Home Hygiene Microscopic examination of a smear in women. Colposcopy The conclusion issued by the laboratory indicates

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Microscopic examination of a smear in women. Colposcopy The conclusion issued by the laboratory indicates

Flora smear in women- a laboratory test that determines the types of bacteria that are present in the vagina. This is the most common and simplest method for detecting inflammation and STDs (sexually transmitted diseases).

The examination is absolutely painless. It is performed during a routine gynecological examination. The doctor takes the material with a disposable spatula from the walls of the vagina and cervix. The contents of the vagina (vaginal secretions) are applied to the glass. In the laboratory, the material is stained so that the bacteria become clearly visible.

Purpose of the study

determine the state of the vaginal microflora;
identify sexually transmitted infections and their causative agent;
determine the degree of the inflammatory process;
assess the degree of cleanliness of the vagina, which is mandatory before further diagnostic studies and gynecological operations - cauterization of erosions, removal of polyps, curettage;
assess the health status of pregnant women.

When does a gynecologist take a smear for flora?

complaints of itching or vaginal discharge, other symptoms of inflammation;
preventive examinations;
control of the treatment;
taking hormonal drugs and immunosuppressants;
control of microflora during long-term use of antibiotics;
pregnancy. It is carried out 3 times during pregnancy (at registration, at the 30th and 36th week).

This study has many names: smear for flora, general smear, bacterioscopy, smear for cleanliness. There are also smears on the flora from the urethra and cervical canal. Usually these three types of smears are performed together.

Normal vaginal microflora

A healthy woman's vagina is not sterile. It contains many types of microorganisms, their totality is called microflora. Bacteria constantly compete with each other for habitat on the walls of the vagina and for food.

The most numerous are lactobacilli and bifidobacteria, which attach to the vaginal epithelium. They produce alcohols, peroxide, lactic and other acids, which provide an acidic reaction in the vaginal secretion. As well as lysozyme and other enzymes that inhibit the proliferation of other types of bacteria.

Microorganisms that make up the microflora of a healthy woman

Microorganisms	Number of CFU/ml
Lactobacilli or Doderlein sticks Lactobacillus spp.	10 7 -10 9
Bifidobacterium Bifidobacterium spp.	10 3 -10 7
Clostridia Clostridium spp.	Up to 10 4
Propionibacterium spp.	Up to 10 4
Mobiluncus Mobiluncus spp.	Up to 10 4
Peptostreptococcus Peptostreptococcus spp	10 3 -10 4
Corynebacterium spp.	10 4 -10 5
Staphylococcus Staphylococcus spp.	10 3 -10 4
Streptococci Streptococcus spp.	10 4 -10 5
Enterobacteriaceae	10 3 -10 4
Bacteroides spp.	10 3 -10 4
Prevotella spp.	Up to 10 4
Porphyromonas Porphyromonas spp.	Up to 10 3
Fusobacterium Fusobacterium spp.	Up to 10 3
Veilonella spp.	Up to 10 3
Mycoplasma M.hominis	Up to 10 3
Ureaplasma U.urealyticum	10 3
Candida - yeast-like fungi	10 4

Abbreviation CFU/ml means - colony-forming units in 1 ml of nutrient medium. Each colony-forming unit is a microorganism from which a colony can form.

The number of bacteria is expressed in decimal logarithms in order to avoid writing numbers with a large number of zeros.

In the description of vaginal microflora one can often find the names gram-positive or gram-negative bacteria. These terms mean that the first bacteria are stained according to the method developed by the microbiologist Gram, while the others do not change their color.

Gram-positive rods in a smear, which include lactobacilli, are a good sign. Normally, they predominate in women of reproductive age. During menopause (menopause) and postmenopause, gram-negative bacteria come first.

Depending on their oxygen demand, bacteria are divided into

aerobic- those that develop in the presence of oxygen;
anaerobic- which do not require oxygen to function.

In the vagina of a healthy woman, most bacteria are anaerobes 10 8 -10 9

CFU/ml.

How to make a smear on the vaginal microflora?

A smear is taken in the gynecologist's office. A woman can also undergo this test in a private laboratory.

The procedure includes several stages.

The woman is placed in a gynecological chair.
Insertion of sterile speculum to gain access to the vaginal walls and cervix.
Collection of material from the posterior wall of the vagina. This procedure is absolutely painless. Unpleasant sensations can only occur when the spatula touches the inflamed area.
Applying material to a glass slide. The vaginal secretion is distributed with streaking movements over the skim glass in the thinnest possible layer so that the cells are arranged in one row and do not cover each other.
Fixation of the smear is necessary if it is delivered to the laboratory after more than 3 hours. The treatment avoids cell deformation during drying and makes it possible to preserve the drug.
Smear staining using the Gram method. Methylene blue is used as a dye. After staining, it is easier to establish the type of bacteria and determine the composition of the microflora.
Evaluation of the result, which consists of 3 parts: counting leukocytes, species composition of microflora, assessment of vaginal cleanliness.

Often, a smear is taken from three points at once:

openings of the urethra and paraurethral passages (narrow canals located parallel to the urethra);
vaginal walls;
cervical canal.

The anatomical proximity of these areas leads to the fact that infections and inflammations occur interconnectedly. For each area, use a separate sterile spatula, brush or cotton swab. The taken material is applied to 3 sterile glass slides, separately for each area.
A vaginal flora smear is an absolutely harmless procedure that is allowed, including for pregnant women. During the collection of material, the mucous membrane is not injured, so there are no restrictions after the procedure. It is allowed to take a bath, swim, have sexual intercourse, etc.

How to prepare for this smear?

It is necessary to take a smear for flora no earlier than 3 days after the end of menstruation. Menstrual blood cells in the smear can interfere with the results. The optimal period is considered to be from the 10th to the 20th day of the cycle.
The result of the analysis will be as reliable as possible if you adhere to the following rules.

stop taking antibiotics and antifungal drugs 14 days before;
2 days in advance, stop administering any vaginal forms of drugs - solutions, suppositories, tablets, tampons, ointments, creams;
abstain from sexual intercourse for 2-3 days;
Before the procedure, you should not douche or wash the inside of the vagina.

What does a smear show on the vaginal microflora?

A smear on the vaginal microflora shows the presence of a number of diseases and pathological conditions.

Sexually transmitted infections (sexually transmitted infections). They are evidenced by the presence in the smear of a significant number of ureaplasmas, mycoplasmas, gardenella, gonococci, trichomonas and other pathogenic bacteria.
Inflammation vagina(vaginitis, colpitis) or cervical canal(cervicitis and endocervicitis). Evidence of the inflammatory process is a large number of leukocytes in the smear.
Vaginal dysbiosis. Violation of the composition of microflora contributes to the development of diseases of the genital area. Dysbacteriosis is diagnosed when the number of lactobacilli decreases and other types of microorganisms begin to predominate.
Candidiasis or thrush. Normally, single fungi of the genus Candida are acceptable. With a fungal infection, their number increases sharply, and pseudomycelium is found in the smear - threads of elongated cells and bud cells sitting on them.

The flora smear evaluates the following indicators:

4 degrees of vaginal cleanliness

Degree	Identified changes	What is he talking about?
I	The environment is acidic. Leukocytes - up to 10. Epithelial cells - 5-10. Most microorganisms are lactobacilli (Dederlein bacilli). Other bacteria - sporadically. Mucus - a small amount.	Ideal state of vaginal microflora. It is extremely rare in women of childbearing age who are sexually active.
II	The environment is slightly acidic. Leukocytes - up to 10. Epithelial cells 5-10. Most are Dederlein sticks. Gram-positive cocci in small numbers. Small amounts of mucus.	Normal condition. Occurs in most healthy women.
III	The environment is neutral. Leukocytes - over 10. Epithelial cells - over 10. Microorganisms in moderate or large quantities. Gram-negative and gram-negative rods and cocci are present. Single Dederlein sticks. "Key" cells are present. Mucus - moderate amount.	Inflammation of the vagina - colpitis. Symptoms may occur: creamy vaginal discharge, itching, burning, discomfort during sexual intercourse. Some women are asymptomatic with this condition.
IV	The medium is neutral or alkaline, pH over 4.5. Leukocytes - over 30 or the entire field of view. Epithelial cells - in large numbers. Microorganisms in massive quantities. The microflora is represented by various opportunistic and pathogenic microorganisms. Dederlein's rods may be absent. There is a lot of mucus.	Severe inflammatory process. Symptoms: copious vaginal discharge (white, yellowish, greenish), often with an unpleasant odor. Itching, burning, dryness, discomfort. Unpleasant sensations, pain during sexual intercourse.

What is the norm for a smear on the vaginal microflora?

In smear microscopy for flora, the following is considered normal:

flat cells of the vaginal epithelium - up to 10 in the field of view;
single leukocytes - up to 10 in the field of view;
cells of the intermediate layer are single;
“false key” cells - rare;
the total number of microorganisms is “moderate”, sometimes “large”;
mucus - in small quantities;
Lactobacilli predominate among bacteria; other types of microorganisms are rare and rare.

The smear should not contain:

Large numbers of destroyed epithelial cells. This indicates cell lysis, which occurs with abnormal growth of lactobacilli.
Key cells. These are epithelial cells covered with various bacteria.
Parabasal cells. Cells of the lower layers of the mucosa. Their appearance indicates significant inflammation or atrophy of the mucosa.
"Massive" amount of bacteria, except lactobacilli.
Yeast cells with pseudomycelium and blastopores (bud cells). Their presence indicates thrush.
Strict anaerobes - most of them are pathogens.
Gonococcus - pathogens of gonorrhea.
Trichomonas - causative agents of trichomoniasis.
Atypical cells which are a sign of precancerous or oncological changes .

Some microorganisms (chlamydia, various viruses) are not detected when examined under a microscope due to their small size. To identify them, a blood test for ROC is necessary.

What do leukocytes indicate in a smear on vaginal flora?

Leukocytes- These are white blood cells that are designed to fight infection. They can exit through the wall of blood vessels and move independently. Leukocytes have the ability to phagocytose - they engulf bacteria and digest them. Once the bacterium is digested, the white blood cell is destroyed. This releases substances that cause inflammation, manifested by swelling and redness of the mucous membrane.
Normally, the number of leukocytes in the vagina should not exceed 10. A large number of leukocytes indicates inflammation. The higher the number of leukocytes, the more pronounced the inflammatory process.

Why is sensitivity to antibiotics performed when examining a smear?

Antibiotic sensitivity or antibiogram- determining the sensitivity of bacteria to antibiotics. The study is carried out simultaneously with smear culture if pathogenic bacteria that cause inflammation or sexually transmitted infections are detected in the vagina.

There are a large number of antibiotics, but not all of them are equally effective against different groups of bacteria (antibiotics do not affect viruses). It happens that after a course of antibiotics the patient does not recover or the disease returns after a few days/weeks. This happened because antibiotics that had little effect on the causative agent of the disease were prescribed for treatment.
In order for treatment to be as effective as possible, it is necessary to determine which antibiotics:

completely destroy the bacteria that causes the disease;
stop the growth of the pathogen;
do not affect the life activity of this bacterium.

Based on the research carried out, a antibiogram. This is a list of antibiotics to which bacteria are sensitive.

How is antibiotic sensitivity testing performed?

After the bacteria that caused the disease have been identified, they are distributed into several test tubes with nutrient media. A specific antibiotic is added to each tube. The test tubes are placed in a thermostat, where optimal conditions are created for their reproduction.

After cultivation (about 7 days), the growth of bacteria in test tubes is analyzed. Where bacteria are sensitive to the antibiotic, colonies do not form. This drug is optimal for treating the patient. In a test tube where drugs to which antibiotics are insensitive are added, the growth of bacteria is the most intense. Such drugs cannot be used to treat this disease.

What is smear culture?

Smear culture or bacteriological culture (bacteriological culture) of a smear is a laboratory test in which the contents of the vagina are placed in a nutrient medium and optimal conditions are created for the growth of bacteria.

Objectives of the study:

identify the causative agent of genital infection;
establish the degree of contamination - the number of bacteria in the vagina;
monitor the state of microflora after long-term treatment with antibiotics and cytostatic drugs. It is carried out 7-10 days after discontinuation of the drug.

In what case is smear culture prescribed?

to all pregnant women upon registration;
with inflammatory processes in the genital organs;
Gram-negative diplococci were found in the smear - to confirm gonococcal infection (gonorrhea);
with vulvovaginitis, recurrent or chronic.

How is microbiological testing performed?

Vaginal discharge is placed in nutrient media - solutions or jelly-like masses that contain nutrients for bacteria. Test tubes and Petri dishes are placed in a thermostat for 3-5 days, where the temperature is constantly maintained at about 37 degrees, optimal for the proliferation of microorganisms.

After cultivation, the laboratory assistant evaluates the results. From each microorganism, during the process of division, a whole colony of bacteria grows. Based on its appearance, the laboratory technician determines the type of pathogen. And by the number of colonies one can judge the concentration of these microorganisms in the vagina. Next, the concentration is compared with normal values.
Those bacteria whose concentration exceeds 10 4 CFU/ml are considered significant. At this concentration, microorganisms can cause disease. If such a quantity of bacteria is detected, the result of the analysis is considered positive.

The conclusion issued by the laboratory states:

view microorganism that predominates in the smear;
pathogenicity microorganism - ability to cause disease:

Pathogenic - the presence of which can only be caused by disease.
Opportunistic - bacteria that cause disease only when immunity decreases, with a significant increase in their number.

concentration microorganism in the vagina. In numerical terms and in the form of verbal characteristics: “meager”, “moderate growth”, “abundant growth”.

In a laboratory report, the number and growth of bacteria can be characterized by the degree of:

Degree	Features of bacterial growth
Degree	Liquid culture medium	Dense nutrient medium
I	Growth is very poor.	There is no bacterial growth.
II	Moderate growth	Up to 10 bacterial colonies.
III	Abundant growth.	From 10 to 100 colonies.
IV	Massive growth.	Over 100 colonies.

I degree is the norm. In degree II, they speak of a violation of the vaginal microflora. III-IV degrees indicate a disease caused by this type of bacteria.

Colposcopy is a gynecological research method involving a targeted and detailed examination of the cervix using a specially designed microscope.

The main purpose of colposcopy is to identify foci of epithelial degeneration into erosion or even neoplasia (precancer).

The procedure is performed as part of a routine gynecological examination in a clinic or diagnostic center.

There are several different colposcopy methods that allow you to identify all possible anomalies in the structure of the cervix and cervical canal, which allows you to identify areas of erosion and dysplasia (degeneration) of the epithelium. This method is the earliest and life-saving diagnosis of tumor processes.

Indications for colposcopy

Colposcopy is indicated for all women over 30 years of age as the main method of screening and diagnosis.

In addition, colposcopy is indicated for monitoring the cervix after treatment, for examining women of any age at risk for oncology.

Today, doctors are inclined to perform colposcopy during any in-depth gynecological examination, especially if there are patient complaints.

Contraindications

Despite the simplicity of the study, there are a number of contraindications to colposcopy:

first 8 weeks after birth,
3-4 weeks after the abortion,
recent treatment of the cervix using cryodestruction or surgical treatment.

When performing a special, extended colposcopy, a contraindication is an allergy to iodine or acetic acid.

Temporary contraindications for colposcopy may include:

bleeding from the uterus or cervix, including menstruation,
pronounced inflammatory process,
severe state of ectocervix atrophy.

Methodology

The examination is carried out by a gynecologist in a special treatment room with a colposcope. This is a special system on a tripod with illumination and the ability to additionally magnify the image with lenses up to 15-40 times.

The device is placed at a distance of approximately 20-25 cm from the cervical area. All areas of the cervix are examined by rotating special screws on a microscope.

Colposcopy is performed before two-handed examination and other procedures in the gynecologist's chair, but in this case, the discharge is first removed from the surface of the cervix.

During the research process, it is possible to conduct a targeted biopsy of particularly suspicious areas and establish an accurate diagnosis.

Colposcopy is a painless procedure, although it may cause slight discomfort when processing reagents or taking a biopsy.

Kinds

Colposcopy is carried out in several types:

A survey or simple colposcopy is an examination of the cervix and cervical canal without the use of any means. Gives an idea of the shape and size of the cervix, its condition, the presence of injuries and ruptures, the nature of the discharge, the condition of the mucous membranes and blood vessels.
colposcopy with color filters, especially green ones, allows you to assess the condition of the vascular network.
advanced colposcopy method. This is an examination of the cervix and its assessment using treatment with special substances. Typically, a 3% solution of acetic acid is used to evaluate the vascular reaction and the isolation of areas of neoplasia due to this. The second stage is treatment with a solution of glycerin and Lugol. Pathological areas are not stained with this solution and are clearly visible upon examination.
chromocolposcopy method with treatment of the cervix with special dyes. Abnormal areas of tissue are not stained.
a colpomicroscopy method with a magnification of up to three hundred times, which allows one to evaluate the microscopic structure of cells and their constituent elements (nuclei, cytoplasm, inclusions).

Preparation for the procedure

Colposcopy is performed outside of menstruation, preferably immediately after or before menstruation.

On the eve of the study, you should stop having sexual intercourse, using lubricants and douching.

Before the procedure, you can take paracetamol to facilitate the examination process.

Carrying out colposcopy

On average, the examination takes 20 minutes, before which you need to undress from the waist down and lie down on a gynecological chair.

The doctor will conduct a visual examination of the vagina and cervix by inserting speculum into the vagina. The speculum will remain in the vagina during the procedure. During the process, the walls and cervix will be irrigated with saline to prevent the mucus from drying out.

After a general examination of the cervix with a microscope, it is treated with acetic acid - this can be unpleasant and may resemble a burning sensation. In a couple of minutes, inspection and further processing with Lugol with glycerin will begin.

If a biopsy is necessary, the doctor will take a piece of tissue no larger than 2-3 mm with a special tool; this may cause short-term discomfort. If necessary, the doctor will also perform curettage of the cervical canal, which gives a pulling discomfort due to cervical spasm.

After the procedure

After colposcopy, it is necessary to wear panty liners for about 3 days; there may be slight spotting bleeding due to damage to blood vessels. There may be liquid discharge that is dark or green in color and odorless, but this is acceptable.

After colposcopy, sexual intercourse, douching and the use of tampons, vaginal preparations and intimate hygiene products are prohibited for 5 days.

Complications after colposcopy

Colposcopy is a safe method that rarely causes complications.

However, in rare cases there may be:

increased bleeding,
temperature increase,
abnormal discharge,
pain in the lower abdomen for more than one day after the procedure.

These symptoms that do not go away on the second day are a reason to immediately consult a doctor.

Normal microflora in the vagina, cervical and urethra is evidence of a woman’s excellent health. To study it, a special analysis is carried out - a smear on the flora. This is the most common gynecological examination. The analysis makes it possible to identify the presence of infections, pathogenic microorganisms and establish the causes of painful and other unpleasant sensations. Material for study is collected by a gynecologist during an examination in a gynecological chair. The process is absolutely painless, safe and highly informative.

In order to obtain reliable data, you should properly prepare for the procedure. Your doctor will help you decipher the results. But it wouldn’t hurt to know what certain indicators mean, what their norm is and what deviations indicate.

Flora smear in women - indications for the procedure

A smear for microscopic examination in women is often performed during a routine examination by a doctor. To maintain your health, you should visit a gynecologist once every six months. Additionally, the procedure is prescribed if there are the following indications:

Pain in the lower abdomen that bothers a woman regardless of the day of her cycle.
Painful urination that is not associated with nephrological or urological diseases.
Itching and burning sensation in the vagina.
Pathological vaginal discharge, which has an unpleasant odor, dark color and heterogeneous structure.
Planning pregnancy to exclude the presence of an inflammatory process or infectious disease in the genitals.
Completing a course of antibiotics to make sure there is no thrush, which often occurs when the body and immune system are weakened.
Constant overwork, stress, anxiety, poor nutrition and a decrease in the body's defenses due to frequent colds.
Pregnancy, because during this period the number of beneficial lactobacilli decreases significantly. This causes a decrease in the body's defenses, as a result of which the genitals are more susceptible to various types of infections.

In addition, a woman can consult a doctor at any time for a flora smear.

How to prepare for the study and the procedure for conducting it

In order for the data obtained during a microscopic examination to be correct, it is necessary to properly prepare for the procedure. First of all, the following rules should be observed:

Refrain from sexual intercourse for two days before visiting the gynecologist.
Stop using lubricants, vaginal suppositories, and douching a couple of days before the procedure.
The procedure cannot be performed during menstruation.
You should not take a bath 2 days before taking a flora test.
On the day of your visit to the gynecologist, do not use detergents other than regular toilet soap to wash your external genitalia.
Try to refrain from urinating for three hours before the procedure.

The procedure is performed by a gynecologist on a gynecological chair. A special speculum is inserted into the vagina, and material for examination is collected using a spatula or sterile cotton swab. As a rule, a smear is taken from three places - the cervical canal of the cervix, the opening of the urethra and the vaginal mucosa. The procedure does not cause unpleasant or painful sensations and does not require rehabilitation or recovery.

Deciphering a smear in women

A smear test for flora in women can reveal the presence of pathogenic bacteria or ensure excellent health. In a normal state, the microflora is 95% populated by beneficial lactobacilli, the main purpose of which is the production of lactic acid. The synthesized substance helps maintain normal acidity and helps preserve the health of the genital organs from the effects of pathogenic organisms and infectious agents.

In addition to beneficial lactobacilli, the flora is populated by candida and gardnerella, the content of which should be minimal. As a result of a weakened body, these microorganisms actively multiply, which provokes the development of a number of diseases - candidiasis (thrush), vaginal dysbosis and gardenerellosis.

Indicators of microscopic examination of a woman’s smear.
The results of the analysis indicate a lot of data, the decoding of which is explained by the doctor. In order to independently navigate the laboratory extract, read the information below.
To simplify the work, the analysis results indicate letters that have one or another meaning. Thus, to indicate the place from which the material for analysis was collected, the following designations are used:

V (“vagina”) – mucous membranes of the vagina.
C (“cervix”) – cervical canal of the cervix.
U (“uretra”) – opening of the urethra.

Additional designations:

L – this is the designation for leukocytes, of which there should normally be a minimum number. With the development of the inflammatory process, their number increases significantly.
Ep (“epithelium”). An increase in this indicator indicates the occurrence of an inflammatory process in the genital organs.
Gn is a gonococcal bacterium, which indicates the presence of a gonococcal infection.
Trich – the presence of the causative agent of trichomoniasis in the flora.

Smear standards for women:

Slime. In the vagina and cervix, its small presence is normal, but its presence in the urethra indicates an infectious disease.
Gonococci, trichomonas, candida, key cells are normally absent, and the detection of bacteria indicates the development of diseases.

An important indicator is the degree of vaginal cleanliness, of which there are 4 in total:

Grade 1 is evidence of the woman’s absolute health; the smear reveals 95% of lactobacilli and small quantities of leukocytes and epithelial cells.
The second degree of purity is characterized by the presence of a minimum amount of opportunistic microorganisms in the samples.
Grade 3 - in this case, more pathogenic bacteria were identified than Doderlein bacilli.
Stage 4 is characterized by the presence in the smear of a large number of epithelial cells, leukocytes and harmful microorganisms.

Regular smear examinations in women allow timely detection of the slightest pathological changes. This makes it possible to start treatment on time, because in the first stages the disease is much easier to cure. It is especially important to carry out the analysis for women who are planning a pregnancy or are susceptible to frequent colds and stress. You should definitely undergo an examination if you experience pain in the lower abdomen and other unpleasant and uncomfortable sensations in the genitals.

Microscopic examination of a smear allows one to identify beneficial and pathogenic microflora in a woman’s genital tract. Therefore, it is considered a very informative diagnostic method, identifying various diseases in gynecology from inflammatory processes to malignant formations of the genitourinary system.

Typically, the gynecologist prescribes one of three smear examinations to patients: microscopic, bacteriological or cytological. What each gynecological smear means and what test results can be obtained will be described below.

Microscopic analysis of a smear for microflora

Microscopy involves taking a smear from three areas: the vagina itself (V), the cervical canal (C) and the urinary canal (U). In some cases, a smear is taken from the rectum (R). How is content collected for research? The mucus is collected with a spatula or spatula. This is done carefully so as not to damage the mucous membrane in the marked areas. Before this, the doctor inserts a special mirror into the vagina, through which he sees the vaginal surfaces and the cervix. The mucus taken is distributed onto a glass slide and sent for study.

Smear bacterioscopy involves staining the material with a dye, drying it, and identifying the species under a microscope. In this case, not only the species of microorganisms (bacteria, fungi, etc.) is assessed, but also the quantitative indicators of each species. The results of the analysis are reflected on a paper form.

Interpretation of individual microscopy indicators

The transcript of the smear contains the following information:

Epithelium. Its presence is the norm up to 15 units. in sight. Examination of the vagina reveals squamous epithelium, a smear from the cervical canal reveals columnar epithelium. Epithelial values exceeding normal values indicate inflammation in the organ. Interpretation of the parameter is possible only in conjunction with other analysis data.
Leukocytes. For the vagina, the norm is about 5 units. in sight. For the vagina – 10 units. For the cervix – 30 units. in sight. Some white blood cell content is necessary for the organ to support and protect against adverse conditions. Exceeding the indicator means the presence of inflammation (colpitis, cervicitis or urethritis). The laboratory mark “covering the field of view” means that the inflammation is at the peak of its development, that is, in an acute form.
Bacteria. In women of childbearing age, gram-positive rods with lactobacilli are normally found in the vagina. The content of microorganisms in the cervical canal is lower than in the vagina. Normally, there should be no microflora present in the urination channel. A variety of pathogenic microorganisms explain the development of vaginal dysbiosis or inflammation.
Trichomonas, gonococcus and key cells in healthy women are not shown by normal smears. If there are any, then we are talking about the existence of trichomoniasis, gonorrhea or gardnerellosis, respectively.

Read also: How is the possibility of having twins transmitted?

Preparation for smear microscopy. Following the basics of preparation for a smear test will help you obtain the most reliable test results. These are the rules:

Eliminate antibiotics approximately 14 days before the smear test.
Do not use local contraceptives, antibacterial and antiseptic drugs approximately 3 days before the test.
The day before the smear, you should not be sexually active.
Three hours before visiting the gynecologist, you should not wash your face or douche.

Taking a smear is considered a painless and safe procedure, which is recommended for all women to perform once every six months.

Cytomorphological analysis of smear

This type of female smear has other names - a smear for cytology or for atypical cells; Pap testing. The purpose of this analysis is to detect atypical cells indicating the development of a pathological condition in the cervix (dysplasia or malignancy). The Pap test allows you to diagnose papilloma viral infection, which is directly related to dysplasia and cancer. Material for analysis is collected from the surface of the uterine cervix bordering the vagina, as well as from the cervical canal. The material applied to the glass is sent for study. According to the results of the study, smears are divided into 5 types:

The first is that the composition of the cells of the material (cytogram) has no features. In other words, the cervix is in perfect order. Second, the composition of the cells characterizes inflammation or mild dysplasia. Having seen a similar result, the doctor prescribes treatment for inflammation and subsequent Pap test. Third, the cells contain signs of mild or severe dysplasia. For such tests, the doctor usually recommends additional examination in the form of colposcopy, biopsy of cervical tissue and histological examination of the collected material.

Type 4 – characterizes a precancerous condition of the genital tract in women, suspected of cancer. With this test result, the patient receives a referral for examination with subsequent treatment to a gynecological oncologist. Type 5 – malignant formation or cancerous tumor. The woman receives further examination and specific treatment in an oncology clinic. Similar to the situation with a smear for microflora, the accuracy of cytology is determined by the literacy of the woman’s preparation for collecting the material.

A mandatory procedure when visiting a gynecologist is to take biological material to assess the condition of the microflora and epithelial cells of the vagina, the internal mucous membrane of the uterine body, endometrium, and cervical canal.

A gynecological smear, the examination and interpretation of which is carried out in a laboratory setting, is highly informative.

The analysis allows us to determine the hormonal level of the reproductive system, the amount and composition of vaginal discharge, the bacterial content of microflora in women, prevent inflammatory processes, identify developmental pathologies, the presence of neoplasms and infections that are sexually transmitted.

Diseases of the female reproductive system are dealt with by a specialized branch of medicine - gynecology.

There are many reasons for patients to apply: undergoing a medical examination for employment, pregnancy, painful or unpleasant cramping sensations in the lower abdomen, itching or burning, thrush, heavy menstruation or discharge of unknown origin.

A general smear or microscopy is performed during a preventive examination or during pregnancy planning. The result is the study of the cervical and urethral canal, vagina, and in virgins - the rectum.

Papanicolaou cytology analysis makes it possible to timely detect the papilloma virus, precancerous conditions of the epithelium, and cervix. It is recommended that all females with hereditary cancer diseases and those over 21 years of age undergo a Pap test.

A bacteriological research method, bacterial culture in women, is recommended if there is a suspicion of an inflammatory process, a disorder of the microflora, which was caused by opportunistic and pathogenic microorganisms.

PCR is carried out in the form of an analysis for infections transmitted mainly through sexual contact. Provides complete information about the bacterial composition of the internal microflora.

The effectiveness and reliability of the method is 98%.

Preparing for a smear test

Before prescribing an examination, the gynecologist or laboratory employee is obliged to warn the patient about how to properly take a smear for flora, what can and cannot be done before the procedure.

Preparation for a microscopic examination involves avoiding strong antibiotics 2 weeks before the expected analysis and visiting the bathroom the day before. You should try not to go to the toilet 2 hours before the test.

It is better to do diagnostics not before, but during menstruation and in the first two days after.

To increase the sensitivity of the test, microflora culture is carried out in the absence of treatment with antibacterial drugs and douching. Be sure to follow a special diet 2-3 days before the bacteriological analysis: limit foods that provoke fermentation or intestinal upset.

Refrain from sexual intercourse with your partner and do not wash yourself 24 hours before data collection.

3-5 days before the prescribed PCR diagnosis, taking any antibacterial and contraceptive drugs is prohibited. It is necessary to avoid sexual intercourse for 36 hours. It is advisable not to shower the day before the PCR and on the eve of the test. The material is taken during menstruation and for 1-2 days after its end.

How to take a smear from women

The technique for collecting material is usually carried out in the morning in the gynecology department or directly in the laboratory itself. Taking vaginal discharge and areas for examination is prescribed only for women who are sexually active. In girls, it is taken more carefully from the lateral vault of the vagina to prevent damage to the hymen, and from the intestines, secretion.

All manipulations take place on a gynecological chair. At this time, the specialist introduces a special mirror depending on the age and physiological characteristics of the patient. If the organs are not yet formed, size XS is used, girls will need a mirror S. After labor, examination instruments with a diameter of 25-30 mm, sizes M, L are used.

The material is collected with a spatula or spatula, brush, applied to a glass slide or placed in a test tube for further transfer of the results to the laboratory.

Microflora smear: interpretation

It is impossible to independently draw a conclusion about how good or bad a smear is without the appropriate knowledge. Using special notations, it is very easy to decipher a microscopic examination of a smear. Depending on the location of the biological material taken, they are distinguished: vagina - “V”, cervix - “C” and urethra - “U”.

Gram-positive rods, “Gr.+” and the absence of coccal flora. The result is “++++”. It is observed quite rarely, most often it is a consequence of intensive antibacterial therapy. Norm: “++”, “+++” rods, the number of cocci does not exceed “++”.

Gram-negative bacteria gonococci - “Gn”, trichomonas vaginalis - “Trich”, yeast of the genus “Candida”. Corresponds to diseases such as gonorrhea, trichomoniasis and candidiasis.

The presence of key cells and E. coli, if they are listed in the microflora, indicates that the patient has bacterial vaginosis.

Flora smear: normal in women

All patients, without exception, from the age of 14 until the onset of menopause, correspond to the same standard, obtained as a result of laboratory microscopic examination.

Leukocytes. Providing protection for the body from penetrating viruses, bacteria and infections, they can be in the field of view, but should not exceed the indicator in the vagina - 10, in the cervix - 30, urethra - 5.

Epithelium. A moderate amount of epithelial tissue is normal. A high number indicates possible inflammation, while a too low number indicates insufficient production of the hormone estrogen.

Slime. A small amount or no quantity is allowed. The maximum daily rate of secretion from the glands of the cervical canal is 5 ml.

Gram-positive rods, “Gr.+”. Lactobacilli and Doderlein bacilli must be present in large quantities. They are responsible for the body's immune response to foreign bodies. They should not be in the cervix and urethra.

“Gr.-”, gram-negative, anaerobic rods are not detected.

Gonococci with the symbol “gn”, Trichomonas, chlamydia, key and atypical cells, fungi, yeast, Candida are absent. If they are detected in the results, the patient is prescribed additional testing for gonorrhea, trichomoniasis, chlamydia, bacterial vaginosis, and thrush.

Smear for purity level

To avoid complications during pregnancy, pregnant women are advised to determine the degree of purity of the gynecological smear. Normally, in a healthy woman, 95-98% of the vaginal microflora consists of Bacillus vaginalis or Lactobacillus bacillus Doderlein. They produce lactic acid, which helps maintain acidity levels.

Pathogenic and opportunistic microorganisms are not able to survive in such conditions. But under the influence of various factors, such as sexual activity, menopause, the menstrual cycle and decreased immunity, microflora indicators can change.

1st degree Normal vaginal cleanliness is pH 3.8-4.5. The environment is acidic. Leukocytes and epithelial cells - no more than 10.
2nd degree. Slightly acidic environment: pH=4.5-5. There is a slight increase in gram-positive cocci and Candida fungi.
3rd degree. Pathogenic microorganisms are activated, mucus appears, and epithelial indicators exceed the norm. Neutral acidity level, pH=5-7. There are over 10 leukocytes. Mucus, key cells are present, gram-negative and gram-positive microorganisms multiply in favorable microflora conditions.
On the last one, 4 degrees, cleanliness is low. pH values reach 7.5. Doderlein's rods are either completely absent or found in single quantities. The vagina is filled with pathogens.

Bacteriological research

The variety of composition, in addition to Lactobacillus bacillus Doderlein, which is an integral part of the vaginal microflora of the woman being examined, does not begin to be studied immediately. Sowing the collected biological material onto a specially created favorable environment for its subsequent growth, development and reproduction takes time.

Bacteriological culture of flora can be assessed through a microscope, provided that the number of representatives of microorganisms increases.

0 class. Observed during treatment with antibiotics. The pathogen is absent.
I class. The number of bacteria does not increase or increases moderately.
II class. Mixed nature of microflora. Up to 10 colonies of bacteria Gardnerella vaginalis or Mobiluncus, the causative agents of gardnerellosis, are detected.
III class. There are about 100 colonies. The microflora is predominantly inhabited by Gardnerella and Mobiluncus. Symptoms of bacterial vaginosis appear.
IV class. Lactobacilli are absent, immunity is weakened. Diagnosis of acquired infectious disease - aerobic vaginitis.

Cytological examination

The probability of detecting areas of altered epithelium, papilloma virus and oncological tumors is quite high after 30 years of age and the beginning of sexual activity.

The correct interpretation of the PAP test depends on the presence or absence of cancerous, atypical cells.

NILM. The clinical picture is without features, CBO. Leukocytes and bacteria are released in small quantities. Primary candidiasis or bacterial vaginosis is possible. The epithelial layer is normal.
ASC-US. Atypical areas of unknown origin were found in epithelial tissue. A repeat analysis is carried out after 6 months to look for chlamydia, dysplasia, and human papillomavirus.
LSIL. To confirm a precancerous condition caused by atypical cells, a biopsy and colposcopy are prescribed. Weak signs of changes in the epithelium.
ASC-H. Pronounced damage to the squamous epithelium. 1% of patients are diagnosed with the initial stage of cervical cancer, the remaining 98-99% have grade 2-3 dysplasia.
HSIL. Concomitant symptoms preceding cancer of the squamous epithelium and cervix were identified in more than 7% of the women examined. 2% have cancer.
AGC. Atypical condition of the glandular epithelium. Diagnosis: cervical or endometrial cancer, advanced form of dysplasia.
AIS. Squamous cell carcinoma, cervical cancer.

PCR analysis

The molecular biological method of PCR diagnostics is distinguished by its high sensitivity and reliability of the data obtained. By creating earlier samples of the isolated and copied DNA section, comparisons are made with the resulting biological material.

Testing for infections using PCR makes it possible to quickly find the causative agent of a disease in the female genital organs by obtaining a positive or negative result.

The polymerase chain reaction facilitates the determination of chlamydia, ureaplasmosis, thrush, trichomoniasis, HPV, HIV, and the search for the causes of difficult pregnancy and hormonal disorders.

The disadvantages of PCR are cases of false data due to incorrect tests and possible mutation of the pathogen's DNA.