The speculum should be carefully positioned so the entire cervix is seen. If excess mucus or other secretions obscure the cervix, they should be gently removed using a proctoswab without disturbing the epithelium. Small amounts of blood will not interfere with cytologic evaluation, but large amounts, as occurs during menses, preclude cytologic interpretation by conventional Pap smear. This is considerably less of a problem when liquid based cytology is used. Gross abnormalities of the cervical epithelium (especially friability, plaque-like or cauliflower lesions, or significant ulceration) should prompt referral for colposcopy, regardless of cytology results, because cytology may be unreliable in the setting of carcinoma. Nabothian cysts (Figure 1-5).
