All people between the ages of 25 and 64 who have a cervix – including lesbian and bisexual women, trans men and nonbinary people – need to go for regular cervical screening tests (formally called ‘smear tests’). To be invited for cervical screening you need to be registered with a GP, who needs to have your current address on file.
These are some useful tips to encourage you to attend your cervical screening appointment by making it easier and more comfortable to have your smear test especially if you experience vaginal dryness, vaginal atrophy, vaginal tightness, menopausal symptoms, post cancer treatment, post op scarring, vulval or vaginal pain or genital skin issues including lichens sclerosus, you may have had a less than pleasant experience during a previous smear test, you have experience sexual trauma or are LGBTQ+.
Firstly if you have any concerns or worries, ask to speak to the practice nurse or your GP and let them know how you feel.
Preparing for your smear test
You can ask your GP or practice nurse to prescribed local oestrogen in the form of a pessary, cream or ring that you use several weeks prior to your appointment. If you are concerned about using HRT, topical/local oestrogen gets absorbed locally into the walls of the vagina, not the bloodstream. The dose of all these preparations is very tiny, for example, using Vagifem, a pessary, twice a week is the equivalent of taking 1 HRT tablet each year. It replaces the depleting oestrogen in the walls of the vagina, helping it to become more flexible and healthier too.
You need to stop using your local oestrogen 2 days prior to the smear test.
Some people who have had breast cancer may be able to use local oestrogen so speak to your oncologist or GP.
In addition to or as an alternative to local oestrogen using a good pH balanced vaginal moisturiser can help when used several times each week. Alway check the ingredients because many well known vaginal moisturisers, including products available on prescription, contain irritating ingredients, such as glycerin, glycols and parabens. I recommend and personally use YES vaginal moisturiser x 2 weekly.
Using medical or silicone dilators or a slim sex toy with a pH balanced lubricant can help to gently stretch the tissues opening up the vagina which will make insertion of the speculum feel more comfortable.
Vaginal speculums come in different sizes so ask your practice nurse to use the smallest one, they can order one for your appointment if they do not have small ones, some women even buy their own online, not that you should have to do this though.
You can ask to insert the speculum yourself, going at your own pace and finding a comfortable position for you.
There seems to be confusion about using lubricant because it may affect the sample, however I’ve asked a consultant in sexual medicine and several practice nurses including my own who said they all use a water based lubricant and would never attempt to do a smear test without it.
You can also take your own water based lubricant to use too. I take YES organic water based lubricant. As long as the lubricant is used only along the shaft of the speculum and is kept away from the end of the speculum where the sample is being taken it should be fine.
Any nurse/GP who refuses to use lubricant, just refuse to have your smear test. No lubricant, no smear test!
Some people find it more comfortable to raise their pelvis by putting their hands under their bottom, it is just a matter of trying different positions to find one that is comfortable for you.
If it feels painful, ask them to stop immediately. Do not allow them multiple attempts as this will cause more anxiety and can lead to constriction of the muscles of the vagina making insertion of the speculum difficult or not possible. From experience I now know there is only one practice nurse I will allow to do my smear test so ask the practice if there is someone else who may be better suited to doing your smear test.
If not, you can ask to be referred to a specialist genital /vulval pain 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.
Anyone who may have experienced trauma, female genital mutilation or abuse can be referred to a specialist clinic as mentioned above. Many specialist clinics offer counselling and psychosexual therapy so it is important to talk to your GP. My Body Back Project runs clinics in London and Glagow for those who have experienced sexual violence and for trans men. You can find a list of specialist FGM clinics across the UK on the NHS website.
Many people in the LGBTQ+ (lesbian, gay, bisexual, transgender and queer) community choose sexual health clinics over gynaecology services for screening as they tend to be more openly inclusive and prepared to cater to different needs. Specialist trans services like CliniQ in London and Clinic T in Brighton offer cervical screening.
On a practical note, women who have a disability may not be able to access the room/clinic, get up onto the examination couch or position themselves comfortably due to limited mobility or pain so adaptations need to be in place, such as home testing which is done in some areas of the UK or being referred to a specialist clinic as mentioned above.
Jo Trust has leaflets in different languages that can be downloaded by people or by healthcare professionals too.
Self Sampling – The Future of Cervical Screening
Researchers have developed a non-invasive test to detect cervical pre-cancer by analysing urine and vaginal samples collected by people themselves which could transfom the way in which screening is done and encourage more people to attend their appointment.
“The initial use of self-sampling is likely to be for women who do not attend clinic after a screening invitation and in countries without a cervical cancer screening programme. In the longer term, self-sampling could become the standard method for all screening tests. The study indicated that women much preferred doing a test at home than attending a doctor’s surgery,” said Dr Nedjai, who is Senior Research Fellow and Director of the Molecular Epidemiology Lab at Queen Mary University of London, UK. (National Cancer Research Institute Nov 2019)
- Talk to your GP/practice nurse in person or over the phone.
- Ask the practice if they have a small speculum in stock and if not, ask them to order one for your appointment or purchase your own if you wish to
- Ask to be prescribed local oestrogen to use for several weeks prior to your appointment.
- Use a vaginal moisturiser for 6 weeks prior to your appointment.
- It is recommended that you have your smear test mid menstrual cycle if you still menstruate
- You can take a friend or family member with you
- No sex at least 24 hours before your test as sperm, lubricant or spermicidal gel may 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 local oestrogen for menopausal symptoms, stop using for 2 days before your screening and on the day.
- Do not use a tampon for 2 days before screening
- Do not use feminine hygiene products ( not that these are recommended as they disrupt vagina pH and our friendly bacteria) for 2 days before screening
- You can be covered with a paper towel if you feel embarrassed or keep your skirt on if you are wearing one
- Take your own water based lubricant to use if you would like to
- Insert the speculum yourself.
- The more relaxed you are, the less discomfort you will feel, I tend to chatter all the way through my smear test, other people wear headphone to listen to music or a podcast.
- If it feels painful, ask the nurse to stop and ask to be referred to a specialist clinic
- You can have a smear test at a sexual health clinic if you do not want to go to your GP surgery if you can find one in your area that is funded to do smear tests.
I hope you find these tips useful and will encourage you to attend your cervical screening appointment as it could save your life.
Jo’s Trust: www.jostrust.org.uk
Eve Appeal : www.eveappeal.org.uk
The Daisy Network (charity for premature ovarian insufficiency): www.daisynetwork.org.uk
British Menopause Society: thebms.org.uk
Royal College of Obstetrics and Gynaecology: www.rcog.org.uk
Menopause Support: menopausesupport.co.uk
Dr Louise Newson, menopause specialist: www.menopausedoctor.co.uk
My Body Back : www.mybodybackproject.com
National FGM Support Clinic