What exactly is a cervical smear test and what is involved?
It’s cervical cancer prevention week (10th – 16th June 2019) and I am a nurse who works in gynaecology, so I think now would be the perfect time for me to talk about what it’s like to have a cervical smear test. Sounds fun right?!
I know most of you have probably already had one but I know lots of ladies who haven’t. Those of you who are reading this who are under the age of 25 – have you ever had your first smear? Many haven’t.
My aim is to help women understand why it’s important to attend their smear test and what happens in a smear test – I want to put anxious minds at ease.
I will also give you some tips to help you prepare and get through your smear test.
I won’t deny that smear tests are a little bit unpleasant. I can think of way better things to be doing with my vagina. But as a nurse and a woman who ended up needing treatment to my cervix, I will say that they’re fundamental to the prevention of cervical cancer.
That’s a pretty sweet deal I reckon.
I’m aware of the negativity towards cervical screening – I’ve been told many times (usually by women growling at me on an examination couch) that there should be a better way of taking smear tests in this day and age.
The fact remains that in order to gain access to the cervix to take the smear and visually examine it, the vaginal walls need to be pushed apart and held open, and at the moment the only way to do this is to insert a speculum and scrape cells off and out of the cervix using a brush made of silicone brushes.
This isn’t anywhere near as bad as it sounds by the way. Inserting the brush without a speculum would more than likely lead to obtaining an inadequate sample and would be quite painful.
I’d like to point out here that I will use the term “practitioner” sometimes, and by that, I mean the qualified person taking the cervical smear. This can be a practice nurse, doctor or specialist nurse. It usually takes place at your GP practice or outpatient gynaecology clinic based in a hospital.
So, let’s get down to it.
Why do we go for a cervical smear test?
One of the first things to mention here is that a smear test is not a test that gives a diagnosis – it’s just a screening tool. A smear does not look for cancer, so if you go for your smear test and you receive a letter that says you have abnormal results, those results do not mean you have cancer.
Get ready for some fun facts…
Over the past few decades, it was discovered that HPV (human papillomavirus) is responsible for almost all cases of cervical cancer. HPV is passed on through sexual contact so can cause cell changes in areas such as the vulva, the vagina, cervix, penis, anus, mouth and throat. Condoms do not give 100% protection against HPV for this reason.
The virus is so common that it’s estimated that at least 80% of the population will have a strain of HPV at some point in their life!
There are over 100 strains of HPV and most of them don’t cause any problems (many of them can just cause warts), but there are a few strains that are considered as “high risk”. Those HPV strains are the mean ones that put women at higher risk of getting cervical cancer, however, most women with these strains won’t get cervical cancer because their immune system will naturally fight against, and get rid of HPV using their immune system.
But not all women will fight off HPV, and that’s why it’s important that we attend our cervical smear test.
It takes years for HPV to develop into cancer if it does develop into cancer, which is why we have our smear test every three years.
Across the UK a new way of smear screening is being rolled out; instead of looking for abnormal cells first we now look for HPV first, and then look for abnormal cells using the same smear sample.
If these cells are found in a woman’s test she’ll then be given an appointment to be seen at a colposcopy clinic, where her cervix will be examined closely and biopsies may be taken in order to get a diagnosis of what the smear has picked up.
A cervical biopsy sounds pretty scary, but they’re actually tiny and usually just feel a bit like mild period cramps.
So here’s what it’s like having a smear test.
Pre-child smear test:
I have been on both sides of these experiences; I have assisted in countless smear clinics as a nurse, but my first experience of a smear was as a patient.
Around my 25th birthday in February 2013 I was invited for my first routine smear at my GP practice. I was of course nervous. I suffer from anxiety and my bits had only ever been seen by partners I knew and trusted, and the thought of the brush ‘scratching’ away at my cervix made my toes curl.
I was afraid it was going to hurt. But I knew the importance of it and I knew countless women who’d been for their smear tests and survived. So I booked my appointment for when I had a day off so I wasn’t rushing from or to anywhere, and tried not to think about it too much.
For the day of my appointment, I made sure I felt comfortable by showering and shaving everything from the neck down like I always did back then (I am now 31 and have a child… shaving is a rarity these days).
Please note – you do NOT need to shave your pubes or legs just for a smear test. We don’t care about, nor do we even notice, women’s body hair. We are only interested in the job at hand and how you’re feeling. That being said, if shaving makes you feel better and will encourage you to go for your smear then go ahead, but please don’t worry that the practitioner is going to care about body hair. Also washing isn’t compulsory and won’t affect the examination or sample taken at all, but most women feel more confident and comfortable if they do wash.
I made sure I’d been for a pee before my appointment.
If you begin your appointment and realise you need to have a wee while you’re whipping your knickers off, it’s OK to tell the nurse or doctor that you’re going to the toilet. We would rather you had an empty bladder and were comfortable.
I was seen by the practice nurse who, fortunately, was very friendly and talked everything through with me. I asked a few questions about the examination and how long the results would take to come back, and I also informed her that I was nervous.
If you’re nervous, tell them! There’s no shame in it and I promise you, you’re not alone. The practitioner will know to take extra steps to insert the speculum slower, in stages and to talk you through it.
Note: I am disappointed to hear that friendly practitioners aren’t always the case for many women but please, don’t let this be a reason for you not to go for your smear test. If you are unhappy to go ahead with the smear with a certain practitioner then you don’t have to – you can inform them that you’d feel more comfortable with someone else and speak to the receptionist. Also, you have the right to ask them to pause or stop at any point, to ask questions and to report unprofessional behaviour.
Once we’d spent a few minutes discussing the procedure and we’d both asked the questions we needed to, the nurse went to get a chaperone (a third-party is usually required when an intimate examination takes place with patient consent). I went behind the curtain to remove my clothing so that I was wearing nothing from the waist down. Well, apart from my socks. I wasn’t parting with those. I then lay on the examination couch and opened up the paper dignity sheet provided to cover me up.
The nurse asked if I was ready before entering and came in with the chaperone. She closed the curtain behind her for privacy. She then asked me to bend my knees up and drop them to the sides with the soles of my feet against each other. This position is great because not only is it hilarious, but it is used to give good access to the entrance to the vagina. She switched on an examination lamp and aimed it my vulva so she could see properly during the full procedure. Lucky lady.
She then told me to take deep breaths and to try and relax my pelvic muscles as she was about to insert the speculum. Easier said than done, but doable if you imagine you’re relaxing enough to have a wee and letting your bum sink into the bed.
It was a disposable plastic speculum that she had coated with some lubricating gel – gone are the days of freezing cold metal ones.
Once I was ready she gently inserted the speculum (a speculum is a bit like a small pair of tongs that are inserted closed and are opened up slightly once inside) which was absolutely fine. She then told me that it might feel like there is some pressure as she opened the speculum, which there was. It felt uncomfortable but it wasn’t painful, and the pressure feeling eased off after a few seconds. She then told me she was about to take the smear, which I didn’t feel very much. There was a slight poking sensation at surface of my cervix. It was over within 10 seconds and she took the speculum out right away. This was also painless.
She placed the sample in a pot and offered me some tissue to wipe the gel away before leaving me to get dressed behind the curtain.
And that was that. It was over from start to finish in around 3 minutes and I was absolutely fine.
I received my results in the post around 4 weeks later. Because this was a few years ago I was tested for abnormal cells first, so my results came back stating that I had CIN 2/moderate dyskaryosis (moderate degree of abnormal cells) and I needed to go for a colposcopy and then a LLETZ (large loop excision of transformation zone) procedure to treat the abnormal cells.
(I will be writing about these experiences as separate posts as I didn’t want to bundle them all in one big post).
Although all of that sounds terrifying, I was seriously glad that I went for my smear test. Had I have not, I could have had cervical cancer by now.
I had more speculum examinations during my investigations and treatments, and then another smear test after treatment which all felt ok. But I thought I’d briefly talk about my latest smear test which was after my son was born. A smear test should only take place 12 weeks after giving birth in order to get clear results.
It wasn’t much different, to be honest. I was really worried about it because I had two-second degree tears from giving birth to Archie, and although they healed very well they were painful for months after. Having sex was so painful and almost impossible sometimes, so I wondered how the hell they were going to get a speculum in there!
I climbed onto the bed and got into position whilst explaining that they may struggle to get the speculum in, but before I knew it the speculum was in and the smear test was done. It barely hurt and I didn’t feel much at all other than the slight pressure of the speculum opening up for a few seconds.
Those results came back as normal so I remained on the 3-yearly programme.
Smear tests from the perspective of a Gynaecology Nurse:
I am not trained to take smear tests but I assist as a nurse in colposcopy clinics, where smears are frequently taken. Colposcopy clinics are usually held all day every day.
It is very, very rare that we meet a woman who cannot tolerate having a smear test taken. When we do meet a woman who can’t tolerate it, they tend to be women who have other health concerns such as vaginismus (where the muscles of the vagina tighten involuntarily, usually at physical contact, making any kind of penetration into the vagina very painful or impossible), trauma or painful skin conditions of the vulva and/or vagina causing pain, or severe anxiety about any intimate contact due to PTSD (post-traumatic stress disorder), usually stemming from a woman having experience of sexual abuse and/or rape.
These women tend to be referred to us by their GP as they were unable to tolerate their smear test there, and in a gynaecology department, we have examination couches with stirrups which actually make it more comfortable for a woman to have a speculum examination. We also have Entonox (AKA gas and air), different sizes of speculums and are generally more trained to assist a woman who needs extra care and support during a smear test or colposcopy. Very rarely, the woman’s GP has prescribed pain relief or diazepam to relax them beforehand.
The actual procedure itself is no different – I would be the chaperone and also the assistant who passes the practitioner the equipment required, as well as supporting the woman. The practitioner chats to the woman first about why they’re there, what to expect and about any concerns about the procedure. The woman is invited to express that she is anxious and what she feels her requirements are.
The procedure then takes place using the equipment required – this can be a smaller or longer speculum, more time required to insert the speculum slowly or for entonox to be used. I usually talk the woman through controlled breathing and relaxation techniques if they are struggling with their smear test. The sample is sent off in the same way a GP practice would send it.
So there you have it. That was a long post about a minor thing, but I hope that it has shed some light on what is still a bit of a taboo subject, and has encouraged you to go and get that smear test to please ladies.
My fellow Blog Squad ladies are all up to date so make sure you are too 🙂
If you have any questions then please feel free to pop them in the comments at the bottom of this page and I’ll answer them as best I can.
Sarah K x
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