A simple visual examination of the vagina and cervix before pregnancy can save you from many problems. For example, a doctor can see the inflammatory process and prescribe treatment without risk to the fetus. In this case, the doctor must take a smear for leukocytes (smear for flora). If there are a lot of them, then treatment is necessary. You may not have any external symptoms of inflammation such as discharge or odor, but the environment in your vagina may be unhealthy. The source of inflammation is, for example, such simple things as staphylococci and streptococci, candida (), gardnerella, trichomonas, etc. All these pathogens are often present in a healthy body in a dormant state and are activated only when.

Perhaps a more advanced visual study - .

What is a flora smear?

Correctly not asking for a smear on the flora: Bacterioscopy. A smear is taken by a gynecologist after inserting a vaginal speculum, under eye control, using a disposable spatula (a plastic stick with a widened end). The material taken with a spatula is evenly distributed over a clean glass slide with a wide stroke. It is incorrect to apply the material in a thick layer, a drop, or a small smear - this will make it much more difficult for the laboratory doctor to do his job. Material from different areas is placed on the glass separately, on the back of the glass the place where the smear was taken is marked: “U” - urethra, “C” - cervix, “V” - vagina. After this, the glass is air dried and sent to the laboratory. In the laboratory, the smear is stained and examined under a microscope.

What may be on the results form of a finished smear analysis for flora

Epithelium. Cells that line the vagina and cervix. Normally they should be present. Their number varies depending on the phase of the menstrual cycle and the hormonal drugs used. The more female sex hormones (mid-cycle, estrogen intake, pregnancy), the more epithelium. The absence of epithelial cells may indicate epithelial atrophy, lack of estrogen, or excess of male sex hormones.

Leukocytes. Cells that perform a protective function, “eating” infectious agents. With inflammation in the vagina (colpitis, vaginitis), their number increases in proportion to its severity and the number of pathogens. Normally, the number of leukocytes in the first phase of the menstrual cycle is up to 10 per field of view (a section of glass visible under a microscope), in the second - 10-15 per field of view. An increased content of leukocytes is sufficient to establish the fact, but not enough to determine its causative agent. And it is very desirable to find the pathogen in order to choose the right antibiotics.

Rod flora(morphotype of lactobacilli). This is normal flora (microorganisms that should live in the acidic environment of the vagina), except for which nothing should be detected in the smear.

Everything presented below should not be present in a normal smear:

Cocchi. Bacteria are spherical (as opposed to rod-shaped). Sometimes appearance is enough to make a diagnosis (diplococci (double) - gonorrhea, a combination of cocci, small rods and “key” cells - bacterial vaginosis), sometimes culture is necessary for an accurate diagnosis.

Small stick. Most often anaerobic (not using oxygen) bacteria, gardnerella. A sign of either infection or, especially when there are more of them than lactobacilli.

"Key" cells. Epithelial cells covered with small rods. A sign of bacterial vaginosis - vaginal dysbiosis - a condition in which instead of aerobic (oxygen-loving) lactic bacteria, anaerobic organisms, including small rods, multiply in the vagina.

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Mushrooms. Causative agents of candidiasis (thrush). Depending on the severity of the process, the smear may contain fungal spores (unexpressed candidiasis, possibly without manifestations), hyphae, and fungal mycelium (common candidiasis).

Trichomonas. Whole or destroyed. Causative agents of trichomoniasis. Large single-celled organisms with flagella.

Sowing on flora

Sowing. If necessary, you can culture pathogens present in the vagina to test their sensitivity to antibiotics and antifungal drugs, which will allow you to prescribe the most effective treatment. Bacteriological research(sowing, cultural method) is the cultivation of bacteria on nutrient media. The method is much more sensitive than microscopy, because it allows you to detect the pathogen at a low concentration, when it does not enter the smear. The analysis is taken again after inserting the speculum, under the control of the eye, from the cervical canal with a special sterile swab.

The cultural method (bacteriological, bacterial culture) is the so-called. the “gold standard” for diagnosing many infections and the main method for monitoring the effectiveness of treatment. It is much more sensitive and specific (see below) than a conventional smear and has advantages over DNA diagnostics (PCR). The fact is that what is important is not the detection of a microbe, but the proof that it is the causative agent of the infection, and this is not the same thing. The body often contains microorganisms, the so-called. “conditional pathogens” (for example, gardnerella), which normally do not cause disease, but with a decrease in immunity and the development of dysbacteriosis, they can cause. Their detection does not prove their role in the development of infection. But their growth on nutrient media indicates that, firstly, they are viable (they can grow and cause disease), and secondly, they are numerous (individual microorganisms are suppressed by those who are more numerous, and then it is not the infectious agent that grows on the media, and normal flora). Another advantage of bacteriological research is that it allows you to calculate the amount of the pathogen (by the number of colonies grown), as well as determine sensitivity to antibiotics (different antibiotics are added to the nutrient medium and it is seen which drug kills the bacteria). The only drawback of the method is the length of time it takes (bacteria grow for several days) and the demands on the laboratory.

What is the PCR method?

DNA diagnostics (PCR). DNA diagnostics includes several methods, but the most common is polymerase chain reaction (PCR). This is the detection of pathogen DNA in the material. DNA is a molecule that contains all the information about a cell. In cells of organisms of the same species (for example, mycoplasma genitalia), certain sections of DNA are the same. Therefore, knowing the structure of these areas in the main pathogens, it is possible to create mirror copies that will find and bind to them. Finding even one such site is enough for the PCR to be positive. This indicates the extremely high sensitivity of the method.

The method is good for diagnosing infections that are not detected in smears: genital herpes. However, the method is unacceptable for determining the effectiveness of treatment of the same diseases, because and after the cells decay, pieces of DNA may remain in the body.

For example, it is undesirable to use the PCR method to diagnose gardnerellosis, because These bacteria are normally found in the vagina. They should not be in the smear, and in this case, bacterioscopy is a sufficient method for diagnosing gardnerellosis and monitoring treatment. But the DNA of these bacteria can and should be present; this is not a criterion for the disease.

Gynecological tests are a type of diagnostics to determine the condition of the organs of the reproductive and reproductive systems. A mandatory part of the examination when planning pregnancy or hospitalization. They help identify STIs, sexually transmitted diseases, and pathologies leading to female infertility.

The Women's Medical Center is one of the few clinics in Moscow that has its own laboratory. We perform more than 2000 tests, including hormonal studies, microbiological tests (PCR, PAP, ELISA). The results can be discussed with a specialized specialist.

Cost of female tests

• 3 500 R Initial consultation with an obstetrician-gynecologist + ultrasound
• 500 R Flora smear
• 300 R Smear collection
• 1 500 R Culture with determination of sensitivity to an extended range of antibiotics
• 400 R Diagnosis of a single infection using PCR (qualitative determination)
• 600 R Diagnosis of a single infection using PCR (quantitative determination)
• 1 500 R Smear for oncocytology
• 7 000 R Pipelle biopsy
• 2 500 R Pap test liquid

Why and when to take gynecological tests?

Laboratory examination should be carried out not only for pain, discharge, unsuccessful attempts to conceive, but also as a preventive measure. Many problems treated by gynecology develop latently, without any symptoms. Using microbiological tests, it is possible to identify hidden genital infections, inflammation of the appendages, infertility, hormonal disorders that cause disruptions in the menstrual cycle, and to diagnose precancerous conditions of the uterus and endometrium at an early stage.

They undergo gynecological tests after examination by a doctor, who draws up an individual list of tests. Laboratory control is necessary for making a diagnosis, monitoring the effectiveness of treatment, and monitoring during the prenatal period of pregnancy, so most often the examination is repeated at least 2 times with an interval of 2-4 weeks.

Specialists

Main types of analyzes

The following studies are carried out in our laboratory:

• smear for infections - allows you to determine the composition of the microflora and detect pathogenic microorganisms that cause inflammation;
• bacterial culture - microbiological analysis, during which the degree of activity and interaction of beneficial and “hostile” bacteria, their reaction to antibiotics is monitored;
• PCR – the study takes place at the cellular level, helps not only to detect, but also to identify infectious agents;
• PAP test - is prescribed to diagnose precancerous changes in the epithelium of the cervix. For women over 30 years old it is mandatory;
• cytology/histology – analysis of cells and tissues of biomaterial (smear, scraping, biopsy) aimed at early detection of ovarian, cervical, endometrial cancer;
• hormonal panel - helps to notice disturbances in the functioning of hormone-producing and reproductive organs. Prescribed to women who have problems with their sex life, conception, and menstrual cycle.

The biomaterial for hormone tests and PCR tests is venous blood. To diagnose sexually transmitted infections, a smear or urine is examined using the same method.

How to prepare properly

There are no special preparation requirements. A woman needs to adhere to the standard rules that usually precede a trip to the gynecologist:

• on the eve of the examination, refrain from sexual relations;
• carry out thorough hygiene of the external genitalia with running water;
• You cannot douche or use vaginal suppositories.

If you have the results of previous tests on hand, you need to take them with you and show them to the doctor. It is better to donate blood from a vein in the morning, on an empty stomach, and avoid physical and nervous stress.

By contacting the MLC, you will not have to run from one laboratory to another. Take all gynecological tests in 1 day in one building. Call us to choose a day convenient for your consultation.

A woman’s health and well-being consists of many components. A woman is a hormonally dependent creature, i.e. the normal activity of the reproductive system is based on the refined work of the endocrine glands. In addition, the microflora of the body, including the biocenosis of the vagina, significantly affects the girl’s quality of life.

Imbalances in the healthy vaginal microflora not only lead to painful symptoms that significantly reduce the daily activity of the fair sex, but also lead to the development of various gynecological diseases. And this, in turn, is a formidable risk factor for infertility.

Tests in gynecology

Gynecology is a very subtle and delicate science, so there are a very large number of diagnostic methods. One of the simplest and most inexpensive diagnostic methods, which are carried out in any antenatal clinic or gynecological hospital, are various smears on the flora.

There are several types of flora smears:

• Bacterioscopic analysis or microscopic examination (direct smear on the flora).
• Cytological analysis - to detect atypical cells for this location (PAP test).
• Bacteriology or bacterial culture to identify pathological flora.

All smears are carried out after a special gynecological examination, which includes examination of the external genitalia, palpation of the uterus, and examination of the cervix in the speculum.

Many women ask the question: “When exactly can you get tested, and on what day of the menstrual cycle should this be done?” There are no strict restrictions in this matter. However, gynecologists recommend taking smears at the beginning of the menstrual cycle, immediately a few days after menstruation. You can also take a smear just before your period.

Preparing for analysis

Any woman should remember that any diagnostic procedure must be preceded by certain preparation. It is carried out in order to avoid false results, which may prompt the doctor to make an incorrect diagnosis and prescribe inappropriate treatment.

Preparation for taking a vaginal smear (rule of twos) includes:

• Two days before the examination you need to abstain from sexual intercourse.
• Stop taking antibiotics two weeks before.
• Stop taking hormonal medications and administering vaginal suppositories and creams 2 days in advance.
• It is not recommended to urinate 2 hours before the procedure.

After deciphering the results, it is possible that the results will be bad. In this case, a repeat vaginal smear is taken.

Smear microscopy

Bacterioscopic analysis is one of the most informative in the diagnosis of gynecological pathologies. This method has a fairly impressive list of indications:

1. The presence of subjective discomfort in the perineal area in a woman (itching, burning, unpleasant odor, etc.).
2. Complaints of pain in the lower abdomen.
3. The presence of pathological discharge (profuse mucous, mixed with blood or pus, leucorrhoea with an unpleasant putrefactive odor).
4. Annual preventive examinations.
5. Advance pregnancy planning.
6. The immediate period of bearing a child.
7. When changing sexual partner.

A smear on the flora is taken from several locations: the vagina, urethra or urethra, cervical canal and sometimes, if there are special indications, from the rectum.

What can a smear test reveal? A vaginal smear provides the doctor and patient with detailed information about the state of microcinosis in the intimate area. The smear shows:

• The number of leukocytes in the cervical mucus.
• The number of leukocytes in the cervical area.
• Presence and number of red blood cells.
• Epithelial cells and their number.
• Character of mucus.
• Bacteria, including “good” ones - lactobacilli, their composition and quantity.
• The presence and quantity of pathological microorganisms - Trichomonas, gonococci, fungi, etc.

The procedure is non-traumatic and painless. Healthy women are recommended to undergo bacterioscopy of vaginal discharge once every 6 months.

Norm

Each of the above indicators has its own limits, deviations from which (usually upward) are considered to be the development of some inflammatory or infectious pathology. It is worth keeping in mind that the norm for a healthy woman of reproductive age, a teenage girl and a woman in menopause may have some variability. There are also individual norms for vaginal discharge in pregnant women.

So, let’s look at the norm for each of the indicators during microscopy of vaginal discharge.

Leukocytes. These are so-called white blood cells. They act as immune defenders of our body from any external infectious agents. Normally, single leukocytes are present in the cervical canal and on the cervix. But if, when deciphering the smear analysis, an increase in the number of leukocytes is observed, then this indicates the beginning of the development of the inflammatory process in the vagina.

The norm varies depending on the location:

Sometimes the white blood cell count in the vagina and cervix can be 100 cells per field of view or higher. This indicates an acute stage of inflammatory pathology.

Epithelium. Normally, single epithelial cells are present in vaginal discharge. The normal number of these cells is up to 15 in the laboratory technician’s field of view. In vaginal discharge, squamous epithelium is determined at all stages of its development. And in a smear from the cervical canal and on the surface of the cervix, columnar epithelium is found. The difference in epithelial cells depending on the location is due to the different cellular structure of the walls of the vagina and cervix. An increase in epithelial cells may indicate the presence of a chronic inflammatory disease (often with a latent asymptomatic course).

Slime. Normally, this substance is absent in the urethra, but is present in the vaginal cavity. Depending on the period of the menstrual cycle, the volume of mucus can vary from scanty to abundant. When pregnant women secrete a large amount of mucus, a high glycogen content is also found in it. Glycogen is a special protein that is a nutrient medium for lactobacilli.

Microorganisms. In women of reproductive age, including during pregnancy, microscopy of vaginal discharge reveals gram-positive flora. These are lactobacilli - cells that provide normal microcinosis of the vagina. In postmenopausal women and girls before menarche (their first period), little or no lactobacilli are detected. A sharp decrease in these cells indicates bakvaginosis. Predominantly in these age categories the presence of coccal flora is observed.

In addition to lactobacilli, microscopy can also detect pathological bacterial flora - Trichomonas, gonococci, gardnerella. Normally, in healthy women and during pregnancy, these cells are completely absent. Their detection indicates the presence of a sexually transmitted disease.

In addition to bacteria, fungi of the genus Candida can be detected. Their presence in vaginal discharge indicates carriage or the development of a disease such as thrush.

Smear in pregnant women

As mentioned above, some indicators during pregnancy may differ from the norm in non-pregnant women. A smear for flora during pregnancy is taken three times:

• During pregnancy registration (up to 12 weeks).
• At 30 weeks.
• Immediately before birth, in the last week of pregnancy.

The main difference in smear analysis when deciphering it is that during pregnancy there are a larger number of lactobacilli. In addition, during pregnancy there is a larger volume of mucus enriched with glycogen.

Let's summarize and compare the indicators of a healthy woman of reproductive age and a woman during pregnancy.

In addition to these indicators, the smear may reveal the presence of cells atypical for a given location. The so-called ugly cells are called atypical, i.e. these are cells with dramatically changed shape, size and structure. As a rule, they are detected by scraping from the surface of the cervix. The presence of this indicator indicates incipient uterine dysplasia. Dysplasia is a precancerous disease that is characterized by cellular and tissue restructuring of the organ. In this case, a more extensive study is required and a cytology smear is required.

Gynecologists currently take no more than one day to decipher tests. The results are calculated using a special apparatus or manually. A vaginal smear gives a detailed picture of the state of a woman’s reproductive system, including during pregnancy. Microscopy of secretions for flora is a low-cost diagnostic method, widespread and accessible to every woman.

Gynecological tests for hormones are prescribed for disorders of the reproductive system, weight gain, deterioration of the skin and hair, problems with the mammary glands, and pregnancy.

Hormone tests in gynecology help diagnose pathologies and determine the state of the physiological systems of the body and individual organs. All laboratory tests are prescribed by a doctor according to the clinical situation and must comply with the medical examination plan.

Reasons for taking gynecological hormone tests

The analysis must be taken at a certain phase or day of the cycle and prepared for it in a special way in order to obtain the most reliable results.

Monitoring hormonal balance in gynecology must be done not only for preventive purposes. It helps monitor the development of the genital organs and age-related changes in the ovaries. Monitor a woman’s condition during pregnancy and after childbirth.

Violation of hormone concentrations has causes and symptoms of deviation. Failures in the endocrine system must be promptly identified and treated; they cause serious diseases, the list of which is impressive.

What hormones are being studied?

The functioning of the endocrine glands is influenced by numerous external factors - nutrition, physical activity, overwork, daily routine, stress, alcohol, smoking.

It is impossible not to take into account abortions, sexually transmitted diseases, low immunity, frequent sore throats, acute viral respiratory infections, and pathologies of the endocrine system.

Taking into account the patient’s lifestyle and internal factors, the gynecologist may prescribe hormone tests , to determine the condition of the reproductive system organs and correct their functionality.

Most reproductive health problems in women are associated with hormonal imbalance, in this case, a hormone analysis in gynecology will give a comprehensive answer. The main group of active substances that are being studied are thyroid-stimulating and other pituitary hormones, sex hormones:

• luteinizing hormone (LH);
• follicle-stimulating hormone (FSH);
• progesterone;
• testosterone;
• human chorionic gonadotropin (hCG).

Features of analysis and preparation for laboratory research

The doctor directs you to determine the concentration of a specific sex hormone, taking into account the day of the cycle and the date of ovulation .

Before sending her for analysis, the gynecologist conducts a thorough examination of the patient, talks with her, and then decides on the need to determine the concentration of a particular active substance:

They take a hormone test in a specialized laboratory. Preparation for gynecological tests for hormones involves following the following rules:

• Venous blood sampling for gynecological hormone tests is done on an empty stomach.
• You need to donate blood for analysis in the morning. The level of active substances fluctuates throughout the day, the “morning” value of active substances is considered the most accurate.
• Be sure to take into account the doctor’s recommendation on which day of the cycle to take the test.
• Before the study, exclude active loads.
• The day before blood sampling, smoking and drinking alcohol are prohibited.
• Check with your doctor for how many days you need to abstain from intimacy.
• A week before the test, stop using hormonal medications.

Deviation from the norm

Gynecological hormone tests should be interpreted by a doctor, who sent for laboratory testing. A deviation in the concentration of a substance indicates certain pathologies:

1. LH ensures the normal functioning of the female reproductive system. Its high content is associated with hypofunction or polycystic ovaries, early menopause. Injuries, tumors, unbalanced nutrition, and physical overload cause a decrease in the amount of the substance.
2. FSH is responsible for the secretion of estrogen and ovarian health. Delayed puberty, inflammatory processes in the genitals, frigidity, infertility indicate a lack of this hormone.
3. Estradiol is the main sex hormone in women. During menopause, its amount decreases sharply. The lack of this substance in women of childbearing age causes disturbances in the uterine cycle, dysfunction of the uterus, fallopian tubes, and deviations in the development of the genital organs.
4. Prolactin is responsible for the functioning of the mammary glands, ensures their formation and growth in girls, and stimulates lactation in women in labor. A high content of this substance indicates ovarian dysfunction, autoimmune pathologies, and thyroid pathologies.

An increase in prolactin levels is associated with stress, injuries in the chest area, vitamin deficiency, and renal failure. occurs after abortion. An excess of the substance provokes disruptions in the uterine cycle, infertility, the formation of cysts, malignant tumors in the mammary glands, and frigidity.

A reduced level of prolactin is recorded during post-term pregnancy, as a result of taking certain pharmaceutical drugs.

1. High levels of testosterone (the main sex hormone in men) cause skin problems. The norm for women of childbearing age is only 0.290-1.67 nmol/l. But to study hormonal status, testosterone concentration must be determined. Deviations from normal values ​​can cause reproductive dysfunction in a woman.
2. Thyroid-stimulating hormone is secreted by the pituitary gland and is responsible for the full functioning of the thyroid gland. The level of sex hormones depends on the amount of this substance. Metabolic processes in a woman’s body, which are controlled by the thyroid gland, provide the possibility of conceiving and bearing a child.
3. Progesterone is the hormone of pregnancy; its normal course depends on it. In non-pregnant women, its high content provokes excess weight.

There are many gynecological hormone tests available. It is not always necessary to prescribe everything. After clarifying the clinical picture, the doctor makes a referral. To obtain reliable results, it is important to adhere to the rules of preparation for laboratory tests. To prescribe and interpret tests, contact only qualified specialists.