The Pap smear is done as part of the pelvic examination after the speculum has been correctly placed.

Clear area of secretions
First, clear the area of secretions with a large cotton swab. This swab may be used to prepare specimens for examination of vaginal secretions, but any culture specimens should be obtained after the Pap smear. Click here for more information about examination of vaginal secretions and cultures.

Collect ectocervical samples
Collect the ectocervical sample first using the wooden spatula. Insert the longer tip into the cervical os until the flat edge rests against the ectocervix. Rotate the spatula 360 degrees, while keeping the tip of the spatula in the os and the flat portion flush against the cervical tissue. Withdraw the spatula, and wipe the spatula along the glass slide, one side down and then the other. Immediately spray with fixative for a second or two, holding the spray about 8 to 12 inches from the surface of the slide.

Collect endocervical samples
Next, sample the endocervix with the cytobrush. Insert the brush completely into the cervix so that only the bristles closest to the handle are exposed. Slowly rotate the brush a full turn. Remove the brush, and using moderate pressure, roll it across the surface of a second glass slide. Fix with spray as before. The cytobrush may irritate the cervix enough to cause bleeding. Warn the patient that she may experience spotting and that it is normal.

There are several other types of cervical collection devices. Click here for more information. There are also other methods of fixing the samples on the slide. Endocervical samples collected with the spatula and brush may be placed on separate slides, or on the same slide as demonstrated here.

When the Pap specimens have been collected, proceed with collection of culture specimens (if any) and perform the bimanual pelvic examintion.