Don’t fear the smear

The prospect of your first smear is a daunting one for many. Most of the fear I have seen comes from either not knowing the process or what can happen and being scared it’ll be painful and not knowing how it’ll feel for you. There also might be the odd horror story in your mind passed down by friends, probably exaggerated 10-fold since the first time it was told

Even as a medical doctor this was something I put off for a little while.! Heck, I’d even done one as a medical student so knew exactly how the process went, but I didn’t know what it would feel like for me. Would it be painful? Would I bleed afterwards (horror-story induced)? Then I had the smear test and it wasn’t worth putting off in the first place. It honestly wasn’t painful, a little uncomfortable for only a few seconds out of the whole thing and I was absolutely fine afterwards.

So, I thought I’d give some time for us girlies and write here the process of going for a smear and some tips if you’re a little scared about the whole thing in the hope it’ll make your feel less worried.

What is the smear test actually looking for?

Firstly, the smear test isn’t looking for cancer. It’s looking at the health of your cervical cells.

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About 1 in 20 ladies going will have some sort of abnormal changes in their cells. These could be minor and return to normal by themselves, or they may need to be removed to stop them from turning into a cancer at a later stage.

Having the screening test regularly (every 3 or 5 years depending on your age) aims to identify any abnormal changes in the cells of your cervix at an early stage and treat you to stop a cancer developing.

Screening isn’t 100% accurate, but it is the best way to detect any abnormal cells.

Process of having a smear test:

Booking a smear:

  • You’ll get a letter through the post inviting you for your smear test.
  • It’s best to book an appointment if possible in the middle of your menstrual cycle, if you have a 28 day cycle this will be 14 days after the day you started your last period.
  • It’s best not to use lubricant or spermicide in the 24 hours before your smear test as these can affect the test, this way there’s a lower risk of having an inadequate sample.

Having the smear test:

  • Remember, the nurses or doctor performing the examination do this all the time, there is no judgement on your shape, size or if you shave/wax your pubic hair or not – trust me, they will likely have seen it all.
  • They won’t be able to tell when you last had sex or how sexually active you are.
  • You’ll go into a private room with the person performing the test, this is often a nurse or doctor. If you want a chaperone just ask.
  • You’ll undress from the waist down and lie on an examination couch. You should be given something like a long paper towel to cover yourself to keep you feeling more covered up.
  • The nurse will ask if you’re comfortable and slowly insert a speculum into your vagina, this holds the walls open so they can visualise the cervix.
    • This is the part of the examination that can be a bit uncomfortable. Ironically being relaxed makes things easier for both you and the person performing the test. Try some deep breathing.
    • A small amount of lubricant can be used, but not too much as this interacts with the sample.
    • The nurse will go slowly and ask if you’re ok – if it’s painful in anyway let them know. You are in control and they can always stop, pause, or readjust things to try to make it more comfortable for you.
  • They will then insert a small, soft brush to brush against the cervix and collect some cells.
    • There is no sharp object that goes up there!
    • Many women don’t even feel this part of the examination/their cells being collected.
  • The brush and speculum will be removed, and you will be able to get dressed again.
  • The whole appointment often lasts only 5-10 minutes and the actual procedure just a couple.

Results:

  • Results are sent to you in the post.
  • The aim is to get the results back to you in 14 days, but it can take longer.

The possible outcomes:

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Normal result:

  • No abnormal changes seen
  • You don’t need to do anything until your next smear.

Inadequate result:

  • The sample wasn’t able to be processed correctly.
  • This could be due to not enough cells being collected, an infection or the cells not being seen on the microscope.
  • You’ll be offered a repeat test, often in about 3 months.
  • This does not mean you had abnormal cells.

Abnormal result:

  • This is again split into low-grade or borderline changes (medical name for changes is dyskaryosis which you might see written) and moderate or severe, high-grade, changes.
  • The borderline changes mean there are some abnormal cells, but they are very similar to normal cells and they might turn back to normal without any treatment.
    • This will lead to another test for HPV being performed on your cells (if your screening wasn’t primary HPY testing, see below).
    • If this is normal, you’ll have another test when routinely needed.
    • If HPV is found, you’ll be offered a further test called colposcopy.
  • High-grade changes mean cells are more abnormal and you’ll go straight for colposcopy to have a closer look at these changes and might be offered treatment there and then.
    • This doesn’t mean you have cancer – it means some cells are abnormal which if left could develop into cervical cancer.

 

Some changes are happening in the way cervical smear tests are taken and analysed. Primary HPV screening is being introduce where HPV is tested for in the initial smear. This can slightly change the outcome of your smear and possible follow-ups. You can ask your GP practice if primary HPV screening has been introduced into your area and if so how this changes things. By December 2019 the plan is for all cervical screening to the primary HPV screening.

Is it worth getting a smear if I’ve had the HPV vaccine?

In a word, yes.

There are several types of HPV vaccine. All of them protect against the high-risk strains type 16 and 18. These strains of HPV cause about 70% of cervical cancer, but not all of them.

Having a smear can identify changes in the cervix caused by other types of HPV and the small amount of cervical cancer which isn’t related to HPV.

Do I need a smear test if I’m a virgin?

Ultimately, it’s up to you.

If you’ve never been sexually active, including skin-to-skin genital contact as well as penetrative sex, your risk of getting cervical cancer is really low.

Being a virgin can make the test more painful/uncomfortable – something to bear in mind.

Ask your GP if you have any questions.

What to do if I’m scared?

  • Go to your GP ask them to talk you through the procedure and the steps involved showing you the equipment.
  • Talk to your Mum – they really are fountains of knowledge and will have likely been through it themselves.
  • Ask for the small speculum.
  • Bring a mum/sister/friend with you for support in the waiting room. If you want them to come in with you that’s fine too.
  • Tell the nurse or doctor doing it it’s your first smear. We’ve all been there, they’ll understand.
  • Let them know if it’s too uncomfortable and they can pause or stop, you’re in control.

Other resources:

NHS video explaining the process here: https://www.nhs.uk/video/Pages/cervical-screening.aspx

So, all in all, it is a test that takes a couple of minutes, is a little uncomfortable but not painful, and can prevent cancerous cells from developing. Take it from someone who was worried about her’s, it’s really not that bad. I honestly was surprised after building it up in my mind how quick and relatively painless it was.

If you’ve ignored some letters inviting you to have your smear test don’t worry, you can just ring up and book one with your GP.

I hope this helps anyone who’s a bit nervous about the prospect!

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Emma x

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