From the Guidelines
A Pap test at the vaginal cuff (post-hysterectomy) involves collecting cells from the vaginal apex where the cervix was previously located, and should only be performed on patients who had a hysterectomy due to cervical pre-cancer or cancer, or who have a history of HPV infection, as stated in the 2021 guidelines 1. To perform this procedure, first position the patient in the lithotomy position and insert a vaginal speculum to visualize the vaginal cuff.
- Use a cytobrush or spatula to gently scrape cells from the entire vaginal cuff area, ensuring complete sampling of the epithelium.
- Transfer the collected cells to a liquid-based cytology vial or directly onto a glass slide and fix immediately with appropriate fixative. The technique differs from a standard Pap test primarily in the collection site, as there is no cervix to sample.
- Post-hysterectomy Pap tests are generally only recommended for patients who had a hysterectomy due to cervical pre-cancer or cancer, or who have a history of HPV infection, as the risk of vaginal cancer is extremely low in other cases 1. When performing this procedure, be gentle to avoid trauma to the vaginal cuff, particularly in patients who have had recent surgery, as the tissue may be sensitive or vulnerable to bleeding. Key considerations include:
- The presence of a mucopurulent discharge should not postpone cytology testing, and the test can be performed after removal of the discharge with a saline-soaked cotton swab 1.
- The use of instruments designed to sample the cervical transformation zone (e.g., cytobrushes) improves the accuracy of cytology tests 1.
- Both liquid-based and conventional cytology are acceptable because they have similar test-performance characteristics 1.
From the Research
PAP Smear at the Vaginal Cuff
- The provided studies do not directly address how to perform a PAP smear at the vaginal cuff.
- However, 2 discusses the importance of collecting cells from the transformation zone (TZ) and the squamocolumnar junction (SCJ) for cervical cancer screening.
- The study 3 describes the use of an Ayre spatula to obtain a Pap smear, but it does not specify the location of the sample collection.
- There is no information in the studies 4, 5, and 6 that directly relates to performing a PAP smear at the vaginal cuff.
- It appears that the standard procedure for a PAP smear involves collecting cells from the cervix, not the vaginal cuff, as described in 2 and 3.
Related Procedures
- Colposcopy is a procedure used to evaluate abnormal cervical smears, as mentioned in 4.
- The use of topical lignocaine gel for pain relief during colposcopic assessment and biopsy is discussed in 6.
- However, these procedures are not directly related to performing a PAP smear at the vaginal cuff.
Limitations
- The provided studies do not offer guidance on performing a PAP smear at the vaginal cuff.
- The information available is focused on cervical cancer screening and related procedures, rather than vaginal cuff PAP smears.