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A smear on flora - biological purity or microflora - is one of the main research methods practiced in gynecology. Material for such a study is taken from the mucous membranes of the vagina, cervix and urethra. The main task of the gynecologist taking the analysis is to obtain information about the state of the microflora and the presence of causative agents of genitourinary diseases.

There are many microorganisms in the female genital organs, some of them are dangerous, others are harmless to the body, while there are few of them, and still others are absolutely necessary for women's health, as they help to fight pathogenic bacteria that cause inflammatory processes. Flora swab(a smear on the cleanliness of the vagina) helps to determine the composition of the flora and the quality of the environment in which it lives.

What can be found in a vaginal cleanliness smear?

A smear on the cleanliness of the vaginal flora can reveal the following elements:

• Epithelium... These are dead epithelial cells of the tissues covering the organs, in particular the vagina and cervix. Normally, it should be a little. If there is a lot of biomaterial in the test sample, it means that an inflammatory process is taking place in the body. The absence of epithelium is observed in women with hormonal disruptions, with an excess of testosterone and a lack of estrogen. It is not less dangerous symptom leading to early aging of the body and a decrease in sexual function.
• Leukocytes... These are special cells - the defenders against infections, produced by the immune system. Leukocyte cells have White color therefore they are called white blood cells. Normally they should not be a large number of to resist attacks by disease-causing bacteria. A sign of inflammation is an increase in the number of leukocytes.
• Erythrocytes... Erythrocyte cells are part of the blood - they give it a red color. Their concentration in the smear depends on the phase of the menstrual cycle. However, if there are a lot of them, erosion, inflammation or damage to the vaginal mucosa can be assumed.
• Slime.This viscous substance is secreted by the glands of the vagina. Thanks to her, self-cleaning of the genital tract occurs. This means that the mucus must necessarily be part of the smear for the cleanliness of the vagina. If mucus is found in the urethra, this is the first sign of a urinary tract infection.
• Atypical cells... These are cells that differ in structure from normal ones. Normally, they should not be at all - they are a sign of a precancerous condition.
• Gardnerells... These microorganisms belong to conditionally pathogenic flora, which means they are harmless up to a certain point. It is the conditional pathogenicity that allows them to be in the body without causing an attack by the immune system. Under some circumstances, for example, when immunity is weakened or infected with other pathogens, the number of gardnerella increases, which leads to gardnerella, which rarely occurs alone. The detection of these microorganisms in a smear in small quantities is the norm. But an increase in the number of gardnerella indicates vaginal dysbiosis and bacterial vaginosis.
• Key cells.This is the name of the epithelial cells that stick to each other by microbes and viruses. They appear with gardnerellosis and weak immunity.
• Cocci.Spherical bacteria having a pathogenic (gonococcus) or opportunistic (staphylococcus) character. In case of detection of cocci pathogens, very serious treatment is necessary.
• Candida... This fungus can be found in small amounts even in healthy women. If there is more candida than lactobacilli, then candidiasis or, as this disease is called, "thrush" begins. This happens when taking antibiotics, pregnancy and a decrease in immunity.
• Trichomonas... This bacterium, the causative agent of a dangerous disease of trichomoniasis, cannot always be detected when examining a smear for the cleanliness of the vagina due to its ability to change its shape. To confirm its presence, an additional analysis is carried out - bacterial inoculation (bacterial culture). But if it is found, treatment cannot be avoided.
• Dondrain sticks - lactobacilli... The main female microorganisms that support the health of the reproductive system. Their presence in the smear for the cleanliness of the vagina is strictly necessary.

When do you need to take a swab for flora?

It is recommended to take a smear on flora at any. Unfortunately, many women's diseases are hidden, so this analysis is simply irreplaceable. In addition, there are direct indications for the delivery of a gynecological smear for the cleanliness of the vagina:

• Inflammation of the pelvic organs;
• Pregnancy planning;
• Pain in the lower abdomen;
• Itching, burning, and unnatural vaginal discharge;
• Pregnancy;
• Taking antibiotics or hormones;
• Sex partner change.

In these cases, a smear on the cleanliness of the vagina will help identify disturbances in the flora.

How to properly prepare for a vaginal cleanliness smear?

Before visiting a doctor, you should follow some recommendations:

• Do not use vaginal medications and douching;
• Refrain from sexual intercourse for a couple of days;
• Immediately before taking a smear, try not to urinate for 2-3 hours.

It is best to go for an examination after the completion of menstruation, in 5-6 days. The direct sampling of biomaterial from a woman is carried out by a gynecologist using a disposable spatula. The procedure is absolutely painless.

How to decipher the analysis - a smear for cleanliness of the vagina

The analysis can only be deciphered by a specialist with the appropriate qualifications. It is advisable that this is done by the same doctor who took the smear for analysis. Doctors designate all indicators with several letters for brevity. It looks like this:

V - vagina;

C - cervical canal of the cervix;

U - urethra;

L - leukocytes;

Ep - epithelium;

GN-gonokokkovoi;

Trich - Trichomonas.

A healthy smear contains mucus, which indicates a normal pH level, and lactobacilli (Doderlein sticks), which make up 95% of the total microflora.

The sign "abs" on the form of the analysis result indicates the absence of this or that component, and the sign "+" - its presence.

Normal indicators of a smear for the purity of flora

What is the degree of vaginal cleanliness

Based on the result of a smear on the cleanliness of the vagina, the degree of cleanliness of the vagina is determined. There are only 4 of them:

• 1st degreecharacterized by a normal number of leukocytes in the test sample. Lactobacilli make up the bulk of the total microflora. Epithelium and mucus - in moderation. If, after examining the biomaterial, 1 degree of vaginal purity is assigned, this means that the body's immunity is strong, the microflora is in perfect order and there is no threat of inflammation or infections.
• 2nd degreealso determined by the indicator of leukocytes in the norm. In the microflora of the vagina, cocci and fungi are present along with lactobacilli. Mucus and epithelium - within the permissible concentration. These indicators are considered the norm, but the microflora is not ideal. This can cause inflammation due to lowered immunity.
• Grade 3: the number of leukocytes is increased. Most of the microflora consists of pathogenic and pathogenic microorganisms: fungi, cocci. There are very few lactobacilli, but a lot of mucus and epithelium. These are all signs of infection or severe inflammation that require immediate treatment.
• 4 degree: a large number of leukocytes and pathogens. Lactobacilli are not observed. There is a lot of mucus and epithelium, which indicates a pronounced inflammatory process. An urgent medical examination and treatment is required.

If the first two degrees are considered the norm and do not require special attention, then the third and fourth degrees speak of an infection of the internal genital organs. Various gynecological procedures for such indications cannot be carried out without preliminary treatment and re-examination.

The analysis of a smear for cleanliness of the vagina has great importance to study the work of the immune system and identify infections and inflammations, especially chronic ones. If necessary, the doctor can conduct an extended examination of the discharge using special methods of analysis: cytomorphological and bacterial.

Every woman who respects herself and her own health must visit the gynecologist's office at least once a year. If a representative of the fair sex has a chronic disease in terms of women's health, she visits a specialist every six months for a preventive examination and follow-up.

It is known that routine check-ups include a series of examinations. First of all, the gynecologist asks the woman about the presence of complaints, finds out the regularity and duration of the menstrual cycle, the presence of PMS, the regularity of sexual activity, methods of contraception, in parallel, a visual examination of the genitals can take place with the help of a special gynecological mirror, then the gynecological material is taken for laboratory research ... Then, the mammary glands and nearby lymph nodes are examined.

Some ladies postpone visiting a gynecologist if menstruation is expected in the coming days or menstruation occurs at the moment. Is this decision justified or is it possible to take a smear during menstruation?

When and why a gynecological smear is prescribed

The gynecologist conducts a survey and examination in order to suggest a diagnosis based on complaints, anamnesis and a visual assessment of health. What is the reason for the need to take an analysis, especially during a preventive visit?

The doctor takes material for research at each new visit of a woman. On the one hand, this is how screening is carried out (detection of latent diseases or ailments at the initial stage in those examined who have no complaints), and on the other hand, laboratory diagnostics makes it possible to clarify the diagnosis, to confirm the final recovery after treatment.

A smear "for flora" is prescribed when the color, consistency, odor of the discharge changes, especially if these qualitative changes in leucorrhoea are accompanied by itching, the laboratory assistant examines the microflora sometimes even during menstruation.

In addition to microorganisms living in the studied environment, the smear helps to determine the cellular composition - leukocytes, epithelium, including cells atypical for this organ.

What is the best time to take a smear?

The most favorable time to conduct an examination is 7-10 days of the cycle, when menstruation is completely over. During this period, the woman's body provides the most reliable information about both inflammation and microflora imbalance. Therefore, it is worth planning a visit taking into account the day of the menstrual cycle.

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A ban on the collection of material during menstruation is not a hard and fast rule. If there are complaints of a sharp deterioration in well-being, it is worthwhile to conduct a study without delay, then the gynecologist indicates that menstrual flow may be present in the material. The same attitude to taking a smear during mass medical examination. A woman can go to the doctor on another day or agree to take the material taking into account her critical period.

You can take a smear a few days before your period. Then the information about the microflora will be quite reliable, but the study of the hormonal sphere is not carried out.

Preparing for the procedure

It should be noted that a gynecological smear includes a study of material from the vagina, cervical canal, and in some cases, the urethra.

If a woman has planned a visit to a gynecologist, she should adhere to some preparation rules so that the result is as informative as possible.

• Before a smear, it is recommended to wash off the night before, so that under the influence of intimate hygiene products, you do not "lubricate" the result.
• It is better to refrain from depilation and carry it out a couple of days before the procedure.
• It is advisable to abandon the daily panty liner.
• Refrain from vaginal sex for a day, or better - two before the examination.
• If material is collected from the urethra, do not urinate for an hour before examination.
• Stop taking medications 7, and preferably 10 days before taking the material. If you cannot stop taking certain medications, tell your gynecologist that you are being treated with certain medications at the time of the examination.
• On the recommendation of the gynecologist, on the eve of the examination, the so-called food provocation of infections can be performed. This means that after drinking alcohol, smoked meats, pickles, the pathological microflora is activated and displayed as a sharply positive result in a smear. To provoke gonorrhea, a gonovaccine is sometimes used, it is administered intramuscularly one day before the examination.

How is the procedure carried out

Material for research is selected completely painlessly. The woman at the reception is located in the gynecological chair. The doctor installs a special mirror of the appropriate size, which allows you to examine the vagina and cervix. The gynecologist collects cells from intimate areas, namely the vagina, cervical canal with a spatula.

If, on examination, erosion or other pathological focus is found, then the material for laboratory diagnostics is taken from this area. If it is necessary to collect the test cells for PCR, a brush is used, not a spatula.

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If a sexually transmitted disease is suspected, the contents of the urethra (urethra) are examined to complete the picture, from there the discharge is taken with a hook-shaped instrument.

The procedure as a whole does not cause any sensations. Only in the presence of some pathology during the sampling of material, slight bleeding and discomfort may appear. For some time after a smear from the urethra, a slight burning sensation is felt.

A smear during menstruation

Do they still take a smear during menstruation? Yes, in some situations this is possible. For example, if an infectious process is suspected. It is quite difficult to take material from the uterus and vagina for laboratory diagnostics, because the mucous membranes are covered with bloody discharge, visualization is severely impaired, so the examination will not be thorough enough. Skipping your morning wash is also tricky. And the result will be somewhat distorted due to the presence of menstrual flow in the smears.

If, for objective reasons, the delivery of a smear coincided with the period of menstruation, it is worth adhering to the following rules, in addition to the generally accepted ones:

1. Evening and morning washing of the external genital organs should be carried out without special means for intimate hygiene, with boiled water.
2. Do not use tampons at night or immediately before taking a smear.
3. Be sure to use a diaper on the chair.
4. The doctor will indicate on the samples obtained that they were from a menstruating woman.

Opinion of doctors

Gynecologists say that there is no such period when it is absolutely impossible to take smears during examination. It should be noted that in some situations, when the result directly depends on the hormonal background of a woman, it is important to adhere to the recommended timing. If the material is examined for microflora and / or the presence of atypical cells, then it is permissible to take it during menstruation.

A gynecological smear helps determine the following indicators:

• The level of leukocytes (normal level - single cells in the field of view).
• The number of epithelial cells (single in the field of view).
• Microorganisms (cocci / sticks), as a rule, in a healthy woman, gram-positive sticks predominate.
• Yeast mushrooms (not normally detected).
• Gonococci, Trichomonas, chlamydia - pathological microflora, is not normally determined. Its presence indicates the presence of an infection or a combination of infections.

According to the above indicators, the degree of cleanliness of the vagina is determined, from the first to the fourth. The first - the ideal result, is found in young girls who have not begun their sex life. 2-3 degrees are normal variants, and the fourth indicates the presence of an infectious and inflammatory process.

With every planned visiting a gynecologist in the antenatal clinic, as well as upon admission, treatment and discharge from the hospital, a number of studies are carried out, including a smear on the flora.

This method research is aimed at identifying the prevailing flora in and, as a consequence, in the presence of pathogens, determining their type and quantity.
Scheduled inspection... With a planned visit to a gynecologist, a number of measures should be taken to ensure that the smear test result is the most reliable and informative.

1) A smear should be taken between periods, or 3-4 days after their end. This should be done so that the blood, which has an antimicrobial effect, does not spoil the smear picture.
2) 1-2 days before visiting a gynecologist, you should refuse sexual intercourse.
3) 2-3 days before taking a smear, you should not do vaginal douching, so as not to wash out the flora

4) It is necessary to abandon intimate hygiene products 1-2 days before the examination, so as not to disturb the acidity of the vaginal environment and, as a result, not to affect the flora.
5) Hygiene procedures should consist only in washing with warm water the night before. In the morning, immediately before the visit, no procedures should be carried out.

6) Any topical dosage forms such as ointments, suppositories, vaginal tablets, etc. can radically change the ratio of microorganisms and, as a result, the picture of the smear. Therefore, 1 week before the study, it is required to stop using the drugs, except for those cases when it was agreed with the doctor.
7) If possible, you should not urinate for 2-3 hours before the manipulation.

Emergency smear collection... Upon admission to the hospital, it is not possible to complete most of the points, so smears are taken in the morning, before any hygiene procedures are taken.

What flora should be in a normal smear?
The degree of "cleanliness" of the vagina directly depends on the quantitative content of lactobacilli - Doderlein sticks. It is they who create the optimal acidic environment of the vagina, which prevents the development of pathogenic flora. How less content Doderlein sticks in the vaginal flora, the lower the acidity and the more growth of other microorganisms occurs. In this regard, there are 4 degrees of vaginal purity:

I degree- considered ideal. At this degree, Doderlein's rods predominate in the smear, they cover virtually the entire field of view of the smear under the microscope. there are single, epithelial cells in moderate numbers. The environment in the vagina is sharply acidic. Such a smear pattern is typical for persons who are not sexually active and, in connection with modern conditions life and ecology, is the "standard".

II degree- lactobacilli becomes smaller, the number of leukocytes increases. There are single staphylococci, streptococci. The reaction of the vaginal environment is acidic. This type the result is typical for a healthy woman who is sexually active.

III degree- the content of Doderlein sticks has been sharply reduced. Leukocytes are in significant quantities, a large amount of pathogenic flora is characteristic: staphylococci, streptococci, Escherichia coli, yeast-like fungi, etc. The medium is either slightly acidic or neutral. This picture is observed in inflammatory processes of the genital area, a sharp decrease in the protective function of the body.

IV degree- complete absence or single Doderlein lactobacilli, leukocytes and epithelium cover the field of view of the smear. Complete predominance of pathogenic flora. This picture is typical for an active inflammatory process.

For determining speakers and more credibility, this analysis it is recommended to take it in the same institution, so that the smear is examined in the same laboratory and thus, the degree of error would be minimal.
Pregnant women must take a smear on flora at least three times: at the beginning of pregnancy, at 30 and 38 weeks.

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A smear for infection will allow you to find out if a woman, and therefore her partner, has sexually transmitted diseases.

At the same time, part of the identified diseases can be obtained as a result of visiting public places and in the absence of rules personal hygiene.

Taking a smear for the presence of hidden and actual infectious diseases is indicated in the following cases:

• in the presence of cheesy, putrid and green discharge from the genitals;
• with constant painful sensations in the lower abdomen;
• when planning a pregnancy, it is better in this case to pass complex analysis;
• if necessary, surgical intervention in the organs of the genitourinary system;
• constant miscarriage and the onset of labor much earlier;
• impossibility of conception if present good results analyzes in other areas;
• with rheumatological lesions;
• to assess the success of the treatment of genital and genitourinary infections.

You can already find out the result of the analysis Two days later after its delivery.

The delivery of material with a smear occurs from three locations: vaginal mucosa, cervix and urethra. Collecting cells from just one area may not be informative enough.

What does the analysis show?

With the help of a smear for infection, it is possible to identify the presence or absence of many diseases that, when further development can lead to infertility, violations in menstrual cycle and the development of cancer. Based on the results of the analysis, the specialist gives an opinion on the following diseases and pathogens:

• chlamydia and ureaplasma;
• mycoplasmosis;
• gardnerella vaginal;
• Trichomonas and gonococcal lesions;
• cytomegalovirus;
• treponema, provoking syphilis;
• candidiasis of various nature (thrush);
• viral hepatitis;
• defeat by the Epstein-Barr virus;
• human papillomaviruses, including the oncological type.

You can get an analysis by means of a smear for infection quantitative and qualitative types... Quantitative analysis is more informative but has a higher cost.

When receiving a questionable or positive result, patients are advised to additionally donate blood and scrapings. In some cases, a general and chemical analysis of urine is also required. Complete analysis will give more detailed response and help you plan your therapy.

Swab for infections during pregnancy

During pregnancy, testing for latent infections may allow avoid the development of fetal pathologies, the likelihood of which increases sharply in the presence of any infectious lesion. Additionally, the delivery of a smear for infections is indicated for women with an erosive lesion.

During pregnancy development of cervical erosion the uterus can be caused by a hidden infection, which also negatively affects the health of the mother and baby. In addition, erosion can go into the phase of cancer.

Revealing the presence of hidden infections while carrying a baby is also important due to the fact that all these diseases can be passed on to the child during its passage through the birth canal of the mother. Subsequently, this can provoke the development of chronic gynecological and urological diseases.

Preparation for research

To prepare for your research, you should stick to following recommendations:

• 3-5 days before the alleged study, it is worth refraining from intercourse, so as not to blur the real picture of the state of health;
• abandon douching procedures, which can damage the mucous membrane and provoke the production of unnecessary enzymes and particles;
• taking any antibacterial medicines should be finished not earlier than 8 weeks before the date of the scheduled study;
• the laboratory procedure is carried out on the 4-5th day of the cycle after the end of menstruation in the pre-ovulation period;
• before passing the smear it is worth trying do not go to the ladies' room within two hours so as not to introduce excess bacteria into the urethra and vagina;
• taking medications injected inside the vagina must be finished 21 days before dates of the smear;
• to obtain a more accurate picture per day, the patient is recommended to carry out alimentary provocation. It is carried out by eating on the eve of sweet or salty.

average price

The cost of the analysis depends on how many pathogens the doctor will look for in the smear, as well as on how the laboratory and its specialists are advertised. On average, a comprehensive analysis can cost a woman from 3 to 15 thousand rubles.

When ordering an analysis for single pathogens, the cost of the service is lower, but it also has a high price. So, for the analysis for chlamydia, you can pay from 350 to 850 rubles; ureaplasma - 450-750 rubles; to detect the herpes virus or cytamegalovirus, you will have to pay about 450 rubles. On average, the cost of testing for infectious diseases is 500 rubles. In regional centers, the cost of the procedure is 10-20% lower. Sometimes clinics make significant discounts to customers who order complex analyzes... In this case, the cost may decrease by 5-10%.

In antenatal clinics, with constant supervision and registration, you can take the analysis free of charge, but only if there is a referral from a urologist or gynecologist. In private clinics, this direction has no effect.

For their own reassurance, doctors recommend taking a smear annually and immediately after unprotected intercourse with an unfamiliar partner. If you are confident in your partner, and he does not change with you, you can get tested for infectious diseases once every two years.