What happens during your cervical smear test appointment and why it could save your life.
Nervous about attending cervical screening for the first time? No one jumps for joy when they receive their invitation to cervical screening so you are not alone. Also known as a ‘smear test’, many women find cervical screening embarrassing. Who wants to expose their private bits to a health professional? As a result one in four women skip their appointment altogether. But cervical screening literally save lives and it only takes a few minutes.
To make you feel more comfortable and confident about your appointment, Dr Juliet McGrattan explains why cervical screening is carried out, what happens during your appointment and what the results mean:
Why is cervical screening important?
Around 3200 women are diagnosed with cervical cancer every year in the UK and around two women die every day from the disease. This may sound bleak but this is a 75 per cent reduction since 1970. The cervical screening programme began in the UK in 1988 and has saved thousands of lives each year.
Cervical screening explained
Let’s be clear about this, cervical screening is not a test to look for cervical cancer. It is to identify women at high risk of developing it and to prevent cervical cancer from happening.
Cervical screening programmes (in the UK) test for Human Papilloma Virus (HPV). Certain strains of HPV cause cervical cancer. If these strains are found, then the cells from the cervix (neck of the womb) will be examined under a microscope (cytology) to determine a woman’s risk of cancer, her treatment and when she should be tested again.
Cervical screening is not a test to look for cervical cancer. It is to identify women at high risk of developing it.
A swab of cells from the cervix (neck of the womb) are taken, tested for HPV and where appropriate, examined to see if any of them show abnormal changes.
The cells of the cervix are replaced regularly, a bit like the shedding of skin cells. This means that abnormal cells are usually replaced with healthy ones and changes disappear. If, however they become progressively more abnormal then they have the potential to become a cervical cancer and action can be taken before this happens.
What is HPV?
There are many different types of HPV and most women will be infected at some point in their lives and may not even know they’ve had it. At least 15 types of HPV have been linked to causing cervical cancer and are considered ‘high-risk’. They affect the way that cells in the cervix work and reproduce and may eventually cause a cancer to grow. HPV can be spread by any sexual contact including simple skin-to-skin contact of genitals in addition to vaginal, anal or oral sex. HPV can also be spread if sex toys are shared. The body can clear most types of HPV within a couple of years.
When should go for cervical screening?
If you have a cervix you will receive your first invitation to cervical screening at age 25. This can arrive up to six months before your 25th birthday. You will then get an invitation every three years until you turn fifty when it reduces to every five years. Screening stops when you reach age 65 unless you have had any abnormalities in your last three tests.
The age ranges and pattern of invitations has changed over the years. The screening programme is very carefully evaluated to make sure it is not leading to unnecessary treatment for women at the same time as making sure that cervical cancer is prevented in the maximum number of women.
Do you need cervical screening?
We answer your five most common cervical screening questions:
1.Do you need cervical screening if you are under 25?
You don’t need to attend cervical screening if you are under 25. Cervical cancer is very rare in women under 25. Screening in this age group was found to be causing more harm than good because it was leading to unnecessary treatments. However, if you experience bleeding between periods, bleeding after sex or you have an unusual discharge then see your GP.
2. Do you need cervical screening if you have had a hysterectomy?
Attending cervical screening after a hysterectomy depends. Cervical screening is no longer required after a total hysterectomy where the uterus and cervix have been removed unless the surgery was done to remove a cancer, in which case a test from the top of the vagina (vault) may be recommended. In a subtotal hysterectomy the cervix remains and screening will still be required.
3. Do you need cervical screening if you have never had sex?
If you are over 35 and you have not had sex, cervical screening is still recommended for all women. Remember, you don’t need to have penetrative sex to contract HPV. Any type of skin contact between genitals or sharing of sex toys can pass it on. If you have never had any sexual contact at all, then your risk of cervical cancer is very low but it is not zero and you can still have screening if you want it. Discuss this with your nurse or doctor.
4. Do you need cervical screening if you are a lesbian?
You should still attend cervical screening if you are a lesbian. HPV can be passed between two women during sexual activity.
5. Should you attend cervical screening if you are pregnant?
Routine screening should be done at least 12 weeks after your baby is born. If you had a test showing abnormal cells and have been referred for colposcopy, then you should still attend.
Booking a cervical screening appointment
Once you have received an invitation for screening you should make an appointment at your GP practice. Explain your reason for booking so the staff can make sure you are given an appointment with an appropriate member of staff (this may be a doctor or a nurse) and that the appointment is long enough.
Once you have received an invitation for screening you should make an appointment with your GP.
The appointment will be between 10 and 20 minutes long. Try to book a date that is not during your period. The ideal time is in the middle of your cycle. Some sexual health clinics offer cervical screening appointments too.
It is OK to have sex the day before your screening but avoid using a condom with spermicides or other oil-based lubricants as these can interfere with the results and could mean the test has to be repeated.
What happens during cervical screening?
A survey by Jo’s Cervical Cancer Trust in 2018 found that 35 per cent of women are too embarrassed to attend their cervical screening appointment because of their body shape. Be reassured that healthcare professionals are not concerned about your shape, your pubic hair or whether you have shaved your legs. They are just glad you have attended your screening and will carry it out in a professional manner.
The doctor or nurse that sees you will usually have a quick chat with you before carrying out the screening. They will want to confirm your identity, check previous tests results and ask about any symptoms or concerns you may have. This is the ideal time to speak up if you have any anxieties about the procedure.
- You will be offered a chaperone to be present in the room with you.
- You will be asked to go behind a curtain to undress from the waist down. You may choose to wear a skirt to make this easier.
- You will then need to lie on your back on an examination bed, with your feet flat on the bed and your knees up.
- You will be able to cover your bottom half with a large paper towel.
- The examiner will then gently place an instrument called a speculum into your vagina. A speculum is usually made from plastic or metal, and will be clean and sterile.
- Metal speculums will usually be warmed before use and your examiner may use a water-based lubricant to help guide the speculum into your vagina.
- The speculum holds open the walls of your vagina and allows visualisation of your cervix. Sometimes you will need to move your bottom around a little bit, in order for your cervix to come into view.
- A small, soft, flexible, plastic brush will be passed into your vaginaand swept over your cervix. This collects a sample of cervical cells.
- The top of the brush containing the cervical cells will either be dipped or dropped into a pot of preservative fluid. The pot will be sealed with a lid and labelled with your name.
- The speculum will be carefully removed from your vagina.
- You can then get dressed. If a lubricant was used, you can use a tissue to wipe away any excess.
- You may have a little light vaginal bleeding after the test so it’s wise to bring a panty liner or pad.
- Your sample will then be sent to a laboratory for testing and you will usually receive your results within two weeks.
Does cervical screening hurt?
Most women experience only a mild discomfort during cervical screening, when the brush is swept over the cervix. Sometimes there can be a brief crampy, period-like pain. The sensitivity of the cervix varies between women.
The other thing that can be uncomfortable is when the speculum is inserted into the vagina. This is not an issue for the large majority of women but for those who feel anxious and tense and for those who find sex uncomfortable due to tightening of the vaginal muscles (vaginismus) it can create stress.
Most women experience only a mild discomfort during cervical screening, when the brush is swept over the cervix.
Staying as relaxed as possible helps a lot so focus on taking slow, deep breaths and trying to relax your tummy and thigh muscles. Explain your concerns to the doctor or nurse. This is very common so don’t feel embarrassed. They can reassure you, explain things and tell you when they are about to perform each stage of the test.
What does cervical screening test for?
The cervical screening sample will be tested to see if it contains HPV.
The cells taken from the cervix are examined under a microscope, this is called cytology. A report will be written stating whether the cells look normal or abnormal and whether any changes are mild or severe.
How will you get your results?
You will receive your results in a letter directly to you and your GP practice will also receive a copy. Ask the doctor or nurse taking the test when you can expect your results; it’s usually within two weeks of your appointment. If you do not hear within two weeks then contact your GP practice.
Cervical screening test results come back normal in more than 9 in 10 women in Great Britain.
What do cervical screening results mean?
The letter you receive will inform you of your test results:
• Inadequate results
If you have inadequate results this simply means that the sample could not be assessed because there were not enough cervical cells present. The test needs to be repeated.
• HPV negative
If you are PHV negative you don’t need to take any action and can wait for your next screening appointment. No further tests are needed right now because the risk of cervical cancer is so low.
• HPV positive and no abnormal cells
If you are HPV positive with no abnormal cells the risk of cervical cancer is higher than HPV negative but there is no indication of any changes to it the cells. You will be asked to return in one year for another test. If HPV continues to be present you may need colposcopy (see below).
• HPV positive and abnormal cells present
If you have HPV positive and abnormal cells present you will be referred for colposcopy.
What is colposcopy?
Don’t be alarmed if you have been referred for colposcopy. This does not mean you have cervical cancer. This is simply a procedure where the doctor (a gynaecologist) can have a closer look at your cervix. It will happen in the same way as your cervical screening, by inserting a speculum but the doctor uses a microscope with a light to examine your cervix.
If necessary, a biopsy (tissue sample) will be taken from the cervix to examine in more detail and you will receive the results of this several weeks later. What the doctor sees at colposcopy determines whether you need any treatment and when your next screening will be.
Remember that most mild changes to cells go away on their own. Cells with more severe abnormalities have the potential to progress to cervical cancer and will be treated and removed to stop this happening.