This resource is a guide for practitioners to assist them in identifying visual cervical appearances.

The images shown here are some examples of cervices you may see when taking a Pap test.

It is recommended that any visual cervical abnormality be referred for further investigation even if the Pap test is reported as normal.

If you are uncertain about the appearance of the cervix, we recommend you seek a second opinion.

Thank you to all practitioners who provided cervical images for this resource.

Funded by PapScreen Victoria, the Victorian component of the National Cervical Screening Program.

Produced by PapScreen Victoria and VCS Pathology.

Nulliparous1 Eversion/ectropion2 Multiparous Atrophy

IUD Nabothian follicles Polyp Stenosis

Post treatment2 Mucopurulent discharge3 Cervical wart Cancer2

1 Reproduced with permission from: Wolfendale, Margaret, 1995. Taking Cervical Smears. British Society for Clinical Cytology: page 12. 2 Reproduced with permission from: Burghardt, Erich, 1984. Colposcopy Cervical Pathology Textbook and Atlas. Georg Thiem Verlag. Germany: pages 162 & 174. 3 Reproduced with permission from: Cartier, René, 1984. Practical Colposcopy. Laboratoire Cartier. Switzerland: page 168.C

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For pre-menopausal womenCervical sampler broom: rotate 3–5 timesorCervex-Brush® Combi: insert central part of the brush into os and rotate clockwise twiceor Spatula: rotate once or twice, taking care to keep contact with the ecto-cervixplus Endocervical brush: insert ensuring that you can see the lower row of the bristles and make a quarter rotation

For peri and post-menopausal women

Cervical sampler broom: rotate 3–5 timesplusEndocervical brush: insert ensuring that you can see the lower row of the bristles and make a quarter rotationorCervex-Brush® Combi: insert central part of the brush into os and rotate clockwise twiceorSpatula: rotate once or twice, taking care to keep contact with the ecto-cervixplusEndocervical brush: insert ensuring that you can see the lower row of the bristles and make a quarter rotation.

Making the Pap slide: After taking the sample/s they must be placed promptly onto the slide. Wipe both sides of the spatula, cervical sampler broom or Cervex-Brush® Combi onto the slide. If you have taken an endocervical brush sample, roll this gently onto the remaining half (see diagrams).

Fix the slide within 5 seconds, spraying from a distance of around 20cms. The cells expand if they are not fixed quickly and any degree of dysplasia might be underestimated.

Watch the instructional DVD Taking a Pap test to see the correct technique for making and fixing the slide.

Liquid-based cytology: Use plastic sampling instruments and agitate them in the liquid medium to release cells. Dispose of the instruments, do not leave them in the fluid.

Testing for HPV using Hybrid Capture® Brush After taking the Pap test, insert the brush into the cervical os (ensuring you can see the lower bristles). Rotate it 3 times counter-clockwise, withdraw it and snap it off into the tube. HPV testing can also be done on liquid-based samples. Check with your lab.

A guide to taking a high-quality Pap test

© February 2013 Cancer Council Victoria

Disclaimer This resource is a guide for practitioners only. Neither PapScreen Victoria nor any other persons associated with the preparation of this resource accept any liability whatsoever from consequences arising from the use of this resource.

Recommended techniques and instruments to be used when taking a Pap testC

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Special notesEversion: take care to sample the squamo-columnar junction. This is the junction where the columnar epithelium of the endocervical canal meets the squamous epithelium of the vagina. It is the area where cell changes occur.Pregnancy: do not use the endocervical brush or Cervex-Brush® Combi.

To order a free copy of Taking a Pap test: instructional DVD contact VCS Pathology on (03) 9250 0300.Alternatively, watch the video online at www.mshc.org.au. Go to Health Professionals, then Videos.

If you wish to discuss sampling techniques, ring VCS Pathology and ask to speak to a Liaison Physician.

For more information about Pap tests, HPV testing or cervical cancer visit www.papscreen.org.au or call the Cancer Council Helpline on 13 11 20.

Sampling instruments

Cervex-Brush® Combi

Spatula

Endocervical brush

Cervical sampler broom

Hybrid Capture® Brush

Techniques

Cervical sampler broom & Cervex-Brush® Combi

Spatula & Endocervical brush Hybrid Capture® Brush