Counseling Sheet

Agatha M. Thrash, M.D.

Preventive Medicine

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‍PATIENT PREPARATION

‍Have the woman void before positioning her. She should be as comfortable as possible with a small pillow under the head, garments removed from the waist to the knees. Good lighting is essential. Explain to the patient what is being done and proceed gently.

‍PROCEDURE

1. ‍‍Visually examine external genitalia for indications of irritation, infection, or abnormalities.
2. Using clean gloved hands, gently separate the labia.
3. Take a warmed speculum of appropriate size (if pap smear to be prepared, moisten with warm water rather than commercial lubricant) and gently insert vertically. By depressing the perineum and posterior vaginal wall with two fingers the speculum avoids uncomfortable pressure against more sensitive anterior structures and easy entrance to the vagina is gained. Begin the insertion with the speculum on its side, and then rotate to the horizontal position after insertion is almost complete.
4. Slowly open the speculum, bring the cervix into full view; lock in the open position. Speculum can be moved slightly to either side, up or down, permitting inspection of the vaginal walls and cervix. Normally, walls are pink and moist; a slightly milky secretion may be observed.
5. Note the type of discharge, inflammation, irritation, or abnormality.
6. Inspect the cervix, which is about 2 cm in diameter and 2-4 cm. long. The same pink color is normal; it may be darker pink to red, if the woman is taking the "pill," due to hormonal stimulation. The os may indicate the placement of an IUD. Again, any variation from the normal pink smooth tissue, irregular or distorted contours, or unusual discharge should be noted and reported.
7. Do Pap smear: a. Clean cervix of excess discharge with a Q-Tip (excess mucus interferes with test). b. Insert spatula into cervical os, giving it a 360 degree turn. c. Wipe slide with spatula only once leaving an easily visible film of secretion. Do not pass spatula repeatedly back and forth or go in circles. d. Fix immediately in the solution provided by the lab. e. Place slide in cardboard container or bottle. f. Fill out form correctly—making sure all carbon copies are clear and easily readable. Write information in Pap Smear Book in RLC room.g. Write last name of patient on frosted end of slide in pencil. h. Place form around cardboard cover, securing it with a rubber band.
8. Unlock speculum, gently close, and slowly slide it out of the vagina.
9. Wipe off excess lubricant with a single firm front to back motion, and assist the patient in getting out of the stirrups.
10. Clean speculum thoroughly with soap and water. Autoclave, if possible; otherwise place in a solution of one part chlorine bleach to eight parts of water for at least 10 minutes, if clean. Boiling for 15 minutes is also effective. Dry and replace in tray.