How does cervical cleaning affect Pap smear quality. What are the benefits of using an oversized cotton swab for cleaning. Can cervical cleaning reduce inflammatory exudate and inadequate cell sampling. What are the potential drawbacks of this technique.

The Importance of High-Quality Pap Smears in Cervical Cancer Screening

Cervical cancer screening through Papanicolaou (Pap) smears is a crucial tool in detecting early cellular changes that may lead to cervical cancer. However, the effectiveness of this screening method heavily relies on the quality of the sample obtained. Factors such as inflammatory exudate, inadequate cellularity, or failure to sample the transformation zone can compromise the accuracy of Pap smear results.

To address these issues, researchers have been exploring various techniques to improve sample quality. One such method that has shown promise is cervical cleaning prior to obtaining the Pap smear.

Evaluating the Effect of Cervical Cleaning on Pap Smear Quality

A study conducted by Andrew J. Kotaska and Jasenka P. Matisic from the Department of Obstetrics and Gynecology at the University of British Columbia aimed to assess the impact of routine cervical cleaning on Pap smear quality. The research, published in the Canadian Medical Association Journal, compared Pap smears obtained after cervical cleaning with historical control slides from the same women without prior cleaning.

Study Methodology

• Setting: Primary care
• Cleaning method: Dry, oversized cotton swab
• Comparison: Study group (with cleaning) vs. historical control group (without cleaning)
• Additional comparison: Both groups vs. provincial averages for British Columbia

Significant Findings: Reduction in Inflammatory Exudate

One of the most striking results of the study was the dramatic reduction in inflammatory exudate observed in the cleaned samples. Inflammatory exudate can obscure cellular details and make interpretation of the Pap smear more challenging.

How significant was the reduction in inflammatory exudate? The study reported inflammatory exudate in only 0.3% of the 334 cleaned samples, compared to 11.0% of the 652 control smears. This difference was statistically significant (p < 0.001), indicating a clear benefit of cervical cleaning in reducing this common issue.

Improved Sampling of Endocervical and Metaplastic Squamous Cells

Another crucial aspect of Pap smear quality is the presence of adequate endocervical or metaplastic squamous cells. These cells are essential for proper evaluation of the transformation zone, where most cervical abnormalities originate.

Did cervical cleaning improve the sampling of these important cells? The study found that inadequate endocervical or metaplastic squamous cells were reported in only 3.3% of the cleaned samples, compared to 13.8% of the control smears. This significant improvement (p < 0.001) suggests that cervical cleaning may enhance the ability to sample the critical transformation zone.

The Cellularity Conundrum: An Unexpected Finding

While cervical cleaning showed clear benefits in reducing inflammatory exudate and improving endocervical cell sampling, an unexpected finding emerged regarding sample cellularity.

What was the impact of cervical cleaning on sample cellularity? Interestingly, inadequate cellularity was reported in 3.9% of the cleaned samples, compared to only 1.4% of the control smears. This difference was statistically significant (p = 0.01), indicating a potential drawback of the cleaning technique.

This finding raises important questions about the optimal balance between removing interfering substances and maintaining adequate cellularity. Further research may be needed to refine the cleaning technique to address this issue.

Comparing Results to Provincial Averages

To put the study findings in context, the researchers compared both the study group and control group results to provincial averages for British Columbia.

• The study group showed significant improvements compared to provincial averages
• The control group results were similar to provincial averages:
  1. Inflammatory exudate: 11.3% (provincial average)
  2. Inadequate endocervical cells: 14.7% (provincial average)
  3. Poor cellularity: 2.7% (provincial average)

These comparisons further validate the potential benefits of cervical cleaning in improving Pap smear quality on a broader scale.

Implications for Clinical Practice and Future Research

The findings of this study have several important implications for clinical practice and future research in cervical cancer screening.

How might these results impact Pap smear collection techniques? Healthcare providers may consider incorporating cervical cleaning into their routine Pap smear collection procedures, particularly in cases where inflammatory exudate or inadequate endocervical sampling have been problematic in the past.

What areas require further investigation? While the benefits of cervical cleaning are clear, the slight increase in inadequate cellularity warrants additional research. Future studies could focus on:

• Optimizing the cleaning technique to maintain adequate cellularity
• Investigating the long-term impact of routine cervical cleaning on cancer detection rates
• Exploring alternative cleaning methods or materials that may offer similar benefits without compromising cellularity
• Assessing the cost-effectiveness of implementing cervical cleaning in large-scale screening programs

The Role of Cervical Cleaning in Improving Overall Screening Efficacy

Cervical cancer screening programs rely on high-quality Pap smears to effectively detect precancerous changes. By significantly reducing inflammatory exudate and improving endocervical cell sampling, cervical cleaning has the potential to enhance the overall efficacy of these screening efforts.

How might improved Pap smear quality impact cervical cancer prevention? Better quality samples could lead to:

• More accurate detection of cellular abnormalities
• Fewer false-negative results
• Reduced need for repeat testing
• Improved patient outcomes through earlier detection and treatment of precancerous lesions

While the slight increase in inadequate cellularity remains a concern, the overall benefits of cervical cleaning appear to outweigh this potential drawback. However, ongoing research and refinement of techniques will be crucial to optimize this promising approach to improving Pap smear quality.

Practical Considerations for Implementing Cervical Cleaning

For healthcare providers considering the implementation of cervical cleaning in their practice, several practical considerations should be taken into account:

Training and Technique

Proper training in the cervical cleaning technique is essential to ensure consistent and effective results. This may include:

• Standardized protocols for cleaning duration and pressure
• Guidance on selecting appropriate cleaning materials (e.g., size and type of cotton swab)
• Techniques to minimize the risk of reducing sample cellularity

Patient Education

Introducing a new step in the Pap smear collection process may require additional patient education. Healthcare providers should be prepared to explain:

• The purpose and benefits of cervical cleaning
• Any potential discomfort or sensations the patient may experience
• How the cleaning process may impact the overall duration of the procedure

Cost and Resource Implications

While the materials required for cervical cleaning are relatively inexpensive, healthcare facilities should consider the potential impact on:

• Procedure time and patient throughput
• Supply costs for cleaning materials
• Potential long-term savings from reduced need for repeat testing

By carefully addressing these practical considerations, healthcare providers can maximize the benefits of cervical cleaning while minimizing any potential disruptions to their current screening practices.

The Future of Cervical Cancer Screening: Integrating New Technologies

As research continues to refine cervical cleaning techniques, it’s important to consider how this approach fits into the broader landscape of evolving cervical cancer screening technologies.

What other innovations are shaping the future of cervical cancer screening? Some promising developments include:

• HPV DNA testing as a primary screening tool
• Computer-assisted cytology interpretation
• Novel biomarkers for improved risk stratification
• Self-sampling methods for hard-to-reach populations

How might cervical cleaning complement these emerging technologies? By improving the quality of samples obtained, cervical cleaning could enhance the accuracy and reliability of both traditional Pap smears and newer screening methods. This synergy between improved sample collection and advanced analysis techniques has the potential to significantly boost the effectiveness of cervical cancer prevention efforts.

As the field of cervical cancer screening continues to evolve, ongoing research and clinical trials will be crucial in determining the optimal combination of techniques to achieve the highest possible detection rates while minimizing false positives and unnecessary interventions.

In conclusion, the study by Kotaska and Matisic provides compelling evidence for the benefits of cervical cleaning in improving Pap smear quality. While some challenges remain, particularly regarding sample cellularity, the overall impact on reducing inflammatory exudate and improving endocervical cell sampling is significant. As healthcare providers and researchers continue to refine this technique and integrate it with other advancing technologies, the future of cervical cancer screening looks increasingly promising, offering hope for more effective prevention and early detection of this important women’s health issue.

Cervical cleaning improves Pap smear quality

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. 2003 Sep 30;169(7):666-9.

Andrew J Kotaska 
¹
, Jasenka P Matisic

Affiliations

Affiliation

• ¹ Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC.

• PMID:

  14517124

• PMCID:

  PMC202283

Free PMC article

Andrew J Kotaska et al.

CMAJ.

2003.

Free PMC article

. 2003 Sep 30;169(7):666-9.

Authors

Andrew J Kotaska 
¹
, Jasenka P Matisic

Affiliation

• ¹ Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC.

• PMID:

  14517124

• PMCID:

  PMC202283

Abstract

Background:

Cervical Papanicolaou (Pap) smear screening is an effective method of detecting cytological changes in the cervix before they lead to cervical cancer. However, the quality of a Pap smear can be compromised by inflammatory exudate, inadequate cellularity or failure to sample the transformation zone. We evaluated the effect of routine cervical cleaning on Pap smear quality.

Methods:

In a primary care setting, we compared the quality of Pap smears obtained after cervical cleaning (with a dry, oversized cotton swab) with the quality of historical control slides obtained from the same women without prior cervical cleaning. The results for both groups were then compared with statistical averages for the province of British Columbia.

Results:

Inflammatory exudate was reported in 1 (0.3%) of the 334 study smears and 72 (11.0%) of the 652 control smears (p < 0.001). Inadequate endocervical or metaplastic squamous cells were reported in 11 (3.3%) of the study smears and 90 (13.8%) of the control smears (p < 0.001). Inadequate cellularity was reported in 13 (3.9%) of the study smears and 9 (1.4%) of the control smears (p = 0.01). There were similar statistical differences between the study group and provincial averages. The results for the control group did not differ significantly from provincial averages (inflammatory exudate, 11.3%; inadequate endocervical cells, 14.7%; and poor cellularity, 2.7%).

Interpretation:

Prior cervical cleaning with an oversized cotton swab was associated with a lower frequency of smears with inflammatory exudate or inadequate endocervical cells and, to a lesser degree, a higher frequency of smears with inadequate cellularity.

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How to ensure a healthy vagina, vulva, cervix, and uterus

Knowing how to look after your vagina, vulva, cervix, and uterus can lead to a healthier, safer, and more pleasurable life. More than just knowing the anatomy, understanding parts of the vulva and uterus can be the first step towards taking care of your own sexual health, pleasure, and wellbeing. 

The vagina & vulva  

The vagina is the muscular tube inside the body which runs from the vaginal opening to the cervix. The vulva is the external part of the genital area surrounding the vaginal opening.   

The vulva and vagina come in different shapes and sizes and are totally unique to the individual.  

Practicing a healthy lifestyle with a good diet and exercise can help keep the vagina and vulva in good shape. Walking and running can help tone up the pelvic floor, along with pelvic muscle training which is the practice of contracting and relaxing the pelvic floor muscles, also known as Kegels.  

Natural hygiene  

It is normal for the vagina to produce discharge – this discharge helps the vagina to clean itself naturally. Vaginal discharge can vary in amount and consistency throughout the menstrual cycle, pregnancy and menopause based on hormonal changes.   

Healthy discharge doesn’t have a strong smell or colour and shouldn’t cause itching, burning or soreness. However, if you notice any unusual changes in smell or colour or any symptoms such as burning or itching associated with the discharge, contact your local healthcare provider.  

Washing the vagina & vulva  

We recommend gently washing the vulva with water alone or a mild unperfumed soap and to avoid using harsh scented products. This can help reduce the risk of infections such as thrush or bacterial vaginosis caused by perfumed soaps.  

As noted above, the vagina cleans itself naturally. The vagina contains lots of good bacteria which protects it from other organisms and helps keep the pH levels in balance. The healthy pH balance can be disrupted by washing inside the vagina (douching) or using scented wipes and deodorants. We recommend avoiding douching and using scented products.  

Sexually transmitted infections (STIs)  

During sex some bacteria and viruses can get into the vagina and make their way up to the cervix and uterus. These can lead to sexually transmitted infections (STIs) such as chlamydia, gonorrhea, genital herpes, and HIV. The vagina, cervix, and uterus can be protected from these infections by using a condom during sex.  

Condoms are recommended as the only form of contraception to prevent unintended pregnancies and to protect against STIs, including HIV.  

Always seek medical advice if you think you are at risk of an STI or experience changes to the smell or colour of discharge.  

The cervix  

The cervix is the lower, narrow end of the uterus that forms a canal between the uterus and vagina. It helps to keep bacteria and viruses from getting into the uterus and produces mucous to help sperm get through to fertilize an egg around the time of ovulation. 

Cervical screening  

The main tools in the fight against cervical cancer are vaccination and screening. Following the World Health Organization’s guidance, we recommend that all young people 9-26 years receive the HPV vaccination where available.   

Regular cervical screening for adults is also highly recommended. Being screened regularly can help early detection of any abnormal cell changes in the cervix and ensure access to treatment to prevent cancer developing.  

Depending on where you live, you may be invited to a screening. If not, contact your local healthcare provider to set up an appointment. 

The uterus  

Often described as pear-shaped, the uterus (womb) sits in the pelvis between the bladder and rectum and is connected to the vagina by the cervix. The uterus enlarges during pregnancy and often shrinks back to its original size within several weeks after delivery. On either side of the uterus are the fallopian tubes and ovaries, and together with the vagina and cervix make up the female reproductive system.  

The lining of the uterus thickens and sheds each month which is what causes menstrual bleeding. 

Taking care of your uterus 

Like the rest of the body there are several ways to keep your uterus healthy including exercise and diet.  However, there are some medical conditions, which can affect the uterus.  

The uterus can be affected by painful conditions such as fibroids, polyps, endometriosis, and cancer. Some people may experience irregular menstrual bleeding or difficulty getting pregnant. Pain is often felt in the pelvic and lower abdominal areas.  

It is important to seek medical advice from your local healthcare provider if you have any symptoms and concerns. Being proactive about your health and wellbeing can ensure you get access to the right treatment and care should you need it.  

Main photos courtesy of Jessica Dance

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Painless curettage of the uterine cavity in the clinic NEOMED!

• Description

Curettage of the uterine cavity (gynecological cleansing, curettage) is a procedure in which the gynecologist removes the top layer of the lining of the uterus using a vacuum system or a special instrument. Curettage is currently carried out in order to treat and diagnose a wide variety of diseases and pathologies associated with the female genital area.

Why is curettage and histological examination of the obtained material performed? This procedure allows you to prevent a large percentage of complications in the form of uterine bleeding or degeneration (dysplasia) of endometrial cells into malignant ones. Such processes are inevitable with the growth of pathological formations in the area of ​​​​the uterine cavity, as well as their germination beyond its limits (into neighboring tissues).

Histological examination is mandatory to assess the structure of tissues (under a microscope), which are taken during scraping. This is a very important stage of the examination, because it is histology that makes it possible to distinguish precancerous changes and cancer from healthy tissues. Histology results are ready in an average of 10-14 days.

How curettage works in the NEOMED clinic

Before the procedure (during the preliminary consultation), the doctor discusses in detail with the patient all questions about the upcoming manipulation. Since the procedure is a surgical intervention, the doctor will prescribe a series of tests to make sure the procedure is safe. As a rule, this is a smear for microbiocinosis (the degree of purity of the vagina), a study for infections, AIDS, syphilis, hepatitis, a clinical blood test, a coagulogram.

To perform the intervention under general anesthesia, you will need to pass all the necessary tests, the list of which can be found in the appropriate section of the Laboratory website – “Tests before anesthesia”.

On average, therapeutic curettage of the uterine cavity takes no more than 20 minutes. The operation is carried out with the obligatory use of intravenous anesthesia (general anesthesia). Throughout the medical sleep, the patient is under the supervision of an anesthesiologist.

Thus, the absence of pain and complications is guaranteed. Curettage of the cervical canal and uterine cavity in our clinic is carried out in a modern operating room, the equipment of which fully meets the accepted standards of sanitary hygiene.

During the operation, modern surgical equipment from reliable manufacturers of medical equipment is used.

Disposable materials are used, the patient’s condition is under constant control. After the curettage is completed, the woman lies down in a comfortable ward of the day hospital, where she remains until the anesthesia is completely passed under the supervision of the nursing staff and the anesthesiologist. The patient is then discharged.

After a full recovery, the patient can leave the clinic on her own, following all the recommendations of the doctor. Since the procedure is performed under anesthesia, care should be taken to be accompanied on the way home.

How to prepare for the procedure

The following measures should be taken 2-3 days before the curettage.

• refuse sexual contact;
• stop taking medicines that come in the form of vaginal suppositories, sprays or tablets. Of course, unless otherwise agreed with the gynecologist;
• you can not use intimate hygiene products, douching.

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Medical experience: since 2007

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Medical experience: since 1994

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I would like to note the gynecologist Sergey Yuryevich Gladkov. Very good, delicate and competent. I have something to compare with, so now I go only to him … and I will not go to anyone else. And the clinic itself, to be honest, could be better .. although private, but the service there is not very good. I only go because of the doctor.

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I turned to Yulia Valerievna already in position. Signed up for pregnancy management 2-3 trimester. There are some difficulties that she helps me to cope with. A very responsible and attentive gynecologist, I do not regret that I turned to her.

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I made an appointment with a gynecologist at Neomed, it didn’t matter which doctor I got. Since then, I have been seeing Sergei Yurievich for almost 1.5 years. I am very satisfied with the doctor, many problems were solved. With such a gynecologist, I am calm for my women’s health

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Yuliya Kasatkina, 09/27/2018

I have considerable experience in visiting doctors, maybe that’s why I chose a gynecologist for a long time. I heard a lot about Yulia Valerievna and read on the forums with girls, so I had a lot of hopes. While everything is completely satisfied. We’ll look at the results next.

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Anna S., 10/12/2018

I made an appointment with a gynecologist. Everything suited me. Reception on time, did not sit in line, was called to the office. Administrators are friendly. Answered all questions on analyzes, including their cost.

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Victoria S., 10.10.2018

I liked the fact that Nelly Vasilievna came into my position, consulted me and advised me everything that I needed. Her treatment has already helped me. In my opinion, she is a professional in her field. In communication, she is a very calm, polite and pleasant person. In the future, I am not going to change the doctor, I will be observed by her.

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Ksenia Bozz, 12/25/2017

I have been seeing Inna Mingiyanovna for several years now. Competent, qualified, and most importantly attentive Doctor. For a very long time I was looking for a doctor whom I could trust unconditionally, without doubting the accuracy of the diagnosis and that unnecessary procedures would not be imposed. Neomed clinic was recommended by a colleague. And it is Sladkomedov. I went for a trial appointment, I liked the attitude of the doctor. Inna Mingiyanovna found a problem in me that other doctors could not diagnose, treated, without unnecessary manipulations, tests, consultations. Very satisfied with the doctor and clinic…

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I have been visiting this clinic for several years now, I like everything very much: very clean, comfortable.., large bright and warm rooms.., polite and helpful staff .. Thanks to Dr. Gladkov S.Yu. for professionalism: always attentive examination and answers to all questions.. And in the future I plan to contact only this clinic..

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Curettage of the cervical canal in the Operating Room No. 1 “Paracelsus”

Curettage of the cervical canal in the Operating Room No.

1, Aleksandrov

Curettage of the cervical canal is an operative manipulation in gynecology for the diagnosis of pathological conditions, as well as the prophylactic removal of the surface layer of cells. The cervical canal is a hollow tube-shaped organ that connects the body of the uterus and appendages. It is lined with a cylindrical glandular epithelium and produces a mucous secretion.

Curettage refers to one of the most frequent medical and diagnostic procedures, which allows you to clean the inner surface of the cervix from a layer of cells.

Readings

Despite the modern capabilities of diagnostic equipment and the minimization of traumatic effects, the procedure should be carried out only according to strict indications.

Separate curettage of the cervical canal is carried out according to the following indications:

• vaginal discharge of bloody nature between periods, cycle disorders, painful periods;
• suspected metaplasia and malignancy of cervical canal cells;
• endometriosis – spread of endometrial cells to the cervix and posterior cervical space;
• cervical polyp formation;
• the need for a diagnostic study of the inner layer of the cervical canal.

The procedure allows you to diagnose cervical erosion, endometriosis, dysplasia, damage to the myoma nodes of the cervix and some other diseases.

Preparation

Despite the low invasiveness of the manipulation, there are risks of bleeding and other complications, so it is important to assess the general readiness of the patient’s body for it. The gynecologist appoints a list of mandatory examination methods:

• complete blood count;
• biochemical blood test with coagulogram to assess the blood coagulation system;
• vaginal smear for purity, as well as cytological examination;
• blood test for syphilis, HIV, hepatitis.

Preliminary instrumental examination methods include ultrasound of the pelvic organs, ECG to determine risks during manipulation. Also, after a preoperative medical examination, patients have to consult a therapist, who gives an opinion on the safety of curettage.

Procedure

The course of the operation includes the following steps:

• disinfection of the external genital organs;
• intravenous anesthesia for comfortable manipulation;
• control gynecological examination with mirrors;
• introduction of a special dilator into the vaginal cavity;
• gentle dilatation of the cervical canal;
• direct mechanical scraping procedure using a special tool – a surgical curette;
• placing scrapings in a laboratory container for transportation to histological and cytological examination.

Consequences

A successful operation occurs without disturbing consequences for the body, however, there are often minimal discomfort changes after curettage – weak bleeding, discomfort or moderate pain.

Complications include the following conditions:

• inflammatory changes;
• bleeding from damaged vessels;
• perforation into the cavity of other organs.

Recovery

After stopping the bleeding and assessing the general condition as stable, the patient is transferred to the ward, where she is under the supervision of medical personnel for at least 2 hours. It is important to follow all medical prescriptions:

• take antibiotics, antispasmodics and anti-inflammatory drugs;
• refrain from intimacy for about 2 months;
• avoid physical activity for about 4 weeks;
• for the first time to refuse thermal procedures – active insolation, visits to baths and saunas.