Gynecological smear: transcript. Norm and deviations

The most important method of diagnosis in gynecology is a gynecological smear on the flora. For the study, the discharge of the urethra, vaginal mucosa and cervix is taken. It makes possible the study of the pathogenic microflora of the genitourinary system and the assessment of its condition.

A smear on the flora is taken by a gynecologist at every treatment of women and during a preventive examination. Obligatory reasons for the study are complaints of pain in the abdomen, unpleasant itching and burning in the vagina, abundant discharge, indicating the presence of an inflammatory process. When planning pregnancy, after the course of antibiotic therapy is also recommended to conduct this study.

How is a gynecological smear taken? About this further.

Rules for taking a smear on the flora

To increase the informative value of the test results, it is necessary to observe certain conditions:

• A couple of days before the study to give up sexual intercourse;
• Do not use vaginal candles, lubricants and other means, do not douche and limit yourself to taking a shower, giving up baths;
• To visit a gynecologist to choose a period of the menstrual cycle, when there is no bleeding.

On the day of visit to the gynecologist, the external genital organs are washed with soap, other detergents are excluded. It is not recommended to urinate for 2-3 hours before taking the test.

The smear on the flora is taken with sterile instruments (spatula, corncang or tweezers) from three places: the cervical canal, the walls of the vagina and the urethra.

The procedure for taking smears is one of the medical manipulations of a gynecologist, as a rule, it is absolutely painless. It also allows you to control the conduct of therapeutic therapy.

Gynecological smear on the flora: the norm and deviations from it

95% of the contents of the flora of the vagina of a healthy woman are lactobacilli, the main function of which is the production of lactic acid necessary to maintain the necessary acidity, protecting the urino-genital organs of women from penetrating infectious agents.

It is especially important to make a smear on the flora of pregnant women, since during pregnancy the number of lactobacilli decreases, which reduces the natural defense of the organism and, as a consequence, leads to frequent occurrence of infections.

Normally, the microflora of the genitourinary system, in addition to lactobacilli, contains a small number of other microorganisms, such as Gardnerella and Candida. Due to the decrease in immune protection, which is caused by fatigue, emotional overstrain, pregnancy or various diseases, gardnerelles and candidias can accelerate their reproduction, which will lead to the emergence of gardnerellez and candidiasis. That's how informative the gynecological smear is.

Normal parameters in the smear of an adult woman will be as follows:

1. The number of flat epithelium should be equal to 15 cells in the field of view. An increase in this number indicates inflammation. Reduction - about hormonal disorders.
2. The presence of leukocytes in the smear is normal, because it indicates that the body is fighting infections. But they should be no more than 10 in the vagina and the urethra and not more than 30 in the cervix.
3. In a smear a woman should have Dederlein's sticks, and in large quantities. If these lactobacilli are few, then, most likely, the microflora is broken.
4. A small amount of mucus in the smear is acceptable.

If the analysis contains Candida fungi, small sticks, cocci, Trichomonas, gonococci, then most likely there is a disease. Then the study should be deeper and treatment may be required.

Explanation of the smear on the flora

Medical workers have introduced a system of abbreviations and use letters of the Latin alphabet to denote the indicators of analysis.

For example, the places of sampling of a smear are denoted as follows:

• V - vagina - in translation from the Latin "vagina".
• U - uretra - urethra.
• C from the cervix - cervical canal.
• L - leukocytes are the so-called white blood cells, their increase indicates the presence of an inflammatory process.
• Gn is the gonococcus.
• "Pl. Ep. "- a flat epithelium.
• Trich is a trichomonas.

The presence of mucus in the smear is an important indicator of the pH of the vaginal environment. But this is not the whole decoding of the smear.

The number of this or that flora is denoted by the sign "+".

Total allocate 4 categories:

• "+" - the number of the indicator is insignificant;
• "++" - the amount of the indicator is moderate;
• "+++" - increased amount of the indicator;
• "++++" is an overestimated (abundant) amount.
• "Abs" - "absence" - they write in the absence of any of the indicators.

What is a cocca flora in a smear?

Bacteria in the form of balls are called cocci. Normally, smears occur in single cocci. With a decrease in immunity, the number of coccobacillary flora in smears increases. Kokki are divided into gr + (positive) and gr- (negative) Consider their difference.

In microbiology for detailed description of bacteria, in addition to indicating their shapes, sizes and other characteristics, there is still a method of "Gram staining". The smears are exposed to a special coloring drug. The microorganisms remaining after washing the smear with colored, called Gram-positive (gr +), discolored during washing - Gram-negative (gr-). The most common gram-positive microorganisms include, for example, staphylococci, streptococci, enterococci, and lactobacilli. Proteus, gonococci and E. coli are Gram-negative.

Smear during pregnancy

How is the smear test performed in a pregnant woman?

During this period, it produces a large amount of hormone progesterone, which contributes to the increase of lactobacilli (sometimes up to 10 times). Thus, nature itself protects the unborn child from various infections. Therefore, when planning a child, it is very important to make sure that there are no inflammatory processes in the vagina.

At registration on the account on pregnancy at all women take a smear on flora. To evaluate the state of microflora in gynecology, the term "purity of the vagina" is used. It should be known and controlled by a woman throughout pregnancy, for this, a repeated smear on the flora is done at 30 and 38 weeks.

Degrees of purity of the vagina

Gynecologists distinguish four degrees of vaginal purity:

• Degree 1 - a woman is healthy absolutely. The microflora is represented by 95% lactobacilli, possibly the presence of single epithelial cells and leukocytes.
• At the 2nd degree of purity in the smear, opportunistic microorganisms can be found in a small amount.
• The third degree of purity is characterized by a large number of opportunistic microorganisms than Dodderlein's sticks.
• 4th degree of purity: in the smear a lot of leukocytes, epithelium and other bacterial flora. Lactobacilli is small, or they are absent.

For the 1 st and 2 nd degree of purity, a distinct acidic environment is typical, and at pH 3-4 it shifts, becomes alkaline.

Analysis of gynecological smear: interpretation of the results

The analysis of the gynecological smear allows to more clearly diagnose the disease and correctly build a line of treatment.

For example, an increased number of leukocytes and epithelium becomes a sign of an acute or chronic inflammatory process. Detection in the urethra of mucus, which in normal condition does not happen, can talk about the inflammation of the channels of the urinary system.

The presence of a large number of cocci in the smear also indicates the presence of inflammation of the genital organs, a decrease in the purity of the vagina. Normally, the coccal flora in the urethra is absent, and only a single amount is permissible in the vagina.

When a gonorrhea is found in a smear, the patient is diagnosed with "gonorrhea". The presence of gardnerellas and trichomonads testify to the presence of a woman with gardnerellosis and trichomoniasis. The change in the degree of purity and dysbiosis is also indicated by an increase in the number of fungi of the genus Candida, which, as a rule, is accompanied by a small number of Dodderlein sticks.

Considering all the above, it can be said that the microscopy of the gynecological smear testifies to the state of the immune system, is an important marker in the diagnosis of the genitourinary system and its chronic infections.