Don’t fear your smear – what to expect at your cervical screening appointment and why it is so vital.
September marks Gynaecological Cancer Awareness Month and as such, we’re talking about all things intimate health; specifically, the signs and symptoms of the five gynae cancers. As 24th September marks the start of Sexual Health Week, we wanted to focus specifically on cervical cancer. Did you know that cervical cancer is the fourth most common cancer occurring in women and the eighth most commonly occurring overall? (1). Attending a smear test or cervical screening is one of the best ways to prevent cervical cancer developing or progressing. The test, which involves examining cells taken from the cervix, can detect precancerous/abnormal cells so that they can be treated to prevent the occurrence of cancer.
Despite this procedure being readily available to all adult women under the age of around 65 in the UK, statistics have shown a significant decrease in the amount of women attending their cervical screening appointments. According to Jo’s Trust, there has been a recent and ‘worrying trend of fewer women attending screening; especially in the 25–29 age group, with one in three not taking up their invitation in 2014/2015. Also, across the UK figures for those not attending screening show a significant rise as age increases, suggesting that as women age, they consider screening less important' (2). Attending a cervical screening isn’t something that most women look forward to, however it’s incredibly important to attend regular examinations as they offer the best protection against developing cervical cancer. If you’re over the age of 24 and are yet to attend a cervical screening, or it’s been a little while since you last had one and you were wondering whether it’s worth skipping this time, hopefully this blog post will help to reassure you that there’s nothing to worry about and the potential benefits far far outweigh the minor embarrassment of the test! Don’t fear your smear!
First time nerves
It’s natural that you may be a little nervous before your screening, particularly if it’s your first time. Just know that approximately five million women are invited to attend a screening each year, so you can always talk to someone you know about their experience – whether it be a close friend, your mother or sister - to help give you some reassurance and an insider’s knowledge of the whole process. The healthcare professional performing the test will be well-trained and well used to seeing numerous women for the same procedure every day, it is nothing unusual to them at all.
Where and when can I go for my cervical screening?
You can book your cervical screening appointment with your GP, usually you’ll receive a letter from them inviting you to attend. Screenings can be performed by different healthcare professionals, if you prefer to be seen by a woman you have every right to make that clear when you make your appointment and can also request to have a chaperone in the room if it makes you more comfortable. If you’d rather not have your appointment with your GP, you can also ask to see a practice nurse, alternatively you can head to a sexual health clinic or a well woman clinic for the test. Ideally it’s preferred that you don’t attend a screening whilst on your period, mid-cycle is best. Once you’ve attended a cervical screening you will be invited back again typically every 3 years for women ages 24 - 65. Women aged 30 and over may consider a repeat test every 5 years.
How long do they last and what happens at a cervical screening?The appointment should take no longer than around 20 minutes, the procedure itself lasting only 3 minutes. You’ll meet your nurse/doctor who will ask you to go behind a curtain and get undressed from the waist down, covering yourself with a sheet of hospital paper or blanket so that you keep you modesty. Once ready, your nurse will ask you to position yourself with your hands under your pelvis to raise your hips and then spread your knees (a bit like yoga really…). The nurse will then insert a lubricated speculum (an expanding plastic tube) into the vagina in order to be able to see the cervix and then use a little plastic brush to extract the cells. After the cells are extracted and sent off for testing, your results will be returned in around 2 to 6 weeks.
Does the procedure hurt?
Your screening shouldn’t be painful, but some women find them a little uncomfortable. Everyone’s experience is different, but you might feel a little bit of pressure from when the speculum is inserted and a slight twinge. If you’re nervous you may tense up a little, so just take deeps breathes to help you relax your muscles which makes it all much easier. You can even have someone come into the room with you to help ease your nerves. Top tip: Ask for a smaller size speculum if you wish, they come in lots of different sizes.
Will a cervical screening give a final diagnosis?
No. A cervical screening is used to detect early cervical cell abnormalities which, if left untreated, could lead to the development of cervical cancer at a time in the future. You’ll receive a letter a couple of weeks after the test to tell you the results, or often, you can call to get them too.
Is cervical screening more painful after the menopause?
According to Jo’s Trust, ‘after menopause the vagina walls and entrance to the vagina can become smaller. Women may also make less natural lubrication and this can make the internal tissue dryer, less comfortable and more prone to irritation and abrasion, insertion of the speculum (an instrument used to open the vagina so the sample taker can see the cervix) can therefore be more uncomfortable. However, liberal use of an appropriate lubricant can help hugely with that. After the menopause oestrogen levels in the body fall, which causes a condition called atrophic cervix. This happens to every woman. The cells of the cervix do not shed as easily as a woman who has not been through the menopause which can sometimes produce an 'inadequate' cervical screening test result as not enough cells can be collected. If this result occurs you may need to come back to repeat the cervical screening test’ (3). Do talk to your nurse if you’re nervous, uncomfortable or have had a bad experience at a screening previously. They can help advise you on how to make your examination as easy as possible. In some cases your practice nurse may even be able to prescribe local or topical oestrogen in advance of the test, which can help to make inserting the speculum easier.
I’ve always had clear results, should I stop attending screenings after 50?
Cervical cancer is caused by the HPV virus. Anybody who has ever been sexually active is at risk of contracting HPV. It’s recommended that you continue to attend screening appointments when invited, as the process offers the best protection against developing cervical cancer. You will be invited to attend cervical screening until 64 but some women will have them for longer than that depending on their history.
For more information on cervical cancer and the five gynae cancers, visit https://eveappeal.org.uk