The most important diagnostic method 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 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 with each treatment of women and during a routine examination. Mandatory reasons for the study are complaints of pain in the lower abdomen, unpleasant itching and burning in the vagina, profuse discharge, indicating the presence of an inflammatory process. When planning pregnancy, after conducting a course of antibiotic therapy, this study is also recommended.
How is a gynecological smear taken? About it further.
Rules for taking a smear on the flora
To increase the information content of the analysis results, it is necessary to observe certain conditions:
- a couple of days before the study to refuse sexual intercourse;
- do not use vaginal suppositories, lubricants and other means, do not douche and confine yourself to taking a shower, abandoning baths;
- To visit a gynecologist, choose a period of the menstrual cycle when there is no bleeding.
On the day of the visit to the gynecologist, the external genitalia are washed with soap, other detergents are excluded. It is not recommended to urinate for 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 procedures of a gynecologist, as a rule, it is absolutely painless. It also allows you to control the implementation of therapeutic therapy.
Gynecological smear on the flora: the norm and deviations from it
95% of the vaginal flora content of a healthy woman is made up of lactobacilli, whose main function is the production of lactic acid, which is necessary to maintain the desired acidity, which protects the urogenital organs of women from the penetration of pathogens.
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 body's natural defense and, as a result, leads to the frequent occurrence of 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 defense caused by fatigue, emotional overstrain, pregnancy or various diseases, gardnerella and candida can accelerate their reproduction, which will lead to the appearance of gardnerellosis and candidiasis. That's how informative a gynecological smear is.
Normal values in a smear in an adult woman will be as follows:
- The number of squamous epithelium should be equal to 15 cells in the field of view. An increase in this number indicates inflammation. The decrease is about hormonal disorders.
- The presence of white blood cells in the smear is normal, as this indicates that the body is fighting infections. But there should be no more than 10 in the vagina and urethra and no more than 30 in the cervix.
- Dederlein sticks should be present in a woman's 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 a smear is acceptable.
If Candida fungi, small sticks, cocci, trichomonads, gonococci are present in the analyzes, then, most likely, there is a disease. Then the study should be deeper and treatment may be required.
Decoding a smear on the flora
Medical professionals have introduced a system of abbreviations and use the letters of the Latin alphabet to indicate indicators of analysis.
For example, smear sampling locations are indicated as follows:
- V - vagina - in translation from Latin "vagina".
- U - uretra - urethra.
- C from cervix - cervical canal.
- L - white blood cells are the so-called white blood bodies, their increase indicates the presence of an inflammatory process.
- Gn - Gonococcus.
- "Pl. Ep. " - squamous epithelium.
- Trich - 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 interpretation of the smear.
The number of this or that flora is designated with a “+” sign.
There are 4 categories in total:
- “+” - the amount of the indicator is insignificant;
- "++" - the amount of the indicator is moderate;
- "+++" - an increased amount of the indicator;
- "++++" - an overestimated (plentiful) amount.
- “Abs” - “absence” - is written in the absence of any of the indicators.
What is coccal flora in a smear?
Ball-shaped bacteria 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, as well as lactobacilli. Proteus, gonococci and E. coli are gram-negative.
Pregnancy swab
How is a smear test in a pregnant woman?
During this period, she produces a large amount of the hormone progesterone, which helps to increase 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 smear on the flora. To assess the state of microflora in gynecology, the term "vaginal purity" is used. A woman should know and control her throughout her pregnancy; for this, a repeat smear on the flora is done at 30 and 38 weeks.
Vaginal purity
Gynecologists distinguish four degrees of vaginal purity:
- Grade 1 - a woman is absolutely healthy. Microflora is represented by 95% lactobacilli, the presence of single epithelial cells and leukocytes is possible.
- At the 2nd degree of purity, conditionally pathogenic microorganisms in a small amount can be found in the smear.
- The 3rd degree of purity is characterized by a large number of opportunistic microorganisms than Doderlein rods.
- 4th degree of purity: a smear contains many white blood cells, epithelium and other bacterial flora. There are few or no lactobacilli.
For the 1st and 2nd degree of purity, a pronounced acidic environment is characteristic, and at 3-4th pH it shifts, becomes alkaline.
Gynecological smear analysis : deciphering the results
Analysis of the gynecological smear allows you to more clearly diagnose diseases and properly build a treatment line.
For example, an increased number of leukocytes and epithelium becomes a sign of an acute or chronic inflammatory process. Detection of mucus in the urethra, which in the normal state does not exist, 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 genital inflammation, a decrease in the purity of the vagina. Normally, the coccal flora in the urethra is absent, and only a few of them are permissible in the vagina.
If gonococcus is found in a smear, the patient is diagnosed with gonorrhea. The presence of gardnerella and trichomonas indicate a woman has gardnerellosis and trichomoniasis. 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 microscopy of a gynecological smear 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.