Медики получили инструкцию по выявлению и управлению десятью неожиданными находками при мазке на цитологию

Cervical smear testing: ten unexpected findings and how to manage them This eLearning CPD module highlights ten unexpected findings that may arise during cervical smear testing, explaining what nurses need to look for and the appropriate actions to take. Read the full module on Nursing in Practice 365 today. Cervical screening is a routine procedure but can be challenging, and practice nurses play a central role in ensuring it is carried out safely, sensitively and effectively. Although most smear appointments are straightforward, unexpected findings can arise. These may relate to the cervix itself, the surrounding genital tract or factors that influence the safety or quality of the sample. Recognising these findings – and responding in line with local protocols, national screening guidance, and the nurse’s professional scope – is essential for patient safety and programme effectiveness. This module outlines ten unexpected findings a practice nurse may encounter during a smear test and describes the general principles guiding appropriate actions. 1. Visible vulvo-vaginal or cervical lesions Before the speculum is inserted the nurse will examine the external genitalia and vaginal orifice as part of the smear-taking process. Related Article: Be an agent for change for cervical screening Unusual findings at this stage may include: - Ulcers. - Lumps or irregular growths. - Warts – small, fleshy cauliflower-like bumps. - Atrophic changes – pale, thin, dry tissue that may bleed easily. - Polyps – small protruding growths. - Cracks, excoriations, rashes or skin thickening. Visual assessment should continue during speculum insertion and examination of the vaginal walls and cervix. The nurse may occasionally notice lesions on the cervix that are unusual or concerning. These may include: - Ulcerated, friable or necrotic areas. - Abnormal growths or masses. - Markedly inflamed or atypical tissue. - Lesions that bleed on contact. Such findings are not typical of benign conditions like ectropion or Nabothian cysts, which experienced nurses can usually recognise. When the appearance is suspicious, the priority is not simply obtaining the smear sample but ensuring appropriate medical review. Appropriate actions: - Ensure the patient is informed sensitively that an abnormality was noticed. - Avoid diagnosing or speculating about malignancy. - Follow local referral pathways – which may involve a prompt GP assessment, and onward referral such as on a suspected cancer pathway or direct referral to Gynaecology. - As always, document findings factually and completely. The smear may or may not be taken depending on local policy, but referral for clinical assessment is the key step. 2. Contact bleeding or unexpected bleeding Some light bleeding during the procedure, especially with conditions like cervical ectropion, is not unusual. However, unexpected or profuse bleeding, or bleeding from a suspicious lesion, should be approached cautiously. Appropriate action: - Stop the examination if bleeding is excessive. - Explain what has occurred and allow time for the patient to recover. - Refer immediately to the GP or Gynaecology. - Document the bleeding and any suspected cause. Again, the smear may or may not be completed; the decision depends on the severity of bleeding, suspected cause and local guidelines. 3. Cervical polyps Cervical polyps are relatively common and often benign. Many women are unaware of them. They are usually small, smooth and peduncular (where the polyp tissue grows on a stalk, rather than sitting directly on the cervix). Appropriate actions: Related Article: Nurse helpline sees over 1000% rise in cervical screening queries - Reassure the patient that these are often benign findings. - Do not attempt removal. - Refer to a GP or directly to Gynaecology / Colposcopy clinic for further assessment and potential polyp removal. - Proceed with the smear if appropriate and in line with guidance. If a polyp is large, irregular or bleeds easily the urgency of referral may increase. 4. Vaginal or cervical infections Unexpected signs of infection may include: - Thick, malodorous or discoloured vaginal discharge. - Marked erythema, swelling or irritation of the vulva, vagina or cervix. - Cervical inflammation or friability. - Symptoms disclosed during the appointment, such as itching, pelvic pain, dyspareunia or abnormal bleeding. Mild discharge does not always prevent cervical screening from proceeding. However, significant infection or marked inflammation can compromise sample quality and may increase the likelihood of an inadequate or misleading result. In some cases, infection may also make the examination uncomfortable or distressing for the patient. Infections such as candidiasis, bacterial vaginosis and trichomoniasis may be encountered. In addition, some sexually transmitted infections, including chlamydia and gonorrhoea, may present with cervical inflammation, discharge or contact bleeding. Appropriate actions: - Assess whether signs of infection are likely to affect sample adequacy or patient comfort, in accordance with training, local policy and cervical screening guidance. - If significant infection, marked inflammation or unexplained discharge is present, defer the smear test until appropriate assessment and treatment have been completed, as proceeding may result in an inadequate or potentially false-positive sample. - Where clinically indicated and within scope of practice, undertake appropriate investigations such as vaginal swabs or dual NAAT testing for chlamydia and gonorrhoea. - Explain clearly and sensitively why the smear may need to be delayed, reassuring the patient that this is to improve the accuracy and safety of the screening process. - Arrange or provide (for example, if clearly thrush) appropriate treatment, or referral to STI clinic or follow-up, according to local protocols. - Ensure robust safety-netting and recall arrangements so the patient understands when and how to rebook the smear test following treatment. If infection is accompanied by severe pelvic pain, unexplained bleeding, systemic symptoms or suspicious cervical changes, urgent medical or gynaecological review may be required. Related Article: Mythbuster: ‘I don’t need a smear test – I’ve had my HPV jab’ Complete the full module on Nursing in Practice and log 1.5 CPD points towards your appraisal today Article reviewed by Dr Keith Hopcroft, GP and Cogora clinical advisor Sources and further information - NHS England. Cervical screening resources. - UK Government. NHS Cervical screening: cervical sample taker training. 2016 - UK Government. Education pathway. 2025 - NHS Scotland. Cervical lesions – colposcopy. - Nursing and Midwifery Council. The Code. Professional standards of practice and behaviour for nurses, midwives and nursing associates See how our symptom tool can help you make better sense of patient presentations Click here to search a symptom