Pap smear and pelvic examination are very common gynecological procedures done both at the office level and hospitals. Pap smear is targeted more towards prevention while pelvic examination is a more of a diagnostic procedure.
Pap smear is done at well-women clinics, to screen for cervical cancer. It is an office procedure done under aseptic conditions. The woman is put on the lithotomy position with legs spread open and knees bent. The gynecologist inserts a Cusco speculum into the vagina and opens it to visualize the cervix. Once the cervix is fully exposed the gynecologist inserts the pap smear spatula into the cervix through the speculum and scraps the transitional zone of the cervix to get a good sample of tissues. Transitional zone is the area where the ectocervix and endocervix meet. This is region where initial precancerous changes occur. The sample collected is spread on a glass slide and preserved in a formal saline solution. The smear is later examined under the microscope.
Dysplasia, metaplasia, heterochomasia, and nuclear atypia are some of the features looked for in the slides. If suspicious features are detected, urgent action is needed. Infections may give rise to inflammatory changes, necessitating the need of a repeat smear in six months after antibiotic treatment. If pre-cancerous lesions are seen, a repeat smear in six months is indicated. If the repeat smear is also abnormal, urgent gynecological review is essential.
Pelvic examination is a gynecological procedure done on almost every woman who complains of a gynecological symptom. It is a thorough clinical examination where all the salient features of the female reproductive system are analyzed. The gynecologist, after obtaining appropriate verbal consent for the examination, places the woman in the lithotomy position. A male gynecologist will need a female chaperone for the examination. The examination is guided by the information obtained in the history. The vulva is first examined. Then a speculum is inserted into the vagina, to visualize the vaginal walls and the cervix. In case of a lump at vulva (vaginal wall prolapse), a sponge on a stick may be used to manipulate the prolapsed wall to determine its origin. Then the speculum is withdrawn, and the gynecologist will examine the vagina digitally. Cervix, adnexa, uterine size, and other palpable abnormalities are assessed.
In obstetric practice, the pelvic examination is used to determine whether the pelvis is adequate for childbirth. Symphysis pubis, ischial spine, ischial tuberosities, sacral promontory are important bony points of the pelvic palpable during digital examination.
What is the difference between Pap smear and Pelvic Exam?
• Pap smear is a screening test to detect cervical cancer while pelvic examination is a clinical examination protocol.
• A pap smear yields a sample for examination under the microscope. Pelvic examination is a diagnostic procedure that can be altered according to the clinician’s need.