Smear Tests: An opportunity to empower

It's a concerning statistic, but amidst the numbers lies an opportunity for empowerment. This article aims to reassure you about your upcoming smear test, emphasising the steps you can take in ensuring the procedure is as comfortable as possible, in addition to the vital role these screenings play in identifying and preventing cervical cancer. It’s important to remember that your smear test is not just a medical procedure; it's a chance to take control of your health.

What is a smear test?

Cervical smear tests, also known as Pap smears, are a cornerstone of preventive healthcare for women. This simple procedure involves collecting cells from the cervix to identify any abnormalities or early signs of cervical cancer. The importance of these tests cannot be overstated, as they offer an effective means of early detection and intervention.

As per the NHS’ guidance a smear test involves these steps [ii]

1. You'll need to undress, behind a screen, from the waist down. You'll be given a sheet to put over you.
2. The nurse will ask you to lie back on a bed, usually with your legs bent, feet together and knees apart. Sometimes you may need to change position during the test.
3. They'll gently put a smooth, tube-shaped tool (a speculum) into your vagina. A small amount of lubricant may be used.
4. The nurse will open the speculum so they can see your cervix.
5. Using a soft brush, they'll take a small sample of cells from your cervix.
6. The nurse will close and remove the speculum and leave you to get dressed.

The cervical screening test itself should take less than 5 minutes. The whole appointment should take about 15 minutes.

It is really important to remember that you’re in control of the cervical screening and can stop at any time. It’s essential to do what makes you comfortable first and foremost.

What even is normal?

The study carried out by Jo’s Cervical Cancer Trust revealed a plethora of reasons as to why women are choosing to delay their smear tests, however, the most prevalent reasons were concerning body image issues. The Trust are worried that a perception as to what is considered ‘normal’ could be putting lives in danger. From the survey 35% of women agreed that they are embarrassed to attend a smear test because of their body shape, 34% agreed that anxiety around the appearance of their vulva put them off attending and 38% of women had concerns over smelling ‘normally’i. These statistics demonstrate that some women are hesitant to have their smear test due to discomfort related to their body image, in turn spotlighting the significance of creating a body positive culture when discussing and attending sexual health screenings.

Further to this, the survey also found accessibility of appointment an issue. Over a quarter of women surveyed expressed difficulty in making an appointment, and 30% of those who had never had a smear test said they were unaware of where to get the testi.

The risk of missing an appointment

Cervical cancer is the most common cancer in women under 35, yet the charity’s survey of 2,017 women aged 25-35 found 61% are unaware they are the most at risk age group for the diseasei. Missing a smear test appointment can have serious consequences for women's health, as these screenings are instrumental in detecting cervical abnormalities early on, preventing the progression to cervical cancer. According to the American Cancer Society, routine Pap smears have contributed significantly to the decline in cervical cancer rates, with a 70% reduction over the past few decades [iii]

Delaying or skipping a smear test increases the likelihood of missing early signs of potential issues, leading to a higher risk of developing cervical cancer. The World Health Organization (WHO) emphasises that cervical cancer is the fourth most common cancer among women globally, and in 2020 alone, it accounted for over 600,000 new cases and approximately 340,000 deaths [iv]. Timely and regular smear tests are crucial in reducing these alarming figures, offering a lifeline for early intervention.

So, whilst the prospect of the procedure can be unnerving and unpleasant, smear tests may bring a few minutes of discomfort but prevent 75% of cervical cancers [v]. Furthermore, there are measures you can partake in to increase your sense of comfort and better your experience, so you feel at ease during the appointment.

What can you do?

As you prepare for your upcoming smear test it is essential that you put your own needs first and place your own experience of paramount importance. This is about your own health, and you take priority. If it is your first cervical screening, you feel embarrassed or worried, you have had a bad experience before, or you have experienced anything that makes the test hard for you, telling the person doing the test means they can try to give you the right support. They are expert in this field and are here to help you get the assistance you need – and deserve.

On top of voicing your worries to the medical professional you can continue to take matters into your own hands with any of these tips:

• If you feel uncomfortable in waiting rooms, you may want to ask to book the first appointment of the day. This can mean it is quieter and there is less time for you to wait.
• Ask to book a longer or double appointment - Having more time before, during or after cervical screening can help people take in information about the test and process everything that happens. If this would be useful for you, you may want to check if your GP surgery can offer you a longer appointment.
• Ask for a nurse or doctor of a particular gender - You may feel more comfortable knowing that a female or male nurse will be doing your cervical screening.
• Take someone you trust with you. It could be a friend, family member, partner or someone else. They can be in the waiting room or examination room with you to offer support. If you don’t feel confident speaking, they may also be able to speak on your behalf about any worries.
• Ask for a smaller speculum. Speculums come in different sizes. If you find the standard size too uncomfortable, you can ask to try another size which may suit you better.
• Put the speculum in yourself. You may feel more relaxed and comfortable about putting the speculum in your vagina yourself. If you have a partner with you, you may prefer them to insert the speculum.

If you are a trans man and/or non-binary person with a cervix, you may experience dysphoria around cervical screening, as well as other experiences that make the test difficult. If you want to go for cervical screening, there are a number of specialist clinics in the UK, including:

• 56 Dean Street in London
• Clinic T in Brighton
• cliniQ in London

Conclusion

Your upcoming smear test isn't just a medical task; it's a powerful act of self-love and care. Yes, the statistics might seem daunting, but remember, you are more than a number. You’re an individual making a conscious choice to exercise self-care and prioritise your own well-being – that’s a powerful act. By approaching this screening with a new understanding, helpful insights and a touch of confidence, you’re not just preventing cervical cancer – you’re embracing a healthier and happier you. Together, let's debunk the myths, dispel the fears, and celebrate the strength that comes from taking charge of our health.

[i] Body shame responsible for young women not attending Smear Tests, Jo’s Cervical Cancer Trust. (2018) Available at: https://www.jostrust.org.uk/node/1073042 (Accessed: 03 January 2024).

[ii] What happens at your cervical screening appointment (2022) NHS choices. Available at: https://www.nhs.uk/conditions/cervical-screening/what-happens/ (Accessed: 03 January 2024).

[iii] Cervical cancer statistics: Key Facts About Cervical Cancer (2023) Cervical Cancer Statistics | Key Facts About Cervical Cancer | American Cancer Society. Available at: https://www.cancer.org/cancer/types/cervical-cancer/about/key-statistics.html (Accessed: 03 January 2024).

[iv] Cervical cancer (2023) World Health Organization. Available at: https://www.who.int/news-room/fact-sheets/detail/cervicalcancer#:~:text=Cervical%20cancer%20is%20the%20fourth,%2D%20and%20middle%2Dincome%20countries. (Accessed: 03 January 2024).

[v] Smear test rates plunge: Why and what can be done about it?(2021), King Edward VII’s Hospital. Available at: https://www.kingedwardvii.co.uk/health-hub/smear-test-rates-plunge-why-and-what-can-be-done-about-it (Accessed: 03 January 2024).