As someone who has had 10 cervical smear tests during my 51 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.
Unlike many other countries around the world, it is offered for free to people aged 25-64 on the NHS. 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.
People aged 25–49 are invited every three years, and people 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 25-29 year old women diagnosed with cervical cancer has soared by 59.2%.
New statistics published by Jo’s Trust (2017) has found that uptake of cervical screening is now at the lowest it has ever been across all age groups and in almost every local authority, falling from 72.7% to 72% in the last year with over 1.2 million women not taking up their invitation. Among those aged 25–29, uptake fell by 1.2% to 62.1% and the highest fall has been in the 60-64 year olds falling by 1.4% to 69.7%.
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.
A new survey by Jo’s Trust (2018) has found that young women are embarrassed to attend smear tests because of their body shape (35%), the appearance of their vulva (34%) and concerns over smelling ‘normally’ (38%). In a new survey of 25-35 year old women, a third (31%) admitted they wouldn’t go if they hadn’t waxed or shaved their bikini area.
Sex education in school is being revised with the introduction of the new Relationships and Sex Education curriculum in 2019. Clearly lakc of understandign about their body and awraeness of why they need to have a cervical semar test is not getting trhough to younger women.
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.
Anyone who has a cervix, whatever their sexual orientation, should be offered a cervical smear test.
All people between the ages of 25 and 64 who have a cervix – including lesbian and bisexual women – need to go for regular cervical screening tests (formally called ‘smear tests’).
Trans men and nonbinary people who have cervixes should also attend regular screening, but may not receive invitations through the national screening programme due to issues with computer systems, discrimination from healthcare workers and clerical staff and fears about how they will be treated. To be invited for cervical screening you need to be registered with a GP, who needs to have your current address on file.
Why don’t people have a 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.
Women who experience vaginal atrophy, especially during and beyond the menopause or Lichens Sclerosus often find their smear test uncomfortable or painful so discussing this with their practice nurse is important.
1 in 10 women believe smear tests detect sexually transmitted infections, while 13.5% thought that 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.
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, trans men and non binary people find it difficult to access screening services due to a fear of body dysmorphia, attitude of clinical staff and how they will be treated, NHS computer issues not recalling them or including them on the national screening database
Human Papilloma Virus Vaccination
Worryingly, there is a lack of awareness about the HPV amongst young people, 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, as can using dental dams. Some people assume that dental dams are reusable, however you should not flip it over to use again as you will spread infections this way.
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 development. However, uptake in the UK is varied with some girls not having the vaccination and others not completing the course.
It is ging to be offered to boys aged 12-13 years. There are, however, calls for it to be offered to older boys who will miss out on being vaccinated.
A nationwide HPV vaccination programme for men aged 45 or younger who have sex with other men was launched in 2018.
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 because they feel ashamed, and because of this some girls do not complete the course.
What is a Smear Test?
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.
Cervical screening also tests for HPV. HPV primary testing helps identify who is more at risk of developing cell changes or cervical cancer. If high-risk HPV is not found, your sample does not need to be looked at for cell changes, as it is very unlikely you have or will develop them. If high-risk HPV is found, the same sample will be looked at for cell changes. If no cell changes are detected you will be advised when to return for screening in your results letter which is usually 1 year. If cell changes are found you will be sent for more tests and your GP/practice nurse will be able to advise you.
How is a Smear Test done?
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 their nursing career. It takes a few minutes and can feel a bit uncomfortable. Practice nurses and GPs who undertake cervical screening are generally female and you can always ask to have a female HCP instead.
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 underwear 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 they can see your vulva. They may use an angle poise lamp so they can see more clearly. Wearing gloves they 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 they 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. They 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.
How to prepare for your smear test*Ask to be prescribed local oestrogen to use for several weeks prior to your appointment if you experience “vaginal atrophy”: or your smear tests feel painful or uncomfortable *Use a vaginal moisturiser for 6 weeks prior to your appointment.
- 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/pessaries/vaginal moisturiser for menopausal symptoms, stop using for 2 days before your screening and on the day.
- 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
- 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
- Insert the speculum yourself
- 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.
People who have been sexually abused may feel distressed at the thought of having a smear test. My Body Back Project has opened a specialist cervical screening clinic at Barts NHS Trust and in Glasgow for those who have experiecned sexual violence and trans men.
Some women experience vaginismus, involuntary tightening of the vagina, Lichens Sclerosus and women who have vaginal atrophy find insertion of the speculum painful or impossible, therefore tell your GP/nurse. Hopefully your GP will know this and can make it easier for you to have a smear test. Using topical oestrogen for several week beforehand can really help so ask your GP to prescibe some in the form of pessaries or a cream.
Topical oestrogen gets absorbed locally into the walls of the vagina and is the equivalent of taking 1 HRT tablet each year as the dose is so tiny. Ensure beforehand that the nurse/GP has the smallest speculum and take your own water based lubricant. As long as the lubricant is used only along the shaft of the speculum and kept away for the tip will be fine. Any nurse/GP who refuses to use lubricant, just refuse to have your smear test. No lubricant, no smear test!
Tell the HCP that you have vaginal atrophy or Lichens Sclerosus if they don’t spot it and ask them to take their time and be very gentle.
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. These women should be referred to a genital/vulval pain clinic or specialist FGM clinic who wll be able to carry out a smear test comfortably.
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.
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.
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 the women 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)
We’d rather have a bikini wax than a smear test!
A YouGov survey for Cosmopolitan Magazine found women are more comfortable exposing their vulvas than talking about them with 98% of women grooming their bikini line, and 1 in 2 women under 30 having all of their pubic hair removed.
So, just an idea, but could training beauty therapists to educate women about gynae cancers while they have their wax and encourage them to go for a smear test be the answer if this is a place where women are happy to show their vulvas? I know my beauty therapist does.
An even crazier thought, how about holding a cervical screening clinic in beauty salons? Save time, get a neat bikini wax and potentially save your life at the same time!
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.
Heymummy.co.uk blog live streamed having a cervical smear test to help women overcome their fears about having one
Jo’s Trust: www.jostrust.org.uk
Cervical Screening: cervicalscreen1.wordpress.com
Family Planning Association : www.fpa.org.uk
Eve Appeal : www.eveappeal.org.uk
The Daisy Network- www.daisynetwork.org.uk- charity for premature ovarian insufficiency
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
CliniQ : www.cliniq.org.uk
My Body Back : www.mybodybackproject.com
National FGM Support Clinics : www.nhs.uk