What does a cytological examination of cervical smears provide? What is a cytology smear?

For timely detection of various diseases, modern diagnostic techniques are necessary. One of these methods is a cytological examination; a cytological examination allows one to detect cancer at the beginning of its development. In addition, the essence of this study is a complete and comprehensive analysis of the state of the cells, which provides information about the presence of an inflammatory or infectious process, as well as other changes in the cellular structure.

Cytological examination or PCR smear is a tissue examination using microscopic equipment in a laboratory setting. This study allows you to study the microflora of the genital organs and confirm or refute the presence of a virus, infection, cancer cells and HPV in the smear. This type of examination must be carried out regularly, this is especially important for women, since cervical cancer is a real threat to health.

The result of cytology allows you to obtain information about the cells being studied, their number, shape, location and other characteristics. The importance of this analysis cannot be underestimated, as it helps to detect cancerous conditions of cells. In the first stages, the human body does not sense changes in cells and the patient does not feel symptoms, so only such a diagnosis will identify the developing disease. When there are a lot of pathological cells and symptoms of the disease appear, treatment will be much more aggressive.

In the first stage, cervical cancer does not show symptoms, when a woman begins to feel unpleasant symptoms, cancer cells grow strongly and the development of the disease becomes difficult to stop. A tumor in late stages often cannot be treated surgically, and its growth is also adversely affected by chemotherapy or radiation. Diagnosis at an early stage of the disease gives the patient a chance for recovery.

The collection of biomaterial is carried out by scraping a small part of the tissue from the required area with a special tool. Before the procedure, it is necessary to carefully prepare the site for collecting material. A cytological smear of the cervix is carried out after preliminary preparation, namely cleaning the uterus from secretions.

Carrying out the analysis for the patient does not require excessive preparation, in addition, it is carried out in the gynecologist’s office without pain. The collected material is applied to a glass slide, which is delivered to the laboratory.

Characteristics of oncocytology

Cytological examination uses a microscopy technique, which allows specialists to obtain the necessary data based on visual analysis. Based on the visual analysis obtained, the smear is deciphered for cytology by a specialist.

This cytology smear gives an idea of the microflora of the genital organs, that is, the indicators of red and white blood cells, their qualitative and quantitative characteristics, as well as changes in the appearance of flat and cylindrical cells. A cytology smear is considered negative if the norm is met in all indicators. If the indicators deviate from the norm, the doctor diagnoses a malignant disease and a precancerous condition.

However, there is a situation when a repeat cytology analysis is necessary. If a smear for oncocytology shows that the columnar or squamous epithelium is changing, specialists need to obtain additional data over time. A repeat smear for cytology is required after 2-3 months. Thus, a false positive result for oncocytology is excluded. In addition to cytological examination, the patient is prescribed additional studies to get a complete picture of the development of the pathology.

Carrying out analysis

The procedure is carried out during an examination by a gynecologist. A smear is taken from the required location, for example, in the cervical cavity from all walls, and also, if necessary, from the surface of the vulva or vagina. The cells of the uterus tend to constantly listen and are replaced by new ones, so they pass to the lumen of the cervix, and also enter the vagina. The specialist determines how informative the smear will be in each specific case.

Cytological examination is carried out relatively simply and does not threaten complications. For example, taking biomaterial by biopsy will be painful and is carried out using additional equipment, and complications may arise after it. The smear takes a few seconds from the specialist and the patient can go home immediately after the procedure.

Despite the fact that the woman does not feel pain, some discomfort is still present. In addition, when scraping, the epithelium may be injured and a certain amount of blood discharge will appear, which quickly passes and does not bother the patient.

A slide with biomaterial is placed under a microscope, several methods are used for analysis, and it is carried out differently in different laboratories. There are several most common methods:

Papanicolaou method or PAP test, which is characterized by staining with a special contrast agent.
Drying. Bringing the biomaterial to a solid state.

Based on such a study, we can talk about the disease or deny it. The cytological report is deciphered within one to two weeks.

Decoding indicators

During pregnancy, a woman’s immune system is subjected to severe tests, as the microflora of the genital organs changes, because the number of lactobacilli is significantly reduced. Cytological examination during pregnancy is mandatory.

The microflora of a pregnant woman must be maintained. The norm of all indicators in the microflora is the key not only to the normal course of pregnancy, but also to the woman’s health.

For non-pregnant women, the risk of developing the disease is lower; however, cytology is recommended, but less regularly. Decoding of microflora indicators is carried out according to classes:

The smear contains a large volume of Doderdlein bacillus, the concentration of leukocytes is low, the environment is acidic, pH 4.0-4.5. These indicators indicate that the norm of indicators is met and the microflora is good, that is, the woman is healthy.
Infectious agents are present, the environment is acidic (pH 4.5-5.0). Pathologies with this value are confirmed and characterized by the presence of inflammatory processes in the cervix, various viruses, fungi, and HPV.
A small amount of lactobacilli was detected in the smear; the environment is slightly acidic, alkaline (pH 5.0-7.0), this characteristic is considered negative. With such results, it is necessary to repeat the analysis in a few months, and a biopsy is also possible.
There is no presence of lactobacilli in the smear, the environment is alkaline (pH 7.0-7.5), leukocytes are high, and there are many pathogenic microorganisms. Such indicators indicate cervical cancer, as well as an inflammatory process.

Based on such a study, it is possible not only to make a diagnosis, but also to select a course of treatment. Since the procedure is simplified, it is carried out not only according to indications, but also during every examination by a gynecologist, no matter whether it is planned or urgent.

Preparing for analysis

Cytological examination is extremely important for diagnosing pathologies. This study most simply, cheaply, and also informatively establishes the presence of life-threatening diseases for the patient. It is recommended to carry out this analysis at least once a year, as well as a scheduled visit to the gynecologist. Despite the fact that cancer cells grow rather slowly, it becomes possible to conduct a study every two years, however, during this time it is possible to miss the early stage of the disease.

It happens that cancer cells develop quite rapidly, this happens when a lot of time passes between procedures, and also if mistakes were made during previous procedures and the result was interpreted as false negative.

Despite the fact that previous tests were negative, women at risk are recommended to undergo cytology smears regularly, this especially applies to patients with HIV undergoing chemotherapy, using steroids, etc. If a positive result is detected, a test is recommended repeat after a few months or on the recommendation of a doctor, since in 10% of cases the procedure gives a false negative result.

A false negative analysis is affected by incorrect collection of biomaterial, as well as poor preparation for analysis. Rules for preparing for the procedure:

Sexual contacts are strictly prohibited for two days before the test.
You can't douche.
It is prohibited to use vaginal suppositories, tablets, creams, ointments and other medications as treatment for several days.
It is forbidden to urinate before the procedure; this must be done a couple of hours before.
It is necessary to get rid of all inflammatory processes that are accompanied by severe discharge and itching.
During menstruation, material is not collected as planned, however, it is carried out if there is an urgent need.

Determining the pathology at an early stage is very important, because not only will there be a chance to cure the disease using less aggressive methods, but also to preserve the genitals. Therefore, a woman is recommended to visit a gynecologist at least once a year, this will allow the patient to monitor her health and not worry about her future. A normal smear test allows a woman not to worry about her health.

Cytology is a diagnostic method that allows you to study the structure of cells and detect the presence of atypical elements indicating the development of the disease. In gynecology, cytology analysis is a fairly common procedure.

The popularity of the method is easy to explain:

firstly, a diagnostic smear for cytology does not require large expenses;
secondly, a guarantee of reliable results in the shortest possible time;
thirdly, it helps prevent the development of precancerous and cancerous conditions.

Cytology, smear for cytology or oncocytology - these are all popular synonyms of the medical term - Papanicolaou test.

Analysis for cell research in gynecology

The cervical canal or cervix is the anatomical site for collecting cellular material for research in gynecology. This anatomical site functions with two types of epithelium:

stratified epithelium (covers the area of the vaginal part);
cylindrical epithelium (lining the cervical canal at the junction of the cervix and uterus).

According to physiological norms, cellular elements are regularly renewed. Taking a smear for cytology in these parts of the cervical canal helps to detect atypical cancer cells at the initial stage of development.

A cytology analysis helps identify initial changes in the cervical canal of the uterus that contribute to the development of cancer over a short period of time. Given this reason, a cytology test is a mandatory preventive method in gynecology.

Mass smear testing among women belonging to different age groups and segments of the population demonstrates positive dynamics in reducing the incidence of cervical cancer.

If your appointment sheet indicates a smear for cytology, do not panic! This does not mean that you have cancer or are at increased risk of developing it. By no means, a constant preventive examination and a smear for cytology delays the possibility of developing terrible diseases.

Women under 65 years of age should regularly visit a gynecologist and comply with all prescribed requirements. After 65 years, the frequency of submitting material for cytology is determined individually by the attending physician.

A Papanicolaou test is mandatory in the following cases:

All girls/women over 18 years of age. In this case, the analysis is carried out without medical requirements, at will;
Presence of sexual activity;
Women over 30 years of age are required to undergo a medical test once a year;
Pregnant women. Cytology is carried out according to the rules 3 times during the period of gestation;
Interruptions in the menstrual cycle, the presence of human papillomavirus and malignant tumors in close family members are the reasons for a cytology smear every six months.

Factors leading to gynecological diseases and a negative cytology test result:

Nicotine intake;
Insufficiency of vitamins A, C;
Immunodeficiency conditions, including HIV;
Infection with chlamydial and herpes infections;
Long-term inflammatory lesions of the female genital organs;
Isolation of human papillomavirus in the blood;
Systematic use of hormonal contraceptives;
Onset of sexual activity before 16 years of age;
Regular change of sexual partners;
Several births in the anamnesis.

Stages of preparation for the analysis

It is difficult to predict what the doctor will prescribe at your next visit to his office. But if you are going to undergo a regular preventive examination with a gynecologist and undergo a number of necessary tests, follow these simple recommendations:

Forget about nighttime pleasures for a few days;
Move all chemical products for intimate hygiene into the back drawer, stop douching;
Do not use medications, such as vaginal suppositories, sprays, etc. before taking a smear.

A smear for cytological examination is taken during a routine gynecological examination with speculum. The duration of all procedures, including examination, is 15 minutes.

Initially, the doctor assesses the condition of the vaginal walls and the visible part of the uterus after inserting a gynecological “mirror”. After this, the gynecologist proceeds directly to collecting the epithelium of the cervical canal. To do this, you will need a probe, a special swab or brush. Although the procedure is short and unpleasant, try to relax, otherwise the discomfort will increase due to muscle tension.

The resulting scraping is immediately sent to the laboratory for further study. Accurate results from the laboratory will arrive after 1 – 2 weeks.

The results will indicate either "positive" or "negative". It is absolutely clear that if the transcript contains the clause “negative”, this means absolute health of the cervix, the absence of atypical cells.

The item “positive” is not a clinical diagnosis! Yes, such a result indicates the presence of atypical cells, but this does not mean that they will soon become cancerous or are already cancerous. An analysis with a positive result occurs in infectious diseases acquired sexually, and even in inflammatory processes.

The decoding additionally includes the stages of the identified process:

Stage 1 – the cytological picture is not changed;
Stage 2 – there are minor deviations from the norm due to inflammation;
Stage 3 – single cells with abnormalities of cellular elements (presumably malignant);
Stage 4 – single cells of an exclusively malignant nature;
Stage 5 – malignant cells in large numbers (exact diagnosis – cancer).

In case of a positive result, regardless of the stage, additional tests will be prescribed, for example, a repeat cytology test if the results are questionable, or colposcopy.

General condition after taking material for cytology

Do not worry if brownish-green discharge appears within 5 days after taking a smear. This is a normal reaction of the body and does not require treatment. On such not very joyful days, gynecologists advise using personal hygiene products.

To avoid pain and discomfort, take a week's break from sexual activity.

Consult a doctor immediately if, after taking the material for analysis, your body temperature rises, sharp pain in the lower abdomen and heavy bloody discharge appear.

What is a cytological examination?

Cytology- a science that studies the general features of the structure and functioning of cells and their derivatives. She studies individual cellular structures, their participation in general cellular physiological processes, ways of regulating these processes, reproduction of cells and their components, adaptation of cells to environmental conditions, reactions to various factors, and pathological changes in cells.

Cytological examination- this is an assessment of the characteristics of the morphological structure of cellular elements in a cytological preparation (smear) in order to establish a diagnosis of a benign or malignant tumor and non-tumor lesions. It is based on studying, using a microscope, the structural features of cells, the cellular composition of organs, tissues, and fluids of the human body in normal conditions and in pathological processes. The difference between a cytological study and a histological study is that it is not tissue sections that are studied, but cells; the conclusion is based on the features of changes in the nucleus, cytoplasm, nuclear-cytoplasmic ratio, formation of structures and cell complexes.

When is cytological examination used?

Cytological analysis used for:

Screening (preventive examination).
Establishing (clarifying) a diagnosis of a disease.
Establishing (clarifying) the diagnosis during surgery.
Control during treatment and after treatment.
Dynamic observation (for early detection of relapses).

Materials for cytological examination

Liquids: sputum, urine, prostate juice, washings from various organs during endoscopy, as well as from the cervix and uterine cavity ( cytological examination of smears, cytological examination of the cervix), discharge from the mammary glands, scrapings and prints from eroded or ulcerative surfaces, fistulas, wounds, fluid from articular and serous cavities, cerebrospinal and amniotic fluid;
Points: materials obtained during aspiration diagnostic puncture, mainly with a thin needle;
Prints from removed tissues, for example, the surface of a fresh cut, surgically removed or taken for histological examination of tissue.

Purpose of cytological analysis

Main purpose cytological method- get an answer to the question about the presence or absence malignant neoplasm (oncocytology). In the process of differential diagnosis, the nature of the pathological process is determined and inflammatory, reactive, proliferative or precancerous lesions, as well as benign tumors, are identified. The role of morphological studies in the diagnosis of tumors is steadily increasing, since detailed morphological characteristics of the tumor make it possible to more substantiate choose a treatment method(surgical, radiation, chemotherapy and their combination), since tumors have different structures, origins and degrees of cell atypia
respond differently to treatment.

Cytological examination has incomparable advantages over other methods detecting early stage cancer. The development of endoscopic technology and ultrasound research methods has greatly contributed to the widespread introduction cytological examination in the diagnosis of neoplasms from almost all tissues of the body, including internal organs, previously inaccessible to non-operative morphological analysis. Evidence of this is cytological diagnosis of cancer stomach, lung, bladder and other organs in the absence of clinical, radiological and endoscopic manifestations, even before the appearance of signs detected by these methods.

Cost of cytological studies in our medical center

Study title	Clinical material	Expiration date	Price
CYTOLOGICAL STUDIES
Leishman 1 drug	scraping of the epithelium from the endocervix/exocervix	5 w.d.	RUR 780.00
Leishman 2 drugs	scraping of the epithelium from the endocervix/exocervix	5 w.d.	1160.00 rub.
Papanicolaou 1 drug	scraping of the epithelium from the endocervix/exocervix	5 w.d.	1680.00 rub.
Papanicolaou 2 drugs	scraping of the epithelium from the endocervix/exocervix	5 w.d.	2210.00 rub.
Cytological diagnosis of skin lesions, examination of scrapings and impressions of erosions, wounds, fistulas		5 w.d.	660.00 rub.
Cytological diagnosis of thyroid diseases		5 w.d.	RUR 780.00
Cytological diagnosis of diseases of the genitourinary system	smear-imprint, punctate (on glass)	5 w.d.	RUR 780.00
Cytological diagnosis of breast diseases	scraping, impression smear, punctate, detachable (on glass)	5 w.d.	RUR 780.00
Examination of uterine cavity aspirate	aspirate of the uterine cavity, smear-imprint with an IUD (on glass)	5 w.d.	1000.00 rub.
Study of ascitic, pleural, synovial fluid, cerebrospinal fluid, cyst contents	ascitic, pleural, synovial fluid, cerebrospinal fluid, cyst contents	5 w.d.	RUR 780.00
Study of material obtained during surgical interventions	smear-imprint, punctate (on glass)	5 w.d.	890.00 rub.
Examination of lymph node puncture	smear-imprint, punctate (on glass)	5 w.d.	890.00 rub.
Examination of sputum and urine for atypical cells	sputum, urine	5 w.d.	890.00 rub.
Examination of endoscopic material	smear-imprint (on glass)	5 w.d.	890.00 rub.

r.d.- working day

What does a cytology smear show, and for what purpose is it prescribed? This laboratory diagnostic method is necessary for the early detection of cervical cancer, one of the most common cancers of the female reproductive system. This is an inexpensive and informative study that is aimed at identifying atypical cells characteristic of the presence of a malignant process.

Cytology smear - what is it? This is a cytological analysis of scrapings from the cervix, the so-called Papanicolaou test, or, as the doctor usually writes in the referral for the study, a PAP test.

In 1943, the scientific work of the Greek physician G. Papanikolaou, “Diagnosis of uterine cancer using smears,” was published in a specialized medical publication. It aroused great interest among the medical community, and the proposed diagnostic method began to be widely used in clinics. After the name of its creator, a cytology smear from the cervix began to be called a Papanicolaou smear or PAP test for short. By watching the video on YouTube, you can learn more about Georgios Papanikolaou and his discovery, which made it possible to reduce mortality from cervical cancer tenfold.

Every adult woman who is not vaccinated against HPV before sexual activity has a risk of cervical cancer.

What does a cytology smear show?

The Pap test is a highly informative, inexpensive and fast method of laboratory diagnosis of cervical diseases. Its main purpose is:

identification of atypical cells indicating a malignant process;
diagnosis of cervical dysplasia, which is a precancerous disease.

Mass examination of cervical smears (cervical screening) is the main method of secondary prevention of cervical cancer, i.e., a method aimed at identifying the disease as early as possible (primary prevention, i.e., a method of preventing the development of cervical cancer is vaccinating girls against HPV, human papillomavirus).

Who is indicated for a cervical smear test?

Every adult woman who is not vaccinated against HPV before sexual activity has a risk of cervical cancer. Therefore, a cytological examination of a smear from the cervical canal must be performed for every woman starting from 18 years of age. The test is recommended to be carried out annually until the age of 30, regardless of whether the woman is currently sexually active or not (with the exception of virgins). After 30 years and if there is only one sexual partner, it is done once every three years.

In some cases, a cytology smear is performed more often, for example, if women have dysplasia of the cervical mucosa or infection with oncogenic strains of HPV is detected in the body, that is, with an increased risk of developing cervical cancer.

An unscheduled cytological examination of a cervical smear is performed in the following cases:

pregnancy planning;
suspected infection with an oncogenic strain of HPV;
endocrine diseases (diabetes mellitus, obesity, metabolic syndrome);
prescription of hormonal contraception;
upcoming installation of an IUD.

The duration of laboratory testing of a smear from the cervical canal in different medical institutions ranges from 3 to 10 days.

How to prepare for research

In order for the results of a cytological analysis to be reliable, a number of conditions must be met before performing it:

a smear is taken after the end of menstruation, in the first half of the menstrual cycle, that is, before the next ovulation;
48 hours before visiting the gynecologist, you must abstain from sexual intercourse;
two days before the procedure, you should stop using vaginal suppositories, creams, tampons;
within three days they stop performing vaginal douching.

A smear for cytology must be taken before colposcopy or two-manual gynecological examination or no earlier than 48 hours after they are performed.

If the patient has acute or chronic inflammatory diseases of the reproductive system in the acute stage, then a smear should be taken only after completion of their treatment.

How to take a smear for cytology

A Pap smear is taken from a woman during a gynecological examination. The woman lies down in a chair. The gynecologist carefully inserts a Cusco speculum into the vagina, exposes the cervix and wipes it with a swab moistened with saline solution. After this, the mucous plug is removed from the cervical canal using a wooden scraper or a special brush.

Directly to take a smear from the cervical canal, disposable sterile instruments are used (endobranche, screenet, Volkmann spoon, Eyre spatula). One of them is carefully inserted into the lumen of the cervical canal and slowly rotated around its axis, collecting pieces of mucus on its surface. The scraping is taken in the transition zone of the cervix, that is, in the place where the stratified squamous epithelium becomes cylindrical.

After removing the instrument, this mucus is transferred to a clean glass slide. The Cusco speculum is removed and the patient can rise from the chair.

A cytological examination of a smear from the cervical canal must be performed for every woman starting from 18 years of age.

The procedure for collecting a smear for cytology is painless. However, sometimes patients with a labile nervous system complain of slightly unpleasant sensations of pressure in the lower abdomen.

The slide is immersed in 96° ethyl alcohol for several minutes for fixation and dried in air. After this, they are placed in an envelope and sent to the laboratory for cytological examination.

How many days does a smear for cytology take?

The duration of laboratory testing of a smear from the cervical canal in different medical institutions ranges from 3 to 10 days. This analysis is most quickly done in laboratories equipped with special analyzing systems.

Decoding the results

Depending on the result obtained, five classes of smears are distinguished:

The sizes and shapes of the cells correspond to the physiological norm, no signs of atypia are detected.
There are cell changes associated with cervicitis or colpitis.
Single cells with changes in the nucleus and/or cytoplasm are identified.
Individual malignant cells.
Malignant cells in significant numbers.

In addition, the Bethesda classification system is widely used in deciphering smears for cytology:

Low degree of change. These include koilocytosis (cellular changes caused by HPV infection) and CIN I (early stage of cervical dysplasia). Corresponds to class I and II smears.
High degree of change. Includes CIN II, III (moderate and severe cervical dysplasia), carcinoma in situ (initial stage of a malignant tumor). These changes correspond to smears of classes III-V.

The test is recommended to be carried out annually until the age of 30, regardless of whether the woman is currently sexually active or not. After 30 years and if there is only one sexual partner, it is done once every three years.

In the forms of some laboratories, variants of the cytological picture of a smear may have other designations:

NILM– smear class I, normal;
ASCUS– atypical cells with changes of undetermined significance are present, which may be caused by chlamydia, HPV, dysplasia or atrophy of the mucous membrane;
ASC-H– squamous atypical epithelium is detected in the smear, which is typical for moderate or severe dysplasia, as well as early stages of malignant tumors;
LSIL– altered cells in small quantities (typical of HPV infection or initial degree of dysplasia);
HSIL– cellular changes are pronounced, which corresponds to moderate and severe dysplasia, stage 0 cancer;
A.G.C.– altered cells of the glandular epithelium are detected (dysplasia, uterine cancer);
AIS– early stage of carcinoma;
High-grade SIL– cancer originating from squamous epithelial cells.

For any result of a cytology smear, a woman needs to consult a gynecologist. If the test reveals deviations from the norm, the doctor will refer you for further examination (ultrasound of the pelvic organs, extended colposcopy, cervical biopsy, separate diagnostic curettage followed by histological examination of scrapings).

Video from YouTube on the topic of the article:

A smear for flora and cytology is a microscopic laboratory test that allows you to determine the nature of the microflora of the urethra (urethra) in men and the vagina, as well as the cervix in women.

The presence of leukocytes in the blood may indicate an inflammatory process in the organs and systems of the urogenital tract, and in most cases this is exactly the case. This applies equally to both men and women. A smear helps determine leukocytes, but young guys rarely go to a diagnostic center for such a simple test. In addition, during hospitalization, a smear is also not taken from men, since this test is not required when registering for hospitalization. For girls, the situation is the opposite: a smear for flora and cytology is always taken during the initial diagnosis, and women themselves regularly undergo such analysis for preventive purposes.

Norm and pathology for men and women

If we talk about representatives of the stronger sex, then the norm for them is the presence of single leukocytes, transitional epithelium in the smear and the presence of single rods. This is exactly what the research picture looks like for a healthy man. If the number of leukocytes is increased, then you can immediately look for the presence of gonococci, yeast-type fungi, etc., since usually an abundance of leukocytes is accompanied by the presence of infectious bacteria. In this case, treatment is prescribed, and then a repeat analysis is taken to compare the situation.

As for women, an increased level of white blood cells may be the norm, for example, if your period is about to begin. In any other period of the cycle, no more than 30 cells in the field of view are considered normal. The mere presence of cells does not constitute reliable results. It is also necessary to evaluate their morphological state. “Quiet” cells without destruction, which have preserved nuclei and no signs of phagocytosis, already indicate the reliability of the readings. In order not to make a false conclusion during the analysis, it is necessary, among other things, to correctly select the material. For example, an almost completely invisible, “thick” smear is formed due to the accumulation of cells layered on top of each other, including leukocytes. In these cases, it is necessary to prescribe a repeat microflora analysis to eliminate the risk of an erroneous diagnosis.

Flora and cytology: distinctive features

The objects of laboratory research are different organs depending on the gender of the person. Thus, a smear is taken from the male urethra, while there are many female analytical objects (vagina and cervical canal, cervix and urethra). Sometimes, of course, it is necessary to take an aspirate from the uterine cavity, but this will already be biopsy material. It is analyzed by a cytologist who makes a conclusion.

If the examination is carried out for preventive purposes, then aspirates are not taken. Such an analysis can be taken into account only if it is necessary to check the subject for the presence of precancerous and cancerous conditions that affect the functionality of the reproductive organ. Moreover, when the aspirate is filled with formaldehyde, and then applied to glass and stained, a histological preparation is obtained, and it is considered as the last resort in diagnosing malignant formations.

Smear for cytology and flora

When they take a smear with immersion to analyze the flora, experts have the opportunity to accurately see the number of cells, clearly see diplococci, yeast cells, gardnerella and other microorganisms of the biocenosis of the female genital organs. However, such a smear does not make it possible to determine deviations of the epithelium in morphological terms. Changes of a pathological nature in the very structure of the cell or its nucleus can only be seen by an experienced and competent doctor.

But let deciphering the analyzes remain the prerogative of specialists; we will only get acquainted with the basic provisions so as not to panic if a similar problem suddenly turns up.

Cytology studies

The possibilities of cytology analysis are much wider than those of flora analysis. When processing the material, the doctor pays the greatest attention to the epithelium and the condition of its cells. The only purpose of such close attention is to compare and detect the inflammatory nature of the pathology, dysplasia and neoplasm, potentially of a substandard type. In parallel with the main task of the study, the specialist also notes the flora.

Often, a vaginal portion of the cervix MPE (stratified squamous epithelium) and the cervical canal are provided for analysis. If a smear for cytological examination from the cervical canal was taken correctly, then it is considered normal when the cylindrical epithelium is clearly visible in the preparation, single leukocytes are found and there is a “poor” microflora, with a high probability of being accidentally introduced, for example, from the vagina.

It is clear that the substance for cytology gives a more informative picture (staining using the Romanovsky, Papanicolaou or Pappenheim method). First, the cells are studied at low magnification in order to evaluate the preparation itself, and then with immersion, in order to see not so much the epithelium itself, but its nucleus and whether there are any pathological changes in it characteristic of diseases of one type or another.

In short, a cytologist can see, in addition to flora, the causes of changes provoked by inflammation, landmarks of infections that are difficult to diagnose, precancerous and cancerous conditions.

Signs of indirect STI in cytological analysis

It is extremely important to study a smear for STIs in the same way as cytology. The most inexpensive and accessible flora test in all medical institutions is a smear stained with methylene blue. That is why this analysis is the most widely used in gynecology. However, this study does not provide a complete picture of the presence of signs of STDs.

If, when the biocenosis is disturbed, yeast, Trichomonas, Leptothrix and others are visible in a smear or infection, then in cytology even indirect signs of the presence of microorganisms are visible, which is practically impossible to identify in microscopic analysis.

Some examples:

that there is a herpes infection (HSV) is indicated by visible multinucleated cells of a very large size and strange shape, with signs of hardening and/or parakeratosis;
cells with coarse-grained cytoplasm (the so-called “owl’s eye”) indicate the possible presence of cytomegalovirus;
HPV (papillomavirus) infection is indicated by koilocytic atypia (MPE cells have large nuclei with lumens);
if Provacek bodies are seen in MPE cells, this may indicate chlamydia.

Of course, it is not possible to diagnose herpes, papillomavirus or a cytological smear, but it is possible to identify suspicions using indirect signs. This automatically gives grounds for a more in-depth study and helps to narrow the circle and save time in making a diagnosis.

Preparation for correct analysis of flora and cytology

A smear to study the flora is the fastest and most accessible way to determine infectious diseases and inflammatory processes for both sexes. In this regard, it makes sense to understand the terms in more detail in order to understand the entries in the form. But first, we will talk about some rules that are mandatory for correct analysis:

do not have sexual intercourse for several days before the study, and also avoid douching, vaginal suppositories and other local interventions;
the analysis cannot be carried out during menstruation, since the blood will not allow sufficient viewing of the material;
calculate your fluid intake on the day of the test so that you go to the toilet for the last time to urinate 3 hours before the test;
do not take any medications (tablets, injections, etc.) 10 days before the test;
Do not use hygiene products on the day of analysis. It is advisable to use warm boiled water in the morning on the day of the test for women, and for men - in the evening before the test.

By paying attention to all the listed rules and passing the test, you can be sure that the smear will be correct and the color will show the full picture. Having received a specialist’s opinion, you can already delve into its meaning.

What does a male urethral smear show?

Men should be prepared for the fact that the collection of analysis itself is not a pleasant procedure and is often accompanied by uncomfortable sensations even a couple of hours after it is carried out. To make it easier to reschedule the test, the doctor can prescribe a prostate massage for 3-4 days in advance.

After the analysis, you need to carefully monitor your condition. If burning or discomfort continues the next day after collection, or if purulent discharge appears, you should immediately consult a doctor.

In the smear itself from the male urethra, if the subject is healthy, everything is much simpler than in women. And let this moment bring a little peace to men who have undergone such an unpleasant procedure. Below are the characteristics of a normal urethral smear for representatives of the stronger sex:

leukocytes – up to five cells in the field of view;
flora – the presence of single rods;
urethral epithelium - diluted with a general background of a transitional nature, from five to ten cells in view;
small amounts of mucus;
conditionally pathogenic flora in the smear – single microorganisms (staphylococci, streptococci, etc.). If there is a need to differentiate the flora, a Gram smear is used.

If there is an inflammatory process, the smear changes its picture:

leukocytes – a rich picture;
rod flora is replaced by cocci or cocco-bacillary flora;
the presence of microbes (yeast, Trichomonas, etc.);
for correct diagnosis and accurate determination of the type of pathogen, an additional cultural study is carried out (under a microscope it is practically impossible to detect chlamydia, myco- and ureaplasmas, and also to distinguish diplococci that cause gonorrhea from enterococci, streptococci);
It is rare to see E. coli in a smear from the urethra of men. This indicates a complete lack of hygiene. E. coli, which is useful in the intestines, can cause cystitis, prostatitis, urethritis and other diseases if it enters the male urethra. More research is also needed to distinguish E. coli.

Based on the pattern of female smears, the same measures are taken. It must be said that the presence of E. coli, enterococci, staphylococci, streptococci and other microorganisms in women's smears is diagnosed much more often than in men's. The reason for this statistics is the structural features of the female reproductive system.

Urogenital tract in women. Ecosystem Features

Leukocytes are by no means the only cells in a woman’s smear taken for both flora and cytology. Moreover, they only reflect the body’s reaction to changes in the ecosystem of a woman’s urogenital tract, such as changes in hormonal levels and various types of inflammation. As you know, their number increases with the phase of the cycle, and therefore, when collecting, the day of the beginning of the last menstruation is always indicated.

Inflammation is diagnosed not only by the quantitative indicator of leukocytes, but also by closely studying their nuclei. Having entered into a reaction, leukocytes try to absorb the “harmful creature”, but destroy themselves. Neutrophilic (destroyed) leukocytes are not indicated in study transcripts. But the presence of many destroyed leukocytes along with a rich coccal or cocco-bacillary flora provides grounds for diagnosing inflammation.

The anatomy and ecosystem of the female body (epithelium of the vagina, cervical canal, cervix) suggest the presence of microorganisms: obligate or obligatory and acquired from the outside. The latter are the cause of inflammatory processes.

Also, disorders and inflammations can be provoked by other external or internal factors. This promotes the displacement of natural microorganisms by external microbes. A good example of this phenomenon is the dominance of gardnerella, which has replaced lactobacilli, and the consequence of this process is widespread gardnerellosis or bacterial vaginosis.

What does a gynecological smear look like normally?

Despite all the abundance of microorganisms that live in the female flora, the norms for them are, of course, determined. We will try to introduce the reader to the main indicators:

leukocytes. For the norm in the field of view during viewing, quantitative indicators were determined: 10 for the urethra and 30 for the cervix. If the quantitative indicators exceed the specified values, the presence of inflammation can be suspected;
epithelium. For this criterion, the norms also differ depending on where the material for the study is taken from. For the vagina, urethra and cervix, the epithelium is normally characterized by the MPE obtained in the preparation. The material from the cervical canal is a cylindrical epithelium. At the same time, in different phases of the female cycle, the number of cells varies (the average normal value is up to 10 cells). These indicators are still very conditional, since everything needs to be considered in context - the morphology of cell nuclei is of great importance in this sense (shows a smear on cytology);
mucus. For the norm, this component must be present (this is the work of the cervical canal and vagina), but in small quantities. If sampled during the ovulatory phase, the mucus has a crystallized structure resembling a leaf pattern. In cytology this is called the “fern sign”;
rod flora. The presence of single cocci and lactobacilli indicates normality; their quantitative increase indicates pathology.

Norm and pathology in opportunistic flora

Lactobacilli, which are normally always present in small quantities, perform a “sanitary” function, cleaning the vagina. But a smear can also show the presence of other microorganisms.

Gardanella. As a rule, Gardanella does not show itself normally, but when the pH changes, it quickly becomes active. Almost always, after the manifestation of the activity of the gardanella, the activity of the mobiluncus begins. In this case, changes occur in the flora, and the smear shows a significant increase in cocci. This coccobacilli flora is called “bacterial sand” because it covers the epithelium. A similar diagnostic picture may indicate the presence of bacterial vaginosis.
Candida fungi of yeast-like origin can be seen in a smear, since the normal flora also contains them, but does not allow them to develop and multiply. As soon as the situation becomes favorable for the fungi, Candida will quickly begin to multiply, and this will not go unnoticed for the woman. Itching, inflammation,... will immediately appear.
Leptothrix is a union of multiple species of microorganisms acting as a united front. This community has a certain "intelligence": they can imitate chains of mycelium threads or resemble lactobacilli. Therefore, culture is necessary to differentiate Leptothrix.
Actinomycetes - bacteria that resemble cubes and blots in the preparation, almost never cause inflammatory reactions. The exception is when a woman uses an intrauterine contraceptive device.
Other opportunistic forms. Enterococcus faicalis and Escherichia coli may also be present in the smear. The reason for this is the anatomy of the female body - the genitourinary system is located close to the lower gastrointestinal tract.

Also included in the group of other opportunistic forms that can normally be present in small quantities in the female genital tract are corynebacteria, staphylococci, mycoplasmas, streptococci and ureaplasmas. To differentiate these forms, they turn to other research methods, since they cannot always be clearly identified in a smear on the flora.

The listed representatives of the female microflora may be present in a healthy body and not manifest themselves in any way until a certain moment. When the situation for microorganisms becomes favorable, inflammatory processes occur. It must be said that even lactobacilli can become a source of inflammation - the extremely unpleasant disease lactobacillus occurs when there is an excess of lactobacilli with a simultaneous rich bacterial flora.

Pathogenic microorganisms

During unprotected sexual intercourse, there is a very high risk of getting pathogenic microorganisms and causing a lot of trouble. Inflammatory processes of a local nature can quickly migrate to other tissues, organs and systems of the body, and if ignored for a long time, develop into chronic forms of difficult-to-treat diseases.

The presence of pathogenic microorganisms during pregnancy is extremely dangerous, since pathogens often affect the fetus. A smear test during pregnancy is a regular and mandatory procedure, and in case of poor results, it is necessary to begin treatment without delay.

Microorganisms affecting reproductive function:

A standard smear to study the flora, if analyzed with a different approach, can become a test for the degree of vaginal cleanliness. Doctors distinguish four degrees of purity.

Purity grade I. Very rare. A clean smear contains only rod flora, the optimal amount of squamous epithelium and single leukocytes.
Purity degree II. The flora is like that of a smear of the first degree of purity, in which isolated cocci and other non-pathogenic organisms are found. Among healthy women, this is the most common diagnostic result.
Purity degree III. In the flora there are already yeasts with a tendency to activity and reproduction. This result may indicate the initial stage of inflammation, and other studies are prescribed for the correct search.
Purity degree IV. Characterized by the presence of obvious inflammation and the rich coccal or bacillary-coccal flora accompanying this process. After such results, they begin to search for the causative agent of the infection in order to prescribe correct and effective treatment.

A smear on the flora is a simple but indicative method of laboratory research with quick results and great possibilities.