The most important diagnostic method in gynecology is a gynecological smear on the flora. For research, secretions of the urethra, vaginal mucosa and cervix are taken. It makes it possible to study the pathogenic microflora of the genitourinary system and assess its condition.
A smear on the flora is taken by a gynecologist at every visit of women and during a preventive examination. Mandatory reasons for the study are complaints of pain in the lower abdomen, unpleasant itching and burning in the vagina, copious discharge, indicating the presence of an inflammatory process. When planning pregnancy, after a course of antibiotic therapy, it is also recommended to conduct this study.
How is a gynecological smear taken? More on that later.
Rules for taking a swab for flora
To increase the information content of the test results, certain conditions must be met:
- a couple of days before the study to refuse sexual intercourse;
- do not use vaginal suppositories, lubricants and other means that do notdouche and limit yourself to taking a shower, refusing baths;
- to visit a gynecologist, choose a period of the menstrual cycle when there is no bleeding.
On the day of visiting the gynecologist, the external genitalia are washed with soap, other detergents are excluded. It is not recommended to urinate within 2-3 hours before taking the test.
A smear on the flora is taken with sterile instruments (spatula, forceps 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 medical therapy.
Gynecological smear for flora: norm and deviations from it
95% of the flora of a he althy woman's vagina is lactobacilli, the main function of which is the production of lactic acid, which is necessary to maintain the desired acidity, which protects the genitourinary organs of women from the penetration of infectious agents.
It is especially important to do a smear on the flora of pregnant women, as the number of lactobacilli decreases during pregnancy, which reduces the body's natural defenses and, as a result, leads to frequent infections.
Normally, the microflora of the genitourinary system, in addition to lactobacilli, contains a small amount of other microorganisms, such as gardnerella and candida. Due to a decrease in immune defenses caused by fatigue, emotional overstrain, pregnancyor various diseases, gardnerella and candida can accelerate their reproduction, which will lead to the occurrence of gardnerellosis and candidiasis. That's how informative a gyno smear is.
Normal smear readings for an adult woman would be:
- The amount of squamous epithelium should be 15 cells per field of view. An increase in this number indicates inflammation. Reduction is about hormonal disorders.
- The presence of white blood cells in a smear is normal, as this indicates that the body is fighting infections. But they should be no more than 10 in the vagina and urethra and no more than 30 in the cervix.
- A woman should have Dederlein sticks in a smear, and in large quantities. If there are few of these lactobacilli, then, most likely, the microflora is disturbed.
- A small amount of mucus in the smear is acceptable.
If Candida fungi, small rods, cocci, Trichomonas, gonococci are present in the tests, then most likely there is a disease. Then the investigation should be deeper and treatment may be required.
Deciphering a smear on flora
Medical workers have introduced a system of abbreviations and use Latin letters to denote analysis indicators.
For example, swab sampling sites are designated as follows:
- V - vagina - Latin for "vagina".
- U - uretra - urethra.
- C from cervix - cervical canal.
- L - leukocytes are the so-called white blood cells, their increase indicates the presenceinflammatory process.
- Gn – gonococcus.
- "Pl. Ep." - flat epithelium.
- Trich - Trichomonas.
The presence of mucus in a smear is an important indicator of the pH of the vaginal environment. But that's not the whole story of the smear.
The amount of a particular flora is indicated by a “+” sign.
there are 4 categories in total:
- "+" - the amount of the indicator is insignificant;
- "++" - the amount of the indicator is moderate;
- "+++" - increased amount of indicator;
- "++++" - an overestimated (abundant) amount.
- "abs" - "absence" - is written in the absence of any of the indicators.
What is coccal flora in a smear?
Bacteria in the form of balls are called cocci. Normally, single cocci are found in smears. With a decrease in immunity, the amount of coccobacillary flora in smears increases. Cocci are divided into gr+ (positive) and gr- (negative) Consider their difference.
In microbiology, for a detailed description of bacteria, in addition to indicating their shapes, sizes and other characteristics, there is also the “Gram stain” method. Smears are exposed to a special staining preparation. Microorganisms that remain stained after washing the smear are 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 atpregnancy
How is a Pap test performed on a pregnant woman?
During this period, she produces a large amount of the hormone progesterone, which contributes to an increase in 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.
When registering for pregnancy, all women take a swab for flora. To assess the state of the microflora in gynecology, the term "the degree of purity of the vagina" is used. A woman should know and control it throughout pregnancy, for this, at 30 and 38 weeks, a second smear on the flora is done.
Vaginal purity levels
Gynecologists distinguish between four degrees of vaginal cleanliness:
- Degree 1 - the woman is absolutely he althy. The microflora is represented by 95% lactobacilli, the presence of single epithelial cells and leukocytes is possible.
- At the 2nd degree of purity, a small amount of opportunistic pathogens may occur in a smear.
- 3rd degree of purity is characterized by a greater number of opportunistic pathogens than Doderlein sticks.
- 4th degree of purity: there are a lot of leukocytes, epithelium and other bacterial flora in the smear. Lactobacilli are few or absent.
For the 1st and 2nd degree of purity, a pronounced acidic environment is characteristic, and at the 3-4th pH it shifts, becomes alkaline.
Gynecological smear analysis:transcript of results
Analysis of a gynecological smear allows you to more clearly diagnose diseases 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. The detection of mucus in the urethra, which does not exist in the normal state, may indicate inflammation of the channels of the urinary system.
The presence of a large number of cocci in a smear also indicates the presence of inflammation of the genital organs, a decrease in the purity of the vagina. Normally, there is no coccal flora in the urethra, and only a single amount is allowed in the vagina.
When a gonococcus is found in a smear, the patient is diagnosed with gonorrhea. The presence of gardnerella and trichomonas indicate the presence of gardnerellosis and trichomoniasis in a woman. A 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 Doderlein sticks.
Given all of the above, we can say that gynecological smear microscopy indicates the state of the immune system, is an important marker in the diagnosis of the state of the genitourinary system and its chronic infections.
