Checklist
| Preparation | Wash – Name – Explain | |
| Ensure patient and test request details match | ||
| Chaparone | ||
| Allow to undress | ||
| Position patient lying flat, knees flexed & thighs abducted | ||
| Ask patient to cover with sheet | ||
| Clean preparation surface | ||
| Gather equipment | Clean equipment tray | |
| Wash hands | ||
| Speculum | ||
| Lubricating jelly | ||
| Charcoal swab | ||
| NAAT swab | ||
| Tissue paper | ||
| Speculum insertion | Expose patient | |
| Wash hands and put on gloves | ||
| Brief vulval examination | ||
| Lubricate speculum | ||
| Part labia | ||
| Insert speculum with blades closed & lock facing left/right | ||
| Advance speculum into vagina & rotate 90° (lock upwards) | ||
| Open blades slowly, until cervix visualised | ||
| Open blades fully & turn lock to secure in place | ||
| Brief inspection of cervix, discharge, bleeding | ||
| Vaginal swabs | High vaginal swab | |
| Endocervical swab | ||
| Finishing | Unscrew lock | |
| Slowly withdraw speculum, closing blades and rotating 90° | ||
| Offer paper towels to wipe excess lubricating jelly | ||
| Re-cover patient | ||
| Wash hands | ||
| Label samples at the bedside |
Explanation
Background Information
When taking vaginal swabs, there are two types used:
- Charcoal swabs
- Nucleic acid amplification test (NAAT) swabs
Charcoal swabs allow for microscopy (looking at the sample under the microscope), culture (growing the organism) and sensitivities (testing which antibiotics are effective against the bacteria). Charcoal swabs look like a long cotton bud that goes into a tube with a black transport medium at the end. Microscopy involves gram staining and examination under a microscope. Charcoal swabs can be used for endocervical swabs and high vaginal swabs and can confirm:
- Bacterial vaginosis
- Candidiasis
- Gonorrhoea (specifically endocervical swab)
- Trichomonas vaginalis (specifically a swab from the posterior fornix)
- Other bacteria, e.g., group B streptococcus (GBS)
Nucleic acid amplification tests (NAAT) check directly for the DNA or RNA of the organism. NAAT is used to test specifically for:
- Chlamydia
- Gonorrhoea
In women, a NAAT can be performed on a vulvovaginal swab (a self-taken lower vaginal swab) or an endocervical swab. Where gonorrhoea is suspected or demonstrated on a NAAT, an endocervical charcoal swab is required for microscopy, culture and sensitivities.
Preparation
Wash, name, explain:
- Wash your hands
- Introduce yourself by name and role
- Check the patient’s name and date of birth
- Explain the task and get consent
- Ensure the patient’s details match those on the test request form
- Explain the presence and purpose of the chaperone
“Hello, I’m one of the doctors. I have been asked to take some vaginal swabs. This involves inserting a plastic tube called a speculum into the vagina to look at the neck of the womb. I’ll then use a small cotton wool swab to take a sample from inside the vagina and from the neck of the womb. You may feel some pressure and the cold jelly, but it should not be painful. You can ask me to stop at any time. A chaperone will be present whilst I carry out this examination. Is that okay with you?”
Ask the patient to remove clothing from the waist down. Position the patient on the examination couch, lying on their back with their knees drawn up to chest. Ask the patient relax their legs apart so that their thighs are abducted. Cover the patient for privacy until you are ready to begin the examination.
Clean your preparation space, typically a clinical trolley, using appropriate surface cleaning agents.
Gather Equipment
Clean an equipment tray and place it on your preparation space. Wash your hands again after cleaning surfaces.
Gather the following equipment and place it in your clean tray:
- Lubricating jelly
- Speculum – choose an appropriate size based on the size of the patient, age, menopausal status, and whether they are sexually active. Some patients may know which size speculum they need.
- Swabs – charcoal and NAAT swabs
- Paper towels
Depending on the resources available to you, there may be someone who can assist you (e.g., your chaperone). If this is not possible, open the swab packets and remove the lids from the transport containers before starting the examination. This will make it easier to carry out the procedure one–handed, as your non-dominant hand will be holding the speculum in place. Place them in your tray within easy reach.
Speculum Insertion
Return to the patient, wash your hands, and put on gloves. Expose the patient and check that they are comfortable.
Briefly inspect the external genitalia, including labia majora, labia minora, clitoris and introitus, as well as the perineum. Note the skin colour and any redness or breakdown of skin integrity, as well as excoriation marks which may indicate soreness or itching of the vulval skin, and the presence of any discharge or bleeding.
Apply a small amount of lubricating jelly to the speculum blades. Ensure the patient is ready, then gently part the labia with your non-dominant hand. Place the speculum at the vaginal introitus with your dominant hand, ensuring the blades are closed and rotated so that the lock faces the left or right side.
Slowly and gently advance the speculum, ensuring the patient is tolerating the examination. Rotate the speculum 90° as you advance it, so that the lock faces upwards. Gradually open the speculum blades and confirm if the cervix is visible.
Once the cervix is visible, fully open the blades gently and turn the lock to secure the speculum in place. Keep your hand on the speculum to prevent it from sliding out with the blades open, which could cause discomfort for the patient.
Once the cervix is located and the speculum is secured, briefly inspect the cervix to ensure it appears healthy, and check for any discharge or bleeding.
Vaginal Swabs
- High vaginal sample – Insert the swab into the vagina as high as possible towards the fornices and rub it gently against the vaginal walls. Try to sample any discharge present in the vagina. Remove the swab from the vagina and place it into the transport container.
- Endocervical sample – Insert the swab into the vagina and gently place the cotton tip into the cervical os. Rotate the swab several times then withdraw it, noting any contact bleeding at the cervix. Friable cervical tissue may indicate inflammation or infection. Place swab into the transport container.
Finishing
Unscrew the lock and gently withdraw the speculum, rotating it 90° so that the lock faces left or right, as it did during insertion.
Offer the patient paper towels to wipe away any excess lubricating jelly. Collect the swabs and provide the patient privacy to get dressed. Label the swabs with the patient details.
Dispose of all waste appropriately, then clean the tray and trolley. Wash your hands.
Last updated Mar 2025
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