The most important method of diagnosis in gynecologyis a gynecological smear on the flora. For the study, the discharge of the urethra, vaginal mucosa and cervix is taken. It makes possible the study of the pathogenic microflora of the genitourinary system and an assessment of its condition.
A smear on the flora is taken by a gynecologist at eachtreatment of women and during a preventive examination. Obligatory reasons for the study are complaints of pain in the abdomen, unpleasant itching and burning in the vagina, abundant discharge, indicating the presence of an inflammatory process. When planning pregnancy, after the course of antibiotic therapy is also recommended to conduct this study.
How is the gynecological smear taken? About this further.
Rules for taking a smear on the flora
To increase the information content of the test results, it is necessary to observe certain conditions:
- a couple of days before the study to give up sexual intercourse;
- do not use vaginal candles, lubricants and other means, do not douche and limit yourself to taking a shower, giving up baths;
- to visit a gynecologist choose a period of the menstrual cycle, when there is no bleeding.
On the day of visit to the gynecologist, the external genital organs are washed with soap, other detergents are excluded. It is not recommended to urinate for 2-3 hours before taking the test.
The smear on the flora is taken with sterile instruments (spatula, corncang 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 manipulations of a gynecologist, as a rule, it is absolutely painless. It also allows you to control the conduct of therapeutic therapy.
Gynecological smear on the flora: the norm and deviations from it
95% of the contents of the flora of the vagina of a healthy womanmake up lactobacilli, the main function of which is the production of lactic acid necessary to maintain the desired acidity, which protects the urino-genital organs of women from the infiltration of infectious agents.
It is especially important to do a smear on the flora of pregnant women,since during pregnancy, the number of lactobacilli decreases, which reduces the natural defense of the organism and, as a consequence, leads to the frequent occurrence of infections.
In the normal microflora of the genitourinary system, in addition tolactobacilli, contains a small amount of other microorganisms, such as Gardnerella and Candida. Due to a decrease in immune protection, which is caused by fatigue, emotional overstrain, pregnancy or various diseases, gardnerelles and candidias can accelerate their reproduction, which will lead to the emergence of gardnerelleza and candidiasis. That's how informative the gynecological smear is.
Normal indicators in the smear of an adult woman will be as follows:
- The number of flat epithelium should be equal to 15 cells in the field of vision. An increase in this number indicates inflammation. Reduction - about hormonal disorders.
- The presence of white blood cells in the smear is normal, becausethis suggests that the body is struggling with infections. But they should be no more than 10 in the vagina and urethra and not more than 30 in the cervix.
- In a smear, women should have Dederlein sticks, and in large quantities. If these lactobacilli are few, then, most likely, the microflora is broken.
- A small amount of mucus in the smear is acceptable.
If the analysis contains Candida fungi,small sticks, cocci, Trichomonas, gonococci, then, most likely, there is a disease. Then the study should be deeper and treatment may be required.
Explanation of the smear on the flora
Medical workers have introduced a system of abbreviations and use the letters of the Latin alphabet to denote the indicators of analysis.
For example, the places of sampling of a smear are denoted as follows:
- V - vagina - in translation from the Latin "vagina".
- U - uretra - urethra.
- C from the cervix - cervical canal.
- L - leukocytes are the so-called white blood cells, their increase indicates the presence of an inflammatory process.
- Gn is the gonococcus.
- "Pl. Ep. "- flat epithelium.
- Trich is a trichomonas.
The presence of mucus in the smear is an important indicator of the pH of the vaginal environment. But this is not the entire transcript of the smear.
The number of this or that flora is denoted by the sign "+".
total allocate 4 categories:
- "+" - the amount of the indicator is insignificant;
- "++" - the number of indicators is moderate;
- "+++" - increased amount of the indicator;
- "++++" is an overestimated (abundant) amount.
- "Abs" - "absence" - they write in the absence of any of the indicators.
What is a cocci flora in a smear?
Bacteria in the form of balls are called cocci. Normally, smears occur in single cocci. With a decrease in immunity, the number of coccobacillary flora in smears increases. Kokki 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 coloring drug. The microorganisms remaining after washing the smear with colored, called Gram-positive (gr +), discolored during washing - Gram-negative (gr-). The most common gram-positive microorganisms include, for example, staphylococci, streptococci, enterococci, and also lactobacilli. Proteus, gonococci and E. coli are Gram-negative.
Smear during pregnancy
How is the smear test performed in a pregnant woman?
During this period, she had a large numberProgesterone hormone is produced, which increases 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 at allwomen take a smear on the flora. To assess the state of microflora in gynecology, the term "purity of the vagina" is used. It should be known and controlled by a woman throughout pregnancy, for this, a repeated smear on the flora is done at 30 and 38 weeks.
Degrees of purity of the vagina
Gynecologists distinguish four degrees of vaginal purity:
- Degree 1 - a woman is healthy absolutely. The microflora is represented by 95% lactobacilli, possibly the presence of single epithelial cells and leukocytes.
- At the 2nd degree of purity in the smear, opportunistic microorganisms can be found in a small amount.
- The third degree of purity is characterized by a large number of opportunistic microorganisms than Dodderlein's sticks.
- 4-th degree of purity: in the smear a lot of leukocytes, epithelium and other bacterial flora. Lactobacilli little, or they are absent.
For the 1 st and 2 nd degree of purity, a pronounced acidic medium is characteristic, and at pH 3-4 it shifts, becomes alkaline.
Analysis of gynecological smear: interpretation of the results
Analysis of the gynecologic smear allows more clearly diagnose the disease and properly build a line of treatment.
For example, an increased number of leukocytes andThe epithelium becomes a sign of an acute or chronic inflammatory process. Detection in the urethra of mucus, which in normal condition does not happen, can talk about the inflammation of the channels of the urinary system.
The presence of a large number of cocci in the smear is alsoindicates the presence of inflammation of the genital organs, a decrease in the purity of the vagina. Normally, the coccal flora in the urethra is absent, and only a single amount is permissible in the vagina.
When a gonorrhea is found in a smear of the patientis diagnosed with "gonorrhea." The presence of gardnerellas and trichomonads testify to the presence of a woman with gardnerellosis and trichomoniasis. The 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 Dodderlein sticks.
Given all of the above, we can say thatthe microscopy of the gynecological smear testifies to the state of the immune system, is an important marker in the diagnosis of the state of the genitourinary system and its chronic infections.</ p>