Introduction 

1. Greet patient and introduce yourself 
2. Confirm patient details ✍ 
3. Briefly explain the procedure in a patient friendly manner 
4. Tell the patient a chaperone will be present throughout and why 
5. Get patient consent ✅ 
6. Check the patient is not in any pain or pregnant 🤰
7. Ask the patient to use the toilet if necessary 
8. Ask patient to remove underwear whilst you leave the room 
9. Wash hands ✋ 

Equipment 

 Disposable gloves ✋ 

 Paper towels 

 Speculum and light 🔦

 Lubricant 

 Sample pot  

 Endocervical brush 

Inspection 

1. Don gloves ✋ 
2. Ask patient to lie in the supine position then move their heels to their bottom, relaxing their knees so that they fall outwards 
3. Assess the vulva to identify abnormalities 

 Scars: indicate prior surgery or lichen sclerosus 

 Masses: indicates Bartholin’s cyst or vulval malignancy  

 Ulcers: indicate genital herpes  

 Varicosities: varicose veins due to pelvic obstruction (e.g. malignancy) or chronic venous disease  

 White lesions: patchy, surrounding vulva or anus, indicates lichen sclerosus  

 Vaginal atrophy: typically present in post-menopausal women 👵

 Abnormal vaginal discharge: indicates bacterial vaginosis, candidiasis, chlamydia or gonorrhoea   

      4. Assess for vaginal prolapse (lump protruding from vagina - ask patient to cough to make it more obvious) 

What is Bartholin’s cyst ❓ 

 Bartholin’s glands maintain the moisture of the vagina by producing secretions 

 Cysts form if the glands become blocked or infected 

 Cysts are usually unilateral, with fluctuating mass, can be tender or not 

What is Lichen sclerosus ❓ 

 Chronic inflammatory dermatological condition 

 Affects anogenital region 

 Symptoms: puritis, thickened white patches, scarring, adhesions, shrunken labia, narrow introitus, clitoris obscuration 

What causes abnormal discharge ❓ 

 Candidiasis: curd-like discharge, itchy and inflamed 

 Bacterial vaginosis: this, fishy-smelling, not itchy or inflamed 🔥

 Trichmoniasis: frothy, yellow discharge, itchy and inflamed 🔥

 Chlamydia/gonorrhoea: purulent discharge, may be inflamed or not 

Insert speculum 

1. Get patient consent to insert speculum ✅ 
2. Separate labia  
3. Gently insert speculum sideways 
4. Rotate speculum 90° and open blades to achieve optimal visualisation of the cervix 📐
5. Tighten locking nut to fix the blades in this position 

Cervix visualisation 

Inspect cervix: 

 Masses: indicate cervical malignancy  

 Ulcers: indicate genital herpes  

 Open cervical os: indicates inevitable/incomplete miscarriage   

 Erosion surround os: indicates ectropion or early cervical cancer  

 Abnormal discharge: indicates trichomonas, bacterial vaginosis, candidiasis, chlamydia or gonorrhoea 

What is cervical ectropion ❓ 

 Columnar epithelial cells present outside vaginal cervix, often around external os 

 These cells are red in comparison to the pink cervix 

 They often present with post-coital bleeding due to fine blood vessels 

What is cervical cancer ❓ 

 Caused by persistent HPV (human papillomavirus) infection  

 Cervical intraepithelial neoplasia (dysplastic cells) may precede it 

 Symptoms: often asymptomatic in early stages, increased vaginal discharge, vaginal bleeding, vaginal discomfort, cervix may have white/red patches indicates early stages, ulcers/tumours indicate late stages 

Cervical screening 

1. Insert endocervical brush into endocervical canal through speculum (do not touch the brush against the sides of the speculum) 
2. Rotate brush clockwise 5 times 🔄
3. Remove endocervical brush (do not touch the brush against the sides of the speculum) 
4. Put the tip of the endocervical brush in a liquid based cytology container 

Speculum removal 

1. Loosen locking nut  
2. Close blades slightly  
3. Rotate speculum 90° (inspect vaginal walls simultaneously) 📐
4. Use sheet to cover patient  
5. Tell patient the examination is complete and you will leave the room to allow them to change ✅  
6. Appropriately dispose of waste 
7. Wash hands ✋ 

Completion 

1. Label samples appropriately ✍  
2. Thank patient 
3. Inform patient they will receive results via method requested 
4. Document procedure ✍  
5. Send swabs to the lab to process 

Summary:

1. Greet the patient and explain the procedure
2. Inspect the vulva to identify abnormalities
3. Insert speculum into vagina and fix into place by tightening locking nut
4. Inspect the cervix to identify abnormalities
5. Perform cervical screening by inserting endocervical brush into endocervical canal through speculum and rotating
6. Remove speculum by loosening locking nut, closing blades and rotating
7. Complete the procedure by thanking patient and sending swabs to lab