1. Inspect introitus: Using the Pap light, carefully inspect the external genitalia for any abnormality or lesions (Figure 20-1).

2. Insert speculum: Help the patient relax, and gently insert the speculum, moving it slowly to allow visualization of the cervix. If excess mucus is noted on the cervix, gently remove it with a cotton-tipped applicator to improve the accuracy of the test (Figure 20-2).

3. Obtain sample: Before obtaining the cell sample, label the frosted end of the glass slide with the patient’s identifying information, such as name and date of birth. Using a wooden or plastic spatula, gently place the tip of the spatula against the cervical os, and rotate it 360° to collect a sample of cells (Figure 20-3). The sample is then spread evenly over a glass slide (Figure 20-4). Spray the slide immediately with fixative (Figure 20-5). Do not allow the glass slide to dry before applying the fixative. Air drying will cause the cells to enlarge and make interpretation difficult or impossible.

4. Endocervical brush: A cervical brush can be used to obtain endocervical cell samples. Gently place the brush tip in the endocervical canal, and rotate it 360° (Figure 20-6). Roll the brush onto a glass slide, and immediately spray it with a fixative.