As someone who has had 9 cervical smear tests during my 48 years, I can honestly say that it is quick, simple and may be a little uncomfortable for a few minutes, yet I consider it to be an essential part of looking after my health, especially my sexual health. As it only happens every 3 years, it’s not much hassle.
Around 3,000 women are diagnosed with cervical cancer in UK each year. Cervical cancer is the most common cancer in women aged 35 and under.
Offered free on the NHS (unlike many countries around the world) to women aged 25-64, regular cervical screening provides a high degree of protection against developing cervical cancer. Up to 75% of cervical cancers can be prevented from developing through early detection and treatment.
Women aged 25–49 are invited every three years and women aged 50–64 are invited every five years.
Research by the Eve Appeal (2016) has found that 9 in 10 (93%) daughters said their parents never discussed gynaecological health issues with them when they were younger and 84% said their parents never discussed the female sexual anatomy.
Shockingly, 1 in 7 mothers said they do not feel it is their role or duty to educate their daughter about gynaecological health, with the youngest generation of mums being the most reticent – just over a quarter (27%) agreed it was not their role to educate their daughters.
If these mothers don’t believe they should educate their daughters about gynaecological health, are they looking after their own sexual health?
Not having a smear test is the biggest risk to developing cervical cancer
Research by Jo’s Cervical Cancer Trust and Gransnet found that 32% of women over 50 don’t think cervical smears are part of maintaining their health, with 22% believing they don’t need to have them regularly. It’s not just older women avoiding their smear test either.
In the last 10 years, the number of 25 to 29-year old women diagnosed with cervical cancer has soared by 59.2%.
Last year one million women failed to turn up for their smear tests. One in five women missed screening with uptake falling below 78% for the first time in 20 years. Among those aged 25 – 29, uptake fell to 66.3%.
1 in 3 women have delayed or not attended their appointment with an average delay of 26 months, and even more worryingly 1 in 10 women have put off having a smear test for over 5 years.
Poor advice from healthcare professionals
Worryingly, some healthcare professionals are advising gay and bi sexual women that they do not need a smear test because they do not have sex with men. This demonstrates a lack of understanding about the HPV and how it can be spread through mutual masturbation, oral sex and sharing sex toys.
A study of attitudes to cervical screening among gay and bisexual women carried out by the University of Salford in 2011 found that 37% of women questioned said they had been told they did not require a cervical screening test because of their sexual orientation.
All women, whatever their sexual orientation, should be offered a cervical smear test.
Some women admit to being embarrassed about going for a smear test, whilst others said they are concerned it will be painful or just think they are not necessary.
One in 10 women believe smear tests detect sexually transmitted infections, while 13.5 per cent thought it was a test for ovarian cancer.
Often mothers from differing ethnicities don’t have their smear test either due to a lack of understanding about what it is for, fear, embarrassment, shame at a cervical cancer diagnosis, absence of symptoms and a low perceived risk of cervical cancer influenced by beliefs about having sex outside of marriage.
Worryingly, there is a lack of awareness about the HPV amongst young women with more than half of young women unable to identify the cause of cervical cancer as the human papillomavirus (HPV).
HPV is the most common sexually transmitted infection (STI) in the world and it’s the second most prevalent sex disease in the UK after chlamydia.
According to Rob Music,chief executive of Jo’s Cervical Cancer Trust,
“HPV is an extremely common virus. Most of us will catch the virus, with four out of five (80%) of us contracting some type of the virus during our life time”.
13 high-risk types of HPV are responsible for causing cervical cancers, and within this group, types 16 and 18 are the most prevalent, causing over 70% of cervical cancers.
HPV usually goes away on its own without treatment. However, it can remain dormant in the bodies of some women for many years and increase their risk of cervical cancer. This is why cervical screening and the HPV vaccination are important in helping to spot abnormalities and prevent cancer.
Using condoms can prevent the spread of HPV too.
The genital HPV are consided low risk as they do not cause cervical cancer but can cause genital warts.
The HPV vaccination is offered across the UK to girls aged 12-13 years in Year 8 in 3 doses given over 6 months. Used in Australia for the last 10 years, it has been shown to be extremely effective against HPV developing. However, uptake in the UK is varied with some girls not having the vaccination and others not completing the course.
Reasons include parents not consenting to their daughters being immunised because they don’t believe in immunisations even if their daughter wants to be vaccinated, thinking their daughters will have sex if they have the vaccination or having a lack of understanding about the HPV.
There are variations among different ethnic groups, with many girls form a diverse range of ethnic groups reporting not being allowed to have it as it was new, unsafe or they didn’t need it as they were not going to have sex before marriage. The stigma of having HPV also leads people not to seek help becasue they feel ashamed.
Some girls do not complete the course.
Cervical screening is the process of taking a sample of cells from your cervix, which are then examined under a microscope in order to detect changes or abnormalities in the cells that might develop into cancer in the future. Cell changes are usually caused by certain types of the Human Papillomavirus. Successful treatment of these cells usually prevents cervical cancer from developing.
This is a procedure carried out by a practice nurse in your GP surgery or at a sexual health clinic who is trained in smear testing and will probably have done 1000s of them during her nursing career. It takes a few minutes and can feel a bit uncomfortable. Practice nurses and GPs who undertake cervical screening are generally female.
Your practice nurse will explain the procedure to you before carrying it out if it is your first time to reassure you and allay any worries you may have.
You’ll be asked to remove your knickers and lie on the couch. You can leave your skirt on to cover yourself up. Your nurse will ask you to put your heels together and spread your legs so she can see your vulva. She may use an angle poise lamp so she can see more clearly. Wearing gloves she will part your labia, the skin flaps on the outside of your vagina, and examine the surrounding area for any lumps, bumps and signs of skin discolouration.
Using a plastic speculum, on which she will apply a little water based lubricant to make it easier to insert. However, it is not large: it is no bigger than the average penis. Some GP practices allow you to use your own water based lubricant; I take YES organic water based lubricant with me.
Gently sliding the speculum into your vagina, which may feel a bit uncomfortable but should not be painful, your nurse will slowly open the speculum inside you to view your cervix. If you find this uncomfortable, taking deep breaths can help you to relax. She will then take a sample with a small instrument which looks like a brush. This sample is smeared onto a glass slide and sent off for analysis.
The speculum will be removed slowly and you will be given a tissue to wipe any excess lubricant away. The whole procedure should take around 20 minutes from entering the practice room to leaving it.
It is recommended that you have your smear test mid menstrual cycle
You can take a friend or family member with you
Tell your nurse/GP if it is your first screening
No sex at least 24 hours before your test as sperm, lubricant, spermicidal gel can impair the sample and make getting a sufficient sample difficult.
If you have been using vaginal pessaries for an infection, such as thrush, it is advisable to postpone your test for at least a week after completing the treatment.
If using vaginal oestrogen cream for menopausal symptoms, stop using for 2 days before your screening and on the day.
Don’t douche or use a tampon for 2 days before screening
The more relaxed you are, the less discomfort you will feel
Speculums come in a range of sizes so ask for a smaller one if it feel uncomfortable
You can be covered with a paper towel if you feel embarrassed or keep your skirt on if you are wearing one.
You can have a smear test at a sexual health clinic if you do not want to go to your GP surgery.
Women who have been sexually abused may feel distressed at the thought of having a smear test. The My Body Back Project has opened a specialist cervical screening clinic at Barts NHS Trust who have been sexually abused.
Some women experience vaginismus, involuntary tightening of the vagina, making insertion of the speculum difficult or impossible,therefore inform your GP/nurse. Hopefully your GP will know this and can make it easier for you to have a smear test.
In the same way, some women undergo female genital mutilation (FGM), leaving them with a very small opening at the entrance to their vagina which can make inserting the speculum difficult.
It is important to talk to your nurse/GP about any anxieties you may have. Undergoing any vaginal examination may trigger a flashback for you or a panic attack because it makes you remember the time you were cut. If this happens to you ask the nurse to stop and let them know how you feel. They may refer you to a specialist clinic to have your smear taken. Many NHS Trusts offer specialist women’s health clinics designed to ensure you are able to have a cervical screening safely and without pain.
So, please have a smear test, it could just save your life
Tumour Has It
Many people blog about their experience of cervical cancer and I recently had the pleasure of meeting Karen Hobbs at her amazing comedy show “Tumour Has It” which takes you on her journey of having cervical cancer at the very young age of 24. The show made me laugh, cry and really think about what a person goes through when they get diagnosed with cancer. Even though I’ve cared for many people with cancer during my nursing career and have had family and friends who have had cancer, it is hard to put yourself in their shoes.
She also has a brilliant blog “quarterlifecancer.com”. Working with the Eve Appeal, Karen wants to educate all women about checking yourself for any abnormal signs and symptoms, seeking treatment as soon as possible and having a regular smear test so please read her blog and catch her show if you can.
Jo’s Trust: www.jostrust.org.uk
Cervical Screening: cervicalscreen1.wordpress.com
Family Planning Association : www.fpa.org.uk
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