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Smear on flora: indications, training, technique

Medical expert of the article

Vascular surgeon, radiologist
, medical expert
Last reviewed: 17.10.2021

The human body is a complex system, in the proper functioning of which some microorganisms are also involved. Some of them are actively involved in vital and secondary processes, while others just peacefully coexist with us for the time being. It must be said that our health is directly related to the ratio of beneficial and not very beneficial bacteria in the body. Our conditionally pathogenic "neighbors", along with the pathogenic "guests", can noticeably spoil the overall picture of women's and men's health, and to assess how much doctors use a special diagnostic method - taking a smear and examining it. At the same time, flora in a smear is not yet a pathology, rather, its absence is alarming. It is more important to pay attention to the composition of the microflora, which provides the doctor with important information about the patient’s health and methods of recovery.

What is a smear on flora?

Research on microflora is an important part of the gynecological examination in women. Localization of the reproductive organs of a woman, most of which (vagina, uterus, ovaries, appendages) is hidden inside the body, does not allow to visually assess their health, therefore doctors, assessing a woman’s health, simply cannot do without laboratory tests, the material for which is taken through smear.

In men, it would seem, genitals are visible, but an external examination does not allow to assess the composition of microflora and to identify pests in it, if there are complaints about discomfort in the intimate area.

A smear on the flora is one of the important diagnostic methods that allow obtaining a biomaterial for microscopic laboratory testing from the surface of the skin and mucous membranes. Most often, this concept refers to the taking of material from the surface of the vaginal mucosa. But it can also be a biomaterial from areas of the penis that are open or hidden under the skin folds, from the pharynx and nose, or from the ear, if a person has complaints of ill health.

There are several types of such research: general smear, vaginal smear in women or urethra in men with subsequent microscopy (microscopic examination), smear for detecting and determining the type of infection (PCR analysis), cytology smear (Pap smear on atypical cells).

A smear on the microflora followed by studying the biomaterial under a microscope is one of the simplest and most accessible methods of bacterioscopic research, which helps to identify the causative agent of the disease, i.e. The cause of the patient's discomfort, and sometimes people in contact with him. True, to name the identified pathogen by name requires more complex, expensive and time-consuming analyzes, but a smear examination under a microscope using dye reagents tells physicians in which direction they should go.

More complete information about the nature of the infection can be obtained after PCR analysis, the material for which again is the discharge of the genital organs taken during the smear. A predisposition to cancer is detected when conducting a cytological study on the basis of the same biomaterial, but only histological analysis (biopsy), which will require a piece of living tissue, can confirm oncology.

What does the smear on flora include? This study of a biomaterial taken from the surface of mucous membranes for the presence of beneficial (lactic and bifidobacteria), conditionally pathogenic (for example, coccal microflora) and pathogenic bacteria, fungi, protozoa, which also calculates the concentration of each type of microorganism per unit volume, their estimated size and shape. Additionally, the number of red and white blood cells (erythrocytes and leukocytes) in the discharge of mucous membranes is calculated, the content of epithelial cells is determined. The analysis can also reveal the presence of atypical cells, which indicates a susceptibility to tumor diseases.

Such a study is necessary both in the presence of an inflammatory or purulent process, and for prophylactic purposes, because sometimes the infection behaves so quietly that a person, already sick, does not experience any symptoms of indisposition until a certain moment.

Indications for the procedure

The reasons for the analysis of the microflora may be different, it is important to take into account the complaints of patients and features of a particular study. If we are talking about a preventive gynecological examination of women, which the representatives of the weaker sex and who live sexually, should be regularly 1-2 times a year, the smear on the microflora is taken without fail, which is the prevention of the development of infectious-inflammatory and sexually transmitted diseases.

There are situations when an unscheduled visit to the gynecologist is required, implying a smear test. Such situations include violent sexual contacts, suspicion of STIs at the sexual partner, non-selectivity in sexual relations when the risk of infection is increased, and the discovery of a regular partner with unusual lesions, hyperemia or plaque on the penis (it is better to be safe once again).

Other indications for general smear and bacterioscopy in women may be complaints of unpleasant symptoms, such as:

  • pain in the lower abdomen, including urination, pulling feeling,
  • itching, burning in the genital and vaginal area,
  • the appearance of unusual (cheesy, yellow or green purulent) or too abundant transparent discharge, unpleasant smell emitted,
  • hyperemia and irritation in the intimate area, especially some time after sexual intercourse,
  • pain during intercourse.

A serious violation of the microflora of the vagina is a frequent consequence of prolonged use of antibiotics, therefore, even in the absence of gynecological symptoms, it is recommended to undergo a preventive examination by a female doctor with a mandatory smear.

Taking a smear followed by a cytological examination of the biomaterial during an annual visit to the gynecologist is indicated to women:

  • suffering from infertility
  • in violation of the menstrual cycle,
  • with manifestations of genital herpes or human papillomavirus infection,
  • with obesity
  • in the case of hormonal ukontratseptivov,
  • with an active sex life (especially when changing sexual partners),
  • on the eve of the installation of the intrauterine device,
  • if visual inspection revealed non-plastic processes in the cervix (erosion, dysplasia, compaction).

A smear on flora is an important moment of pregnancy planning. It is prescribed to prevent all sorts of unpleasant surprises after conception. Any gynecological diseases should ideally be treated before this point. So mom can take care of the health of her future son or daughter in advance.

Such a study, if necessary, can be carried out even during the childbearing, because it does not imply deep penetration into the uterus, and therefore can not act as a factor traumatizing the fetus. Examining pregnant women in a gynecological chair, doctors take a smear for preventive or therapeutic purposes.

In men, a smear on the microflora is taken from the urethra (in some cases, the sperm or the secret of the prostate gland can serve as a biomaterial for research). Such a study is carried out both for diagnostic and prophylactic purposes when visiting a urologist or a specialist in venereal diseases.

Indications for smear for diagnostic purposes may be as follows:

  • the appearance of unusual, and the more purulent discharge from the urethra without or unpleasant smell,
  • discomfort in the penis (pain, burning, itching, etc.),
  • suspicion of a sexually transmitted infection (in this case, both sexual partners should be examined)
  • long fruitless attempts to become a father
  • casual sex (for prevention).

Flora smear is a diagnostic method used not only in gynecology, urology or venereology. With it, you can diagnose and identify the cause of the development of ENT diseases. The study of discharge from the throat, nose or ear can be assigned to both adults and children with suspected infection.

Such an analysis can be assigned:

  • in acute tonsillitis (sore throat), tonsil suppuration, infectious mononucleosis,
  • in inflammatory diseases of the nose (rhinitis, sinusitis) or throat (pharyngitis, laryngitis) to understand the nature of the pathology, i.e. Determine the type of pathogen,
  • with chronic or frequently repeated rhinitis and systemic colds (for example, with frequent bronchitis),
  • for studying the composition of the discharge from the lower respiratory tract during coughing with tuberculosis, as well as with suspected pneumonia.
  • with various forms of otitis media, damage to hard-to-reach tissues of the organ of hearing (smear from the surface of the outer ear).

For preventive purposes, i.e. Without pathological symptoms, a smear on the flora in the ENT practice is extremely rare.

trusted-source[1], [2], [3], [4], [5], [6]


The quality of the studied biomaterial, and hence the reliability of the results of the analysis is largely dependent on proper preparation for the study. Certain requirements are imposed on the majority of analyzes, including the rules for preparing for the collection of material, which must be followed by both doctors and patients. The accuracy and information content of the information received by the doctor after the analysis to help in the diagnosis and the appointment of adequate treatment depends on this.

In this case, the requirements imposed by different doctors may differ slightly. So the gynecologist will first of all tell the patient what to do before the analysis is impossible. It is believed that sexual intercourse, douching, use of lubricants, certain contraceptives, vaginal forms of various drugs, and bathing can affect the reliability of the analysis for the worse. All this will have to be abandoned a day before the analysis, and it is better to abstain from sexual intercourse for a couple of days before the study.

On the eve of the analysis, hygiene procedures can be carried out in the intimate area, but without the use of detergents. In this case, you can only wash the external genitals and perineum.

In the life of women of reproductive age, an event occurs every month when the uterus is cleansed with the release of blood into the vaginal cavity (menstruation). Since the smear on the flora is taken exactly from the mucous membrane of the vagina and the cervical canal, it is not recommended to carry it out during the month (unless it is for acute indications and with a mark about the phase of the menstrual cycle). The presence of a blood smear somewhat distorts the overall picture and affects the reliability of the analysis results.

On the last day of menstruation or during the first days after menstruation, a smear on the flora will have some value, but there will not be enough information about the epithelial component of the smear (exfoliated cells go out together with menstrual blood), which is necessary for the diagnosis of dysplastic and neoplastic processes. Yes, and accurate data on the balance of microflora of the vagina, such a study will not.

The optimal time for putting a smear on the microflora for prophylactic purposes, for inflammation or suspected infection is 7-10 days after menstruation. It is during this period that the accuracy of microscopic examination information will be maximized. If there are no acute indications and special urgency, doctors offer to postpone the analysis to a more suitable day.

Men in this regard is easier. Their analysis can be carried out on any day when referring to a urologist or venereologist. Nevertheless, some limitations on the eve of the analysis are still worth adhering to.

Rejection of sexual intercourse a couple of days before the study is common for men and women. Men, as well as women on the eve of the collection of biomaterial, are recommended to conduct hygiene of intimate places without the use of detergents (especially with an antibacterial effect). Only neutral soap is allowed.

Representatives of the stronger sex will have to suffer, 2-3 hours before the analysis without visiting the toilet for a small need (it is recommended for women, but only a few follow this rule for obvious reasons). Since in men, the urethra is also a penis, urinating can distort the overall picture of the microflora.

If the otolaryngologist, therapist or pediatrician prescribes a flora smear, then there are specific training rules that reduce the likelihood of a false result.

Patients are advised not to eat or drink anything 2 hours before the test before taking the biomaterial. It is clear that banned hygienic and therapeutic procedures, such as brushing your teeth, gargling or treating it with antiseptic agents, using mouth rinses and mouth fresheners with antibacterial effect, the use of anti-inflammatory ointments and sprays in the outer ear, etc.

Since the smear on the microflora is designed to identify various pathogens, any previous medical procedures aimed at combating them and the inflammatory process should be delayed in time. So, from the reception of various forms of antibiotics and antifungal drugs should be abandoned a week before the analysis. On the admission of other medicines is also worth notifying the doctor even before the intake of biomaterial.

Who to contact?

Technique of the smear on flora

As we have already noted, taking a biomaterial for research on microflora is easy to perform, albeit a procedure that brings some discomfort to the patient. In women, a smear on the flora is taken during a gynecological examination on a chair, which allows you to take the biomaterial not only from the lining of the external genitalia, but also from the surface of the vagina, including the entrance to the cervical canal of the uterus. However, most women experience mild discomfort, which is aggravated if there is severe inflammation and irritation of the mucous membrane.

Ideally, a gynecologist should take 3 types of smears from different parts of the urogenital system of a woman:

  • the opening of the urethra (cystitis is one of the infectious-inflammatory diseases, with symptoms similar to gynecological pathologies),
  • mucous walls of the vagina,
  • the external surface of the cervical canal in the cervix (a smear can show both the presence of infection and the development of dysplastic processes that require further examination - a biopsy).

For the collection of biomaterial there is a special tool - a medical gynecological spatula, which helps to get a sufficient amount of discharge mucous without injuring it. The smear attachment is a flat plastic scoop the size of an ear stick.

If it is necessary to take a smear from the cervical canal as well, doctors prefer a double-sided spoon of Volkmann or a cervical (gynecological) brush.

Recently used disposable plastic tools that are not inferior in strength reusable metal. Such instruments are part of many individual gynecological sets.

Using a medical spatula (Folkman spoon, cervical brush or sterile cotton swab), the biomaterial is placed on a clean glass slide and distributed over it. On the glass, the doctor makes a note indicating the place where the smear was taken from:

  • With the letter C is usually denoted by the cervix,
  • english u talks about urethra
  • the letter V is assigned to a vaginal smear.

It is very important to determine the localization of the infection and the extent of the pathological process.

A smear on the flora during pregnancy, due to the safety and high diagnostic value of the procedure, is considered mandatory. Spend it at least 2 times. Such a study should be carried out at the registration of the future mother in the women's consultation and approximately 30 weeks of pregnancy. Any discomfort in the genital area and lower abdomen during childbirth is also a good reason to visit the gynecologist and assign a smear to the flora, because it is very important that a possible pathology was detected as early as possible before the infection can penetrate the placenta and affect the development of the fetus.

The technique of smear during pregnancy is almost the same as during other periods of a woman's life, only the doctor observes special care and caution, because he is responsible for the health of two people at once.

A smear on the microflora in men can be taken from the urethra, and if there are skin symptoms on the penis and from its surface (using a medical spatula). The apparatus for analyzing the secretion of the urethra is a special disposable probe with a brush at the end, which is inserted into the urethra orifice to a depth of 4-5 cm. The contents of the urethra are extracted through rotational movements, which somewhat injures the walls of the urethra and can be quite painful.

Today, a smear on the flora of men can be taken in a different way, which is considered less painful. It is about sowing, for which special disposable sets are produced. They consist of a tool for introduction into the urethra with a cotton wool at the end (it is also possible to take a swab from the surface of the penis) and the environment where the biomaterial is placed after the swab (placed in a flask).

For taking a swab from the throat, nose or ear, a special disposable spatula is used, which differs from the otolaryngological spatula used to examine the throat.

How much is a smear on the flora?

The procedure itself takes a minimum of time. On gynecological (as part of the examination on the gynecological chair) or otolaryngological smear will take no more than 1-2 minutes. A smear from the urethra in men may require 2-3 minutes of time. But the duration of the analysis of the obtained biomaterial will depend on the type of research being conducted (the result of microscopic studies is usually ready within 1 working day, and PCR analysis in different laboratories takes different times).

trusted-source[7], [8], [9], [10], [11], [12], [13], [14], [15]


Probably, our readers no longer have any doubts about the need for such a simple but highly informative procedure as a smear from the genital or ENT organs. After all, a simple and low-traumatic procedure after examining the obtained biomaterial allows the doctor to make an accurate diagnosis and largely determines the choice of drugs for the treatment of infectious pathologies.

It is easy to imagine how much the incidence among women would decrease if all of them consciously and regularly underwent an examination by a gynecologist, which implies taking a smear. The fact is that the flora found in the smear can tell the doctor much more than the patient's complaints about indisposition. And it is not surprising, because the overwhelming number of infectious diseases has a latent period, when the infection is already in the process of development, but there are still no tangible or visible symptoms.

And even when symptoms appear, not all women pay attention to them. Usually we are not in a hurry to see a gynecologist, trying to find an explanation for our discomfort on the Internet or stories of other people who “also had something similar, but successfully passed” or were cured by certain drugs, methods and means of alternative medicine. It is this attitude to the problem of health that often becomes the cause of neglected diseases that are difficult to treat.

The situation is identical with men, many of whom consider it beneath their dignity to even open their mouth wide while taking a swab from the pharynx, not to tell the urologist about their problems, much less show them off. Well, such is the nature of men, which can be overcome only by an effort of will. And for this you need to be aware of the urgent need to care about your health and to feel responsibility towards your close people. In the case of STIs, it will be more honest to tell everything to be honest and solve the problem together, than to hide your betrayals and thereby cause significant harm to the health of your dear person.

In fact, two minutes of “shame and torment”, which means taking a smear from the intimate area, are not worth lost health, of which there is nothing more important on earth. Whatever flora is found in a smear, the information obtained is of great diagnostic value, because it helps to preserve and, if necessary, restore our health.

trusted-source[16], [17], [18], [19], [20], [21]

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