Cervical cancer is the most common cancer in women aged 35 and under: every year, around 3,000 women in the UK are diagnosed with the disease and two sadly die from it every day.
Luckily, there is a free cervical screening system in place to spot the signs before cancer can develop. It may be best known by its decidedly unsavoury nickname, the “smear test”, but it saves 5,000 lives a year in this country.
There is a lot of confusion about what this malarky involves and all sorts of questions are typed into Google every day. So we thought it was about time we gave you the full lowdown (and by full we mean full, no blushes spared) on the whole shebang.
If we’ve missed anything out, let us know in the comments and we’ll answer your question for you:
How is cervical cancer caused?
In 99.7% of cases, cervical cancer is caused by the human papillomavirus (HPV). This is a common virus that can be transmitted through skin to skin contact in the genital area. It is so common, in fact, that four out of every five sexually active adults will be infected with some form of HPV in their lives. In the majority of cases, this does not lead to cervical cancer, as the body’s immune system will clear the virus by itself without you ever knowing that you had it. Certain strains of HPV are considered high-risk because they are associated with the development of cervical cancer, while others are deemed low-risk because they can cause other problems such as genital warts.
Do I need a smear test if I’ve never had sex?
The risk of getting cervical cancer is really low if you have never had sex. The risk is still there, though, as HPV lives on the skin around the whole genital area, so do still go and get tested. Condoms can help but they aren’t enough to protect you from it fully for the same reason, so only practising safe sex won’t necessarily have ruled problems out either.
I don’t have any symptoms so presumably, I’m fine?
The symptoms of cervical cancer can be barely noticeable, which is sadly why many women are diagnosed too late to be cured. There are some more obvious signs such as bleeding after sex and pain during sex, but these can easily be misattributed to other things like your period and contraception playing up. Don’t assume you’re fine until that result comes back clear.
I haven’t received an invite but my friends have
Smear tests are offered to all women over the age of 25 in England and 20 in Wales. You should receive an invite in the post but if you’re wondering where yours has got to, give your doctor’s surgery a call and make sure they have the correct contact details for you. This is one party you don’t want to miss.
I’m scared it’s going to hurt
First of all, just because your friend said it hurt, it doesn’t mean it will for you. “Hurt” can mean many things, ranging from slightly uncomfortable to unbearable pain, so don’t get too hung up on other people’s negative experiences.
It is women experiencing menopausal symptoms who are most likely to find smear tests uncomfortable, as well as those who struggle with vaginal dryness. If you suffer from the latter, let your nurse know, and they may be able to use a lubricant and/or a smaller spectrum.
These days, most nurses use plastic speculums, which are more comfortable than the old metal jobs and look less scary too. Putting this in will only “hurt” if your vaginal muscles have tensed up. Realistically, being a bit anxious won’t make this happen, so try not to get anxious about getting anxious, like I did.
I struggle with anxiety
Being told to “just relax” is the most stressful thing. You want to scream “I’m trying to goddamn relax, I can’t help being anxious!” and all it does is make your hands more clammy. I know.
So here’s how I did it:
- Book an early morning appointment so you don’t have the whole day to worry about it.
- Get to the doctor on time. Not late, but certainly not early either. If you get there early your heart will start racing in the waiting room as you’ll have nothing to do but dwell. Don’t give yourself the time and opportunity to get worked up.
- Do some deep breathing and focus your mind on something, anything else (this is especially useful when you have followed the above tip but your appointment has been delayed!).
- Go in and pretend you don’t care. Pretend you are someone who is totally chill with the whole situation and refuse to think otherwise. That’s what I did and the nurse told me that it was “great how relaxed I was as most people are anxious”. Oh the irony. Time to rethink a career in acting?
Other tips: Tell the nurse that you’re anxious. My friend did this and they had a nice chat about a hen do she was going on that weekend and it took her mind right off the whole “this stranger is staring at my cervix” thing. Or take a friend with you for moral support.
If you have had a negative smear test experience in the past and cannot face trying again, you can buy home testing kits. We recommend going to the nurse for peace of mind that they have done it properly and given you an accurate result, but if that’s not an option for you, ask a medical professional to recommend a DIY kit.
I’m embarrassed about showing my vagina to somebody I don’t know
I think it’s fair to say that many women feel like this. It’s a private part of the body but, to be frank, you need to get a little perspective here.
Your nurse will have seen literally thousands of vaginas. Vaginas do not bother them. They will not think your vagina is weird, they will just think it is another vagina for them to look after that day. They think of them like arms and legs. I PROMISE. When I went for my smear test, my nurse had her appointments up on her computer screen. She had done five smear tests that morning already and it was only 9am. She was also absolutely lovely.
Remember that you can request a female nurse. Plenty of women do this (I would have done were the nurses at my surgery not all women anyway), so there’s no need to feel awkward about it. Male nurses are professionals, not pervs, but they understand. Just as female nurses understand why some men would prefer to see a male nurse to discuss a penis problem! Sometimes it’s just easier to relax knowing the other person has the same bits as you. It’s cool.
If you plan on having children in the future, medical staff will be seeing your vagina. So you may as well get it out of the way now. Put it this way, I am now totally unfussed about a doctor seeing my vagina because I’ve been there, done that, sadly not got the sparkly sticker because at 27 I’m too old, sob.
Do I have to get naked?
No. You will be asked to undress from the waist down but if you’re wearing a loose-fitting skirt, you can keep this on and simply remove your tights and knickers. The nurse will give you some paper to preserve your modesty.
It sounds super medical but really, all this much-maligned piece of gear is, is a piece of plastic that holds your vagina open so your nurse can see your cervix clearly to swab it.
Swab does not mean scrape. The nurse will not scrape your cervix. It’s more of a gentle sweep but you won’t feel anything. I was waiting for the swab but the next thing I knew she had merrily declared “All done!” and that was that. Bam, done, bossed it.
Do I have to put my feet in stirrups?
Sometimes there will be stirrups on the couch and you’ll be asked to put your feet in them, but not always. My nurse simply asked me to bend my knees as if they were in stirrups, then make my hands into a fist and put them under my lower back to prop things up. It felt silly and we had a chuckle about how unglamourous it was (led by me, not once did I feel like she was laughing at me).
How long does it take?
My last smear test took all of three minutes, so time commitment isn’t an issue here.
When should I book it for?
You can go for a smear test whenever, so long as you aren’t on your period. Ideally, go in the middle of your cycle, so around two weeks after your period. This is because the cervix lowers after ovulation, making it easier for the nurse to locate it, get a better sample of cells and get the job done quickly and painlessly.
Can I have sex before my smear test?
If you use spermicide, lube or any form of barrier method such as condoms then don’t have sex less than 24 hours before the test as the chemicals on these contraceptives may affect the results.
When will I get my results?
The NHS guidelines state that you should receive your results by post within two to six weeks. Mine took just 8 days to come through but it depends on where you live.
I’m anxious about getting my results
This is understandable as we have all heard horror stories about cervical cancer. If someone close to you has cancer it can feel even more nerve-wracking. But remember, cervical screening is not about diagnosing cancer. It’s about detecting changes to cervical cells (“cervical abnormalities”) before they can become cancerous. Realistically, you are highly unlikely to be diagnosed with cervical cancer from a smear test. It’s more likely that you’ll receive one of the following results. Here’s what will happen if you do:
Hurrah! Your cervix looks healthy and you will be invited for another smear test in three to five years. If you notice anything abnormal before then, see a doctor. Between 90 and 94% of screening results come back clear.
Don’t freak out. This simply means that some changes were detected to your cells, but they are not worrying doctors at this stage and will likely go back to normal without treatment. One in 20 screening results show low-grade changes.
Moderate to high-grade changes
One in 100 results show moderate changes, also known as dyskaryosis, and one in 200 show high-grade dyskaryosis. You will be sent for a colposcopy for further investigation. Check out this page for more information on that but, in brief, it is a more detailed look at the cervix using a special microscope instead of the naked eye. It will feel the same as a smear test, with only the speculum going inside your vagina. If you need treatment to remove any abnormal cells, your doctor will advise on what will be best for you, from cryotherapy (freezing) to biopsy. To repeat: it is highly unlikely you will require this, so do not meet trouble half way!
Less than one in 1,000 results show invasive cancer. It is extremely rare for cervical cancer to be diagnosed from a smear test.
Traumatic past experiences mean I can’t face a smear test
The My Body Back Project is a cervical screening clinic especially for women and trans men who have experienced sexual violence. It is also a place where rape survivors can self-test for STIs. The clinic was founded to meet the needs of women who wanted a space to be in full control of their bodies.
The clinic is designed to help women a year or more after their traumatic experience and recommends seeking care and counselling prior to attending for a screening.
The staff are all female and there is the option to book in for an initial consultation with a Sexual Violence Health Advocate for support throughout the process. This service is offered for free in partnership with Bart’s Health NHS Trust. Email [email protected] to book an appointment.