One hundred twenty-four Papanicolaou smears were studied to compare the yield of endocervical cells obtained with the Cytobrush/Ayre spatula method to that of the cotton-tipped applicator/Ayre spatula method. Forty-nine of the 62 Pap smears (79%) obtained with the combination Cytobrush/Ayre spatula method contained endocervical cells, compared to 22 of the 62 smears (35%) obtained with the cotton swab/Ayre spatula method (chi 2 = 24.02, P less than 0.0001). The Cytobrush/Ayre spatula method obtained endocervical cells in 14 of 17 (82.4%) of the patients with stenotic ora, compared to 0 of 12 (0%) patients for the cotton swab/Ayre spatula method (P less than 0.001). The Cytobrush/Ayre spatula method obtained endocervical cells in 8 of 11 (72.7%) postmenopausal patients, compared to 4 of 14 (28.6%) patients for the cotton swab/Ayre spatula method (P = 0.05). Using the cervical Cytobrush for Pap smears increases the recovery rate of endocervical cells, which may improve the detection of cervical dysplasia in the patient population as a whole, in postmenopausal women, and in women with stenotic cervical ora.