You’ve probably heard of cervical screening (sometimes called cervical smears, pap tests or pap smears). It is important that we (women) all get cervical smears regularly to reduce our risk of getting cervical cancer. Today we are going to talk about what cervical smears are, what you can expect when you go to your appointment, and hopefully, make it all a little bit less scary.
What is cervical screening/cervical smears?
Cervical screening (or a cervical smear test) is a test to check for “precancerous changes” on your cervix. The test is looking for abnormal cells that might turn into cancer in the future if they are not treated. This lets us treat things early and stop them from progressing into cancer. It is important to note that it is not a test for cancer, it is to try and prevent cancer.
What is the cervix?
The cervix is sometimes called the “neck of the womb”. It sits at the top of the vagina and opens into the uterus (womb). The cervix has two main jobs: 1) it allows sperm to pass into the uterus when you have sex and 2) it keeps the bacteria that live in the vagina (which is normal) out of the uterus.
Who should get cervical smears?
In the UK, everyone aged between 25-64 with a cervix should get regular cervical smears.
If you have had a hysterectomy (removal of the uterus/womb) AND THEY REMOVED YOUR CERVIX then you don’t need to have cervical smears. Sometimes the cervix is not removed though, so if you are not sure then ask your surgeon.
If you are a trans man and still have a cervix then you are still at risk of cervical cancer so should still have screening.
Why should I get cervical smears?
Cervical screening is always a choice. You are always able to decide you don’t want to but cervical smears are the best way to protect yourself from cervical cancer. If abnormal changes are found on your cervix then these can be treated BEFORE they turn into cancer.
Anyone with a cervix who has ever had any kind of sexual contact (with someone of any gender) is at risk of cervical cancer.
What is HPV?
HPV is the Human Papilloma Virus. There are many different types of HPV, some of which cause genital warts and others which cause cervical cancer (it can also cause cancers of the head/neck/throat/anus). HPV is thought to cause 99% of cervical cancer.
HPV is transmitted through having sex (or any skin-to-skin contact around the genital area) but it is not an infection that needs “treating” other than to monitor it and prevent it from causing cancer. It is not the same as sexually transmitted infections (STIs) like chlamydia and gonorrhoea, for example, that need to be treated quickly to prevent them from being passed on to other people.
Approximately 80% of people who have ever had sex have had HPV – it is VERY common. Most of the time our bodies will clear the infection on their own. Our immune system recognises the virus and gets rid of it. The problem comes if our body is not able to get rid of the virus and it stays in our cells for a long time. This is when it can start to cause changes that might turn into cancer one day.
HPV infection does not usually cause any symptoms which means that most of us do not know we have HPV unless we have a cervical smear to test for it. The cervical smear sample is tested for HPV, specifically looking for the “high risk” types. What different results mean will be explained below.
There is a vaccination available against HPV called Gardasil. It protects against 4 different types of HPV – the common ones that cause genital warts, as well as the high-risk ones for cancer. This vaccination is given as part of the routine vaccination schedule for boys and girls aged 12-13.
There are two doses of the vaccine which are given 6-24 months apart. You need to have both doses to make sure you are properly protected. If you are older than 15 when you have the vaccine you will need to have 3 doses.
If you missed the vaccine when you were at school it is still free through the NHS until your 25th birthday. The NHS website has more information.
Men should also be vaccinated against HPV. This is because they can pass HPV on to women through sex, but also there is increasing evidence that HPV causes other cancers such as head, neck, throat or anal cancers.
The HPV vaccine does not protect against other STIs. It is important to still get checked for STIs regularly or if you have any symptoms.
How do I make an appointment for my cervical smear?
If you are aged 25-64 in the UK and have a cervix you will get regular letters inviting you to have a cervical smear test.
Between the age of 25-49 it is recommended that we have smears every 3 years if everything is normal, and then every 5 years between the ages of 50-64.
Once you have received your letter you can book an appointment through your GP or a sexual health clinic.
It is important to avoid using any vaginal medications, creams or lubricants for 2 days before the appointment. These might affect the results which might mean the test has to be repeated.
Can you have a cervical smear test on your period?
You can, but it makes it more likely the result will be inaccurate.
- It is best to book in when you are not on your period
- Also, try to avoid the 2 days before or after your period
Can I get a cervical smear when pregnant?
Again, you can but it makes it harder to get clear results.
Usually, it is recommended that you wait at least 3 months after you give birth to have a cervical smear.
If you have previously had an abnormal result then your doctor might recommend you still have a smear while you are pregnant. This will not harm your baby or affect your pregnancy.
Things to ask when you are making your appointment
If you want a woman to do the smear test you can tell the practice this
- Most doctors and nurses who do cervical smears are female so the GP practice/sexual health clinic should be able to accommodate this request
You can have another person in the room with you if you wish. This person is called a chaperone and can be a support person (friend or family member) or another member of staff.
If you find the tests very uncomfortable you can always ask for them to use a smaller speculum (I’ll explain what that is in a minute).
What will happen at my appointment?
How long does a cervical smear test take?
The actual test only takes about 5 minutes
The whole appointment will be slightly longer though. This allows time to ask questions and to make sure you understand what is going to happen.
You will be asked to undress and take everything off from the waist down. They will give you a sheet to cover yourself with once you have undressed.
Tip: don’t wrap the sheet around you. Just sit/lie on the bed and place it over your lower body. Otherwise it gets all tangled around you and makes it difficult to get into the right position.
You will need to lie on your back on the bed. Usually you will need to lie with your legs bent, your feet together and your knees apart
- If you do yoga, it is like reclining bound angle pose (supta baddha konasana).
Sometime during the test if the nurse/doctor is having trouble finding your cervix they might ask you to put your fists underneath your pelvis or lie on your side instead. Everyone is different so sometimes your cervix might be a little tricky to find. That is ok.
The actual cervical smear test
The doctor/nurse will use a speculum (a plastic tube) to see your cervix. The speculum is placed inside the vagina and then opened slightly. This is sometimes uncomfortable, but it shouldn’t be painful – if it is painful you should tell the person doing the smear.
Tips: Take nice deep breaths (and pretend you are somewhere else). Try and relax the muscles around your hips and pelvis as much as you can. I know that sounds silly but the more you can relax, the more comfortable the whole procedure will be.
The nurse/doctor will take a sample of the cells from your cervix with a small brush. The nerves that supply your cervix aren’t like the ones in your skin which means that the feeling of something touching your cervix can be very strange. This is normal. The brush is soft and cannot damage your cervix. If it is PAINFUL you should tell the person doing your smear.
When they have the sample, the speculum will be taken out and you can get dressed again.
Note: It is important that you tell the doctor/nurse if you are nervous, uncomfortable or if you have any questions. If you don’t want them to continue for whatever reason you can always ask them to stop. You are in control.
This is what the speculum and the brush will look like:
Things that might make it easier if you are nervous
Bring a support person with you if you want to
Bring something to listen to or read as a distraction
What to expect after your cervical smear
It is normal to have some spotting or light bleeding after a smear test. It is also normal to have no bleeding. If you have bleeding it should stop within a few hours.
You might also have some brown discharge in the days following the smear test. This is just blood that didn’t come out immediately.
You might have some crampy discomfort in your belly immediately after the test but this should settle down quickly.
If you have heavy bleeding or bleeding that continues for more than a few hours then contact your GP.
What do my results mean?
You will get a letter with your results about 2 weeks after your smear test. Most people will get normal results so if it is taking a while try not to worry.
The letter will first tell you if high-risk HPV was found or not.
No HPV found
If not, you don’t need to do anything else and you should get your next smear test in 3 or 5 years (depending on your age). The risk of getting cervical cancer is VERY LOW if you do not have HPV.
If high-risk types of HPV were found on the smear then the laboratory will look at the cells for any signs of abnormal changes.
If there were no signs of abnormal changes then you will be asked to repeat the smear test in a year. This is to check that your body has cleared the HPV.
If there is high-risk HPV found AND signs of abnormal changes in the cells then you will be referred to colposcopy. This is where a doctor looks at your cervix under a microscope (using a speculum again) to look for areas that might need treatment.
Important: If you have HPV, this does not mean your partner has been having sex with someone else. You can have HPV even if you have been with the same person for a long time or even if you have not had sex for a long time.
If the results are unclear then you might need to have another smear in 3 months. This does not mean there is something wrong, sometimes the brush just doesn’t pick up enough cells or there is another reason the people in the lab can’t get a clear result.
The NHS website has more information about cervical screening.
Jo’s cervical cancer trust is also a great resource if you have more questions. They also have support for survivors of sexual violence to be able to cope with cervical screening.
What else do I need to know about cervical smears?
It is important to remember that cervical smears are screening tests. They are not looking for cancer, they are trying to prevent cancer.
If you have anything that is worrying you (e.g. pain, bleeding, unusual discharge), you should see a doctor. Don’t wait for your next cervical screening appointment.
Bleeding after sex, between your periods or after menopause always warrants getting checked out.
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