Cervix in relation to upper part of vagina and posterior portion of uterus. Transformation zone types, determining the<unk>  location:Type 1: Completely ectocervical.Type 2: Endocervical component but fully visible.Type 3: Endocervical component, not fully visible. For best results, a<unk>  should not occur when a woman is menstruating, partly because the additional cells can obscure cervical cells and partly because this part of the menstrual cycle is when the female organs are most inflamed. However,<unk>  smears can be performed during a woman's menstrual period, especially if the physician is using a liquid-based<unk> ; if bleeding is extremely heavy, endometrial cells can obscure cervical cells, and it is therefore inadvisable to have a<unk>  smear if bleeding is excessive. Obtaining a<unk>  smear should not cause much pain, but it can if the woman has certain untreated vaginal problems such as cervical stenosis or vaginismus. It is, however, not comfortable, for two reasons: the cervix is full of nociceptors (pain nerves), and the brush used to collect cells has to be stiff enough to scrape them off of the surrounding tissue. So it can be uncomfortable, but it is generally quick, and the information obtained may be critical. People with underlying pain or tissue diseases that can react to nociceptors being scraped or to excessive cold in the mucous membranes should take appropriate precautions and discuss the process ahead of time with their providers. Many people experience spotting or mild diarrhea afterward. The spotting is usually from the scrape on the cervix, and the diarrhea may be due to indirect stimulation of the lower intestine during the exam. A number of studies have shown that using a small amount of water-based gel lubricant does not interfere with, obscure, or distort the<unk>  smear. Further, cytology is not affected, nor are some STD<unk> ing. The health care worker begins by inserting a speculum into the woman's vagina, which spreads the vagina open and allows access to the cervix. The health care provider then collects a sample of cells from the outer opening or os of the cervix by scraping it with an Aylesbury spatula. An endocervical brush is rotated in the central opening of the cervix. The cells are placed on a glass slide and taken to the laboratory to be checked for abnormalities. A plastic-fronded broom is sometimes used in place of the spatula and brush. The broom is not as good a collection device, since it is much less effective at collecting endocervical material than the spatula and brush. The broom is used more frequently with the advent of liquid-based cytology, although either type of collection device may be used with either type of cytology. The sample is stained using the<unk> anicolaou technique, in which tinctorial dyes and acids are selectively retained by cells. Unstained cells cannot be seen adequately with a light microscope.<unk> anicolaou chose stains that highlighted cytoplasmic keratinization, which actually has almost nothing to do with the nuclear features used to make diagnoses now. In some cases, a computer system may prescreen the slides, indicating those that do not need examination by a person or highlighting areas for special attention. The sample is then usually screened by a specially trained and qualified cytotechnologist using a light microscope. The terminology for who screens the sample varies according to the country; in the UK, the personnel are known as cytoscreeners, biomedical scientists (BMS), advanced practitioners and pathologists. The latter two take responsibility for reporting the abnormal sample, which may require further investigation. Automated analysis In the last decade, there have been successful attempts to develop automated, computer image analysis systems for screening. Although, on the available evidence automated cervical screening could not be recommended for implementation into a national screening program, a recent NHS Health technology appraisal concluded that the 'general case for automated image analysis ha(d) probably been made'. Automation may improve sensitivity and reduce unsatisfactory specimens. Two systems have been approved by the FDA and function in high-volume reference laboratories, with human oversight. Types of screening * Conventional<unk> —In a conventional<unk>  smear, samples are smeared directly onto a microscope slide after collection. However this method hurts as wooden spatulas are used. This causes pain during the procedure. * Liquid-based cytology—The sample of (epithelial) cells is taken from the transitional zone, the squamocolumnar junction of the cervix, between the ectocervix and the endocervix. Liquid-based cytology often uses an arrow-shaped brush rather than the conventional spatula. The cells taken are suspended in a bottle of preservative for transport to the laboratory, where they are analyzed using<unk>  stains.<unk> s commonly look for epithelial abnormalities/ metaplasia/ dysplasia/ borderline changes, all of which may be indicative of CIN. Nuclei will stain dark blue, squamous cells will stain green and keratinised cells will stain pink/ orange. Koilocytes may be observed where there is some dyskaryosis (of epithelium). The nucleus in koilocytes is typically irregular, indicating possible cause for concern; requiring further confirmatory screens and<unk> s. In addition, human<unk> illomavirus (HPV)<unk>  may be performed either as indicated for abnormal<unk>  results, or in some cases, dual<unk> ing is done, where both a<unk>  smear and an HPV<unk>  are done at the same time (also called<unk>  co-testing). Practical aspects The endocervix may be partially sampled with the device used to obtain the ectocervical sample, but due to the anatomy of this area, consistent and reliable sampling cannot be guaranteed. Since abnormal endocervical cells may be sampled, those examining them are taught to recognize them. The endometrium is not directly sampled with the device used to sample the ectocervix. Cells may exfoliate onto the cervix and be collected from there, so as with endocervical cells, abnormal cells can be recognised if present but the<unk>  should not be used as a screening tool for endometrial malignancy. In the United States, a<unk>  itself costs $20 to $30, but the costs for<unk>  visits can cost over $1,000, largely because additional<unk> s are added that may or may not be necessary.
Pap test
Pregnancy test
Cervical screening
Anal Pap smear
Breast self-examination
Male genital examination
Colposcopy
Trichology