Fear of the Smear?

*Disclosure – Trigger Warning – This post talks about sexual assault and rape survivors*

Before we look at statistics and reasons why women avoid their cervical screening tests, I feel it is important to discuss exactly what a smear test is and why they are so important, as there are many people out there who do not understand the process of cervical screening. I myself was unsure of the process and why the screening is so important; I believed that cervical screening was a test to see whether or not you have cervical cancer, but this is not true!

Cervical screening is not a test to identify cancer, instead, it is a test to see whether or not you have a certain type of Hunan Papillomavirus (HPV) which can cause your cells to change. These are known as ‘high-risk’ cells.

If the specific form of HPV is found, then your cell sample will be tested to see if there have been any changes. If there are no current changes, you will be re-invited for a screening the following year. If some of your cells have started to change, you will be referred for treatment in order to prevent these cells from becoming cancerous.

If the specific form of HPV is not found, you will not have to attend another screening for 3-5 years. The time frame in between screenings will depend upon your age; if you are between 25 and 49, you will be asked to return for a screening in 3 years time, if you are over the age of 50, you will be asked to return in 5 years time.

How is a Cervical Screening Conducted?

Cervical screenings are conducted for women between the ages of 25 and 64. When you are due for your smear test, you will be invited to book your appointment via a letter. You are expected to attend a cervical screening every 3-5 years.

A common question from women is ‘why do they only start screening women from the age of 25?’ The answer to this, is as follows:
Cervical cancer is very rare in women under the age of 25. Also, changes in the cervical cells are common in this age group, although these changes often return to normal without any cause for concern. Therefore testing women under the age of 25 could lead to unnecessary treatment and worry. There is plenty of research to show that testing younger women would cause more harm than good.

Your cervical screening appointment should be no longer than 10 minutes long, with the test itself taking around 5 minutes. This is usually conducted by a female doctor or nurse.

  1. You’ll need to undress your lower half, behind a screen, from the waist down. You’ll be given a sheet to put over you.
  2. The nurse will ask you to lie back on a bed, usually with your legs bent, feet together and knees apart. Sometimes you may need to change position during the test.
  3. They’ll gently put a smooth, tube-shaped tool (a speculum) into your vagina. A small amount of lubricant may be used.
  4. The nurse will open the speculum so they can see your cervix.
  5. Using a soft brush, they’ll take a small sample of cells from your cervix.
  6. The nurse will close and remove the speculum and leave you to get dressed.

This is not usually a painful procedure, although you may feel some discomfort. You are able to talk with the nurse or doctor if this helps to put your mind at ease. They will try to make your appointment as calming as possible and will answer any questions that you may have, before, after or during the screening.

You can watch an animated video on the NHS website here, if you would like to understand the procedure in more detail.

It is important that you speak with your GP if you are concerned in any way about the health of your cervix, even if your last screening was clear and you are not due for another for a couple of years, it is better to be safe than sorry! All concerns should be treated as important and you should ask for a screening or a check-up if you feel as though this is necessary… But what sort of signs should you be mindful of?

Symptoms of Cervical Cancer

Please do not panic if you experience any of the following symptoms, these could very well be symptoms of much less serious conditions. However, it is important to be checked by a doctor if you experience any of the below:

  • Blood spotting or light bleeding in-between periods.
  • Menstrual bleeding that lasts longer or is heavier than usual.
  • Bleeding after intercourse, douching or after a pelvic examination.
  • Increased discharge from your vagina.
  • Pain during intercourse.
  • Bleeding after going through the menopause.
  • Unexplained and persistent pain in your pelvis or back.

Fear is Normal

Many women each year, fail to attend their cervical screening appointments. In fact 1 in 4 women will avoid their appointment when invited via letter; this increases to 1 in 3 when looking directly at women between 25 and 49.

Here are some of the reasons why women avoid their cervical screening tests:

  • 50% of non-attenders are women who stated that they were too embarrassed by their body shape to attend their appointment.
  • 48% of non-attenders said that this was due to them being concerned about the appearance of their vulva.
  • 54% of non-attenders said that they were too concerned that they did non ‘smell normal’ and would therefore avoid their screenings.
  • 31% of women in a survey said that they would not attend an appointment if they had not shaved or waxed their bikini area.
  • 35% stated that they would not take time off of work for a cervical screening.
  • 16% said that they would not miss a gym session to attend a cervical screening.
  • 20% of women said that they would rather not know if something was wrong and therefore do not attend.

There are also many women who are frightened to attend for various reasons. This may be because they do not know what to expect, or it could be due to past experiences, such as sexual assault and/or rape.

The procedure can feel intimate and/or invasive due to the position that the test is conducted in and the equipment being used. This can sometimes trigger physical or psychological reactions such as panic attacks, disassociation and freezing. In some cases it may cause flashbacks of the trauma that you experiences. This is okay, you have every right to take your time. You can ask for a double appointment to allow breathing space, allowing you to go at your own pace for the test. You can also ask for a specific doctor or nurse who you already have a good connection with to be with you for your appointment. Although they may not be able to perform the test, they should be able to be present if you wish for them to be. They can also speak to other professionals on your behalf if you would like them to do so.

If receiving the invitation letters are causing you distress, if you are not ready to attend a cervical screening yet, you can ask your GP to remove you from the mailing list until you are ready. However, please note that they may ask you why you wish to do this.

There is also no shame in booking an appointment just to talk about the screening so that you can become more familiar with the procedure and slowly introduce yourself to the idea of going through with the screening. There is also no shame if you book your appointment and are unable to go through with the testing when you get there. You can re-book for a different day and take it as slowly as you like.

If you are not yet receiving help for the trauma that you experienced, here are a couple of helpful links for survivors of sexual abuse and/or rape.

www.rapecrisis.org.uk – England and Wales

www.rapecrisisscotland.org.uk – Scotland

www.napac.org.uk – free support line and email service

www.galop.org.uk – Support for LGBTQ+ Individuals who have experienced such trauma

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