So, it’s that time again, you’ve been invited for your cervical smear test (now known as cervical screening), you know you should do it but the worry of an unpleasant experience may mean you put it off. Or, have you just received your first invitation and worried about what is going to happen next? Either way, if you’ve received the letter, or just want to learn more about the test, you’re in the right place - read on!

Why it’s important to get your test

A cervical screening test (1) is where a sample is taken from the cervix which is tested for high risk strains Human Papilloma VIrus (HPV). If you test positive for this, then your sample will be further tested for any changes to your cells, looking specifically for precancerous changes (this is the method used in England, Wales and Scotland (2). It’s important to remember that a cervical screening test will only be done if you have been invited, or are overdue. You can not have a screening test done on the NHS at any time. It is meant as a tool to help detect people at a higher risk of developing cervical cancer, and not intended for those who have symptoms (1). Cervical screening is still the best chance of helping to detect and treat precancerous changes early (3).

The test involves a clinician inserting a plastic device called a speculum into your vagina to visualise the cervix and using a small brush to take a sample (4).  This test should take no more than five minutes, it may cause some discomfort, but should not be painful. We also know that there may be other fears holding you back from going, such as potential embarrassment or simply not knowing what to expect - and we are here to put those concerns to rest.

Here are some common concerns we hear and our tips to make you feel more comfortable and better informed:

“I’m worried about who is going to take my test”

When you are invited for your screening test by post, you will be asked to book an appointment at your regular GP surgery. A person who performs ‘smear tests’ is usually a nurse or a doctor, and both would have special training to allow them to do this type of test on top of their normal professional training. If you have preference for a nurse, or a doctor, or indeed a male or female practitioner, you can request this (5). Although this is not guaranteed, it can certainly be taken into consideration to allow you to feel more comfortable during your appointment. If you have a regular nurse or doctor who you know and trust, you may be able to request for them to do the test.

It is also important to remember that for any intimate examination, you will be offered a chaperone. This is someone who you can have in the room if you choose, normally a member of staff from the practice (5). Some people like to have a friend attend the appointment with them to ease anxiety, which is something to consider if you are worried.

If you do not feel comfortable having your test at your GP surgery, sexual health clinics can also perform these along with routine sexual health tests.

“Can I bring someone with me?”

If you feel anxious about going alone, you can ask someone you trust to go with you, such as a friend or relative, who can also be with you after your appointment. They can be with you in the waiting room or during your appointment.

“It’s going to be painful”

The cervical screening test is uncomfortable and should not be painful. The whole appointment will tend to last 15 minutes, with the test itself taking about 5 minutes. The most important thing to reduce pain is to be able to relax your muscles. When you are in position for your test, you may have your feet on stirrups or close together on a couch, but your knees should be as relaxed as possible to the sides. I often suggest, if there is a wall on one side of the couch, really relax against the wall. If your muscles are tense, it makes it harder to insert the speculum and see the cervix. If your cervix is difficult to visualise, you may be asked to place your hands underneath your bottom to create a tilt to make things easier. Sometimes coughing whilst in position can also help the cervix become easier to see. You can ask the clinician for a smaller speculum, but just be aware, sometimes it may not be possible to see the cervix with a smaller speculum and hence the examination may need to be repeated. It is possible to ask to insert the speculum yourself. If you feel comfortable to do this, then this may help to reduce discomfort. Breathing exercises can help to keep you relaxed during the appointment. If you feel really concerned about your anxiety levels, do speak to someone before the appointment to see what other measures can be taken e.g. the first appointment of the day to avoid waiting in a waiting room.

“What happens if my appointment falls during my period?”

Your test cannot be performed if you are on your period, so try your best to book an appointment when you think you may not be bleeding, and if you are, then rebook the appointment when you are ready.

“I was invited but never booked my appointment.”

During the pandemic many people missed their screening tests which means that in the UK we have a backlog of people who are overdue for screening (5). If you received a letter and haven’t yet had your test, please do come forward and book your appointment. You can still book even if you were invited weeks or months ago! 

Other points to consider

• If you have other circumstances such as transgender individuals or those who may have experienced domestic violence or sexual assault (6), you can consider going to a specialist clinic. You can find details of these here.

• Research shows that people from ethnic minority backgrounds are less likely to come forward for a test. It is important to speak to your healthcare professional about any anxieties or questions you may have (6). 

• To make things easier for you on the day, you can consider wearing a skirt or dress if you can to make getting ready for the test easier for you (5).

• Please remember, your doctor or nurse is not there to judge your body (or whether you’ve shaved your legs!). It might be hard to remember, but when you go for your smear you are basically one of hundreds who have gone before you and this is very much a routine exam.

• It is important to remember that cervical cancer affects many people in the UK and hence screening is a very important tool to help detect cancer early. If you are delaying your screening, or know a friend or family member who is, share this article and encourage each other to attend!