Cervical screening sample (cytology and HPV)

4 steps1 video

A sample from the transformation zone, taken well, is what makes the screening programme work.

A cervix photographed after acetic acid, with no acetowhite change, a negative visual inspection

Consent and trauma-informed practice

Explain what the examination involves, why it is proposed, and what the alternatives are, in plain language, before anyone undresses.
Ask for permission, and make clear the patient can stop at any point, by saying so or by raising a hand. Stopping is honoured immediately, without persuasion.
Offer a chaperone and record the offer and the response; a student never examines without the supervising clinician present and the patient's specific agreement to the student's involvement.
Privacy: a door that locks or a sign, a sheet, undressing only what is needed, time to undress and dress alone.
Trauma-informed: assume a history you have not been told. Explain each step before it happens, keep talking, avoid sudden touch, ask about pace, and notice dissociation or distress and pause.
Never examine a patient under anaesthesia for teaching without their specific prior consent to that examination.

The sequence

4 steps

01
Locate the transformation zone
The squamocolumnar junction, visible as the boundary of the red columnar epithelium around the os; it recedes into the canal after menopause.
02
Sample
A broom or spatula rotated 360 degrees (five turns with a broom); an endocervical brush rotated a quarter to half turn when the junction is not visible.
03
Transfer
Rinse into the liquid-based vial immediately; label at the bedside; complete the requisition with the date of the last period and relevant history.
04
Explain
When and how the result will arrive, and that spotting afterwards is common.

Speculum examination as above
Liquid-based cytology vial or HPV collection kit; self-sampling kits where the programme offers them

Spotting
Inadequate samples (too little cellular material, obscured by blood or inflammation)