN, allowing early
treatment to prevent progression to invasive cervical cancer. Many women do not have symptoms in the early stages of
cervical cancer, but symptoms can include vaginal bleeding (intermenstrual, post-coital), increased vaginal discharge
and vaginal discomfort. Clinical examination typically reveals white or red patches on the cervix in early disease or a
cervical ulcer or tumour in more advanced disease.

Cervical screening sample

1. Insert the endocervical brush through the speculum into the endocervical canal, avoiding touching the sides of the
speculum with the brush
2. Rotate the brush 360 degrees, in a clockwise direction, 5 times
3. Remove the endocervical brush, avoiding touching the speculum as you do so
4. Immediately transfer the sample to the liquid-based cytology container (follow local cytology guidelines for transferring the
sample from the brush into the container)
5. Label the sample
Transferring the sample into the cytology container
It is important to follow local guidelines for transferring the cervical screening sample into the cytology container.
Methods may include\:
the entire brush
Sweeping the brush against the sides and the base of the container (the 'mash and bash' technique), then discarding
Breaking o
Gently insert the endocervical brush into the external os
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Removing the speculum

1. With your non-dominant hand, hold the blades of the speculum whilst you loosen the locking nut with your dominant hand.
This ensures the blades do not snap shut when the locking nut is loosened.
2. Gently remove the speculum whilst slowly closing the blades and inspecting the walls of the vagina
3. Cover the patient with the sheet, explain that the procedure is now complete and provide the patient with privacy so they
can get dressed. Provide paper towels for the patient to clean themselves.
4. Dispose of the used equipment into a clinical waste bin
Loosen the locking nut

To complete the procedure...

Thank the patient for their time.
Dispose of PPE appropriately and wash your hands.
Complete the cytology request form.
Discuss the results process with the patient, including the average wait time for results and how the results will be
communicated.
Document the procedure in the medical notes, including the details of the chaperone.
Summarise your
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Complete the cytology request form
Example summary
" T o d a y I p e r f o r m e d a r o u t i n e c e r v i c a l s c r e e n i n g t e s t o n M r s S m i t h , a 2 8 - y e a r-o l d f e m a l e.
"
" T h e r e w e r e n o a b n o r m a l i t i e s n o t e d o n i n s p e c t i o n o f t h e v u l v a a n d s p e c u l u m e x a m i n a t i o n r e v e a l e d a h e a l t h y c e r v i x w i t h
a c l o s e d e x t e r n a l o s . I w a s a b l e t o o b t a i n a n a d e q u a t e s a m p l e f o r c e r v i c a l s c r e e n i n g .
"
" I n s u m m a r y, t h e s e
"
I h a v e c o m p l e t e d t h e c y t o l o g y
" I h a v e e x p l a i n e d t h e p r o c e s s f o r r e c e i v i n g r e s u l t s t o t h e p a t i e n t .
"
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