Chapter One

1 Introduction and literature review 
1.1 The pap smear 
1.2 Cytologic sampling techniques 
1.3 Cytology of the female genital tract epithelia 
1.3.1 Stratified squamous epithelium of the vagina and cervix
1.3.2 Cells originating from normal cervical and vaginal squamous epithelium:
1.3.2.1 Superficial squamous cell 
1.3.2.2 Intermediate squamous cells 
1.3.2.3 Parabasal cells 
1.3.2.4 Basal cells 
1.3.2.5 Cells originating from the endocervical epithelium 
1.3.2.6 The squamocolumnar junction (transformation zone)
1.3.2.7 Cells originating from the normal endometrial 
1.4 Cells other than epithelial origin in normal smears of the female genital tract
1.4.1 Leukocytes 
1.4.2 Macrophages or histiocytes 
1.4.3 Spermatozoa 
1.4.4 The normal vaginal flora
1.5 The physiologic cyclic changes as seen in vaginal smears
1.6 Inflammatory processes of the cervix and vagina 
1.6.1 Cytology of acute inflammatory processes 
1.6.1.1 Cytologic atypias in acute cervicitis and vaginitis 
1.6.1.1.1 Superficial and intermediate squamous cells 
1.6.1.1.2 The parabasal Cells 
1.6.1.1.3 The endocervical cells 
1.6.2 Chronic inflammatory processes 
1.6.2.1 The squamous epithelium 
1.6.2.1.1 Pseudoparakeratosis of squamous epithelium 
1.6.2.1.2 Basal cell hyperplasia of squamous epithelium 
1.6.2.2 The endocervical epithelium 
1.6.3 Specific forms of inflammation of the cervix and the vagina
1.6.3.1 Bacterial flora of the cervix and the vagina 
1.6.3.1.1 Lactobacillus (Doderlein bacillus, previously known as Bacillus vaginalis)
1.6.3.1.2 Gardnerella vaginalis (previously classified as Haemophilus vaginalis or vaginale)
1.6.3.1.3 Gram-positive cocci 
1.6.3.1.4 Gram-negative ccocci-gonorrhea
1.6.3.2 Viral infections 
1.6.3.2.1 Herpes genitalis
1.6.3.2.2 Human papilloma virus infection
1.6.3.3 Fungal infections
1.6.3.3.1 Candida albicans (monilia)
1.6.3.4 Parasitic infections
1.6.3.4.1 Trichomonas vaginalis
1.6.3.4.2 Other protozoa
1.6.4 Endometrium in vaginal or cervical smears in women wearing intrauterine contraceptive device
1.7 Disorders of the vagina
1.7.1 Nonneoplastic disorder
1.7.2 Neoplastic disorders 
1.8 Disorders of the cervix 
1.8.1 Hormonal evaluation of the pap test 
1.8.2 Nonneoplastic disorders
1.8.2.1 Squamous metaplasia 
1.8.2.2 Atypical metaplasia 
1.8.3 Neoplastic disorders 
1.8.4 Epidermoid carcinoma of the uterine cervix and related precancerous lesions
1.8.5 Risk factors in cervical squamous-cell carcinoma
1.8.5.1 Sexual intercourse
1.8.5.2 Socioeconomic status
1.8.5.3 Smoking
1.8.5.4 Male factors 
1.8.5.5 HPV 
1.8.5.6 HIV infection 
1.9 Epidemiology 
1.9.1 Distribution among various populations 

Chapter Two

2. Objectives 
2.1 General objective 
2.2 Specific objectives 

Chapter Three

3. Materials and methods 
3.1 Study area 
3.2 Study population 
3.3 Study duration 
3.4 Data collection 
3.4.1 Tools of collection 
3.5 Ethical clearance 
3.6 Data analysis and statistics 
3.7 Inclusion and exclusion criteria 
3.8 Quality control 
3.9 Laboratory techniques 
3.9.1 Safety precautions 
3.9.2 Specimens collection 
3.9.2.1 Cervical scraper or spatula 
3.9.2.2 Fixation 
3.9.2.3 Staining procedure 

Chapter Four

4. Results 

Chapter Five

Discussion 
Conclusion 
Recommendations 

Chapter Six

References 
Appendix 
Abbreviations

1 - Diagnosis of the study group

2 - The contraceptive in the study group

3 - The superficial cell in the study group

4 - The intermediate cell in the study group

5 - The basel cell in the study group

6 - The histiocyte in the study group

7 - The RBCs in the study group

8 - The polymorph the in study group

9 - The endocervical cell in the study group

1 - Collection of exfoliated cells 
2 - The collection of cells removed by brushing or similar abrasive techniques
3 - Epidermoid carcinoma of the uterine cervix and related precancerous lesions
4 - Diagnosis in the study group
5 - The Contraceptive in the study group
6 - The relation between bacterial infection and other diagnosis
7 - The relation between fungl infection and other diagnosis
8 - The relation between HPV and other diagnosis
9 - The relation between metaplasia and other diagnosis
10- The relation between parasitic infection and other diagnosis
11- Endocervical cell - cervical smear – Papanicolaou- x 40.
12- Squamous epithelium cell (Normal cell) - cervical smear – Papanicolaou- x 40.
13- Tricomonas vaginalis - cervical smear – Papanicolaou - x 40.
14- Candida albicans (monilia) - cervical smear – Papanicolaou - x 40.
15- Squamous metaplasia - cervical smear – Papanicolaou - x 40.
16- Polymorph (leukocyte) - cervical smears – Papanicolaou - x 40.
17- Koilocytotic cells (HPV) - cervical smear – Papanicolaou - x 40.