Should smears in a colposcopy clinic be taken after the application of acetic acid?

Conventionally, cervical smears obtained during a colposcopic examination are taken before the application of acetic acid. However, this occasionally precipitates bleeding and removes epithelium from the cervix, particularly in the presence of cervical pathology, making colposcopic evaluation difficult. This study examined the possibility of deferring the smear until the end of the colposcopic examination. In the first part of the study, the cytologic results on cervical samples taken from the same patient before and after the application of acetic acid were compared. In the second part of the study, only one smear was taken per patient (either before or after colposcopic assessment) to eliminate the possibility that the taking of the first smear affected the quality of the second. The results of both parts of the study showed that deferring the smear until after the application of acetic acid leads to an unacceptably high rate of unsatisfactory and falsely negative smears. Thus, deferring the taking of the cervical smear until after the colposcopic evaluation results in a poor cytologic evaluation, although it might facilitate the colposcopic examination in some patients.