These are two photos taken during a Papanicolau test (pap smear) done on a 25 year old woman 6 weeks postpartum. A pap smear can detect potentially pre-cancerous changes (called cervical intraepithelial neoplasia (CIN) or cervical dysplasia), which are usually caused by sexually transmitted human papillomaviruses (HPVs). The test may also detect infections and abnormalities in the endocervix and endometrium.
In the top photo, you can see the metal speculum used to open this woman’s vagina and the wooden Aylesbury spatula used to collect a sample of the cells from the endocervix. The spatula gently scrapes the area around the os in a circular motion to gather cells.
The reddish area is called the “zone of transformation” or squamocolumnar junction where the cervical tissue changes from one type of cell to another. Though it may look inflamed, this is a normal appearance for some women. This is the area from which the health care practitioner will obtain the sample for the pap test because it is the site where cell irregularities are most likely to be found. The zone changes position at various times in one’s cycle, with age, pregnancy, or hormonal contraceptive use, sometimes tucking up into the cervical canal or blossoming outward towards the external os at other times, making it harder or easier to locate for the practitioner. When the zone is more external (as in this picture) some women may experience slight bleeding following a pap test or intercourse, simply because the capillaries are more exposed as well.
The bottom photo is of an endocervical brush being swiped in the os of the cervix. The cells gathered on the brush and spatula will be wiped/smeared on a glass slide and examined in a laboratory or under a microscope to look for abnormalities.