Any pathological anatomy procedure that evaluates cells detached from their original tissue is called cytology; the sample is obtained by rubbing, scraping or washing a body surface

Biopsy, on the other hand, involves the study of a sample of tissue obtained through some type of cut of the affected organ

Cervicovaginal cytology is also called the Pap test due to its creator Georgios Papanikolaou, a pioneer of cytopathology and early detection of cancer.

Every sexually active woman and every woman should be practiced at the age of 21 even though she has never had sex.

Poor cytology, so useful and so repudiated by all women; must feel frustrated and perhaps full of rancor at the ingratitude of its beneficiaries and yet still there, struggling to ensure that women do not die of a cancer listed as a third world cancer, cervical cancer.

What is cervical cytology?

This refers to taking a small sample of the superficial cells of the inner portion of the cervix and its outer surface by using a wooden spatula, cotton applicator or a very fine brush.

It does not generate any major inconvenience since access is easy and easy for the doctor. We know that it is a nuisance for the patient because no woman likes that her most private and private parts are seen or manipulated in that way as we do, position, exposure, speculums (some are cold), pallets, brushes, the light, the doctor seeing directly “that”, and innumerable additional factors …

Unfortunately it is a necessary evil but full of advantages that far exceed the discomfort that it causes: it is not invasive, it is economic, it does not hurt (it only annoys a little), it does not require anesthesia, the result is obtained in a few days, it is adequately sensitive to detect cancer and precancerous lesions of the neck, detect common vaginal infections and sexually transmitted diseases, allow to evaluate the hormonal status of the patient, etc.

How is the sample taken?

Patients with intact hymen: To avoid accidental trauma to the hymen, we obtain a sample of the vaginal fluid by carefully inserting a swab into the vaginal fund. This procedure is not painful nor injures or modifies the hymen and the lady remains as virgin as when she arrived.

Patients sexually active or with perforated hymen: this case corresponds to the majority of women. We begin the procedure by asking the patient for some relaxation and entertaining her with an amicable conversation (sometimes she does, some do not), a sterile, previously lubricated speculum is carefully inserted into the vagina until it reaches the cervix that is placed between the two branches thereof by opening them. At this point the speculum is no longer manipulated and the patient becomes accustomed to the pressure exerted by the “foreign object”. Then a wooden or plastic spatula is gently slid on the surface of the external neck (exocérvix) to obtain cells (cytology proper) and then we introduce an applicator, swab or brush through the cervical orifice to obtain cells of the canal (endocervix), this may generate some discomfort, most women refer to it as a discreet menstrual discomfort.

Conditions to take a cytology:

• Clean, supportive, intimate and well equipped.
• Nurse assistant well presented and impeccable.
• Speculums, clean, sterile and warm and of various sizes for each type of patient.
• A sympathetic, careful, respectful and attentive physician.
• Correct technique.
• Collaboration and relaxation of the patient.

Am I required to practice cytology?

No one can force you to have any procedure done on your body without your consent, this is your most basic and inalienable human right, at least in free societies. The obligation is a personal decision, good (to do it) or bad (not to do it), but it is proper and must be respected although it is the physician’s obligation to explain the benefits and risks of your judgment. In order to obtain a Health Certificate, a recent Pap smear is required: this, although it is coercion, is in many cases the only way to “force” a woman to attend the gynecologist (and many have been saved thanks to this!)

Is it advisable to have cytology every year?

It has been shown that cytology performed regularly can detect most of the cancers and precancerous lesions of the cervix, which are known to have their origin in the HPV virus in more than 90% of cases. Although it could be done over longer periods of time, the annual recommendation is appropriate for countries with a high incidence of cervical cancer

Its detection rate is around 70% but its regular (annual) use in conjunction with the physician’s assessment increases its sensitivity to a point close to 100%. The discard rate of malignant conditions is greater than 90% with a single evaluation. Cost J, Cochand-Priollet B, from Cremoux P, et al. (2003)

Is cytology done for infections and gynecological flows?

Cytological studies are designed to detect cancerous or precancerous lesions, but as a secondary gain we can evaluate the presence of genital infections by bacteria, fungi, viruses and parasites; some of them considered sexually transmitted diseases.

I have seen cases where it is done more often, is that possible?

In some cases of suspicious lesions, control of treatments and in the evolutionary follow-up of particular lesions, we perform cytologies frequently in periods ranging from one month to three or six months, depending on the injury and the criterion of the treating physician based on the updated medical literature.

Facts about cervical cytology:

It is cheaper, more effective, less annoying and easier to perform than other cytologies (eg gastric or lung) and detects infectious, premalignant and malignant lesions

The discomfort caused by the cytology is negligible compared to those caused by the management of a cervical cancer.

Cervical cancer is taken as an indicator of Third Worldism because it implies poor cytological control of the female population of a country.

My recomendation

Practícate your regular gynecological and cytological control, the benefits are much greater than exposing yourself to the risk of genital cancer that would otherwise have been 100% preventable.