Your smear test questions answered
For a lot of women, being summoned for a smear test for the first time won’t give them any worries at all, and they will dutifully book an appointment at their health centre and head off to the screening, taking it all in their stride. For others, however, receiving such a letter might fill them with concern. There is, of course, plenty of information available about the benefits of cervical screening, but little explaining what actually happens before, during, and after the procedure. Some women put off having the test indefinitely, for a variety of reasons — some complicated, others less so. Ultimately, however, the reason that the NHS offers cervical screening to all women aged 25 and over is that it can save lives, so when given the opportunity it is best just to go for it.
We asked doctors about common concerns to help put your mind at rest and make your first smear test as stress-free an experience as possible.
What is the test for?
“A smear test, also known as ‘cervical screening’, is a test to help prevent cervical cancer,” says Dr. Lizzie Tuckey from Bupa UK. “Some people think this is a test for cancer — it’s not. The test actually checks for changes to the cells of your cervix (the neck of your womb) and is designed to pick up any abnormalities. If these are left untreated, they can develop into cervical cancer over time. So catching and treating any changes early can help stop this happening.”
She points out that during the early stages of cervical cancer you don’t tend to experience any symptoms, which is why attending your smear is so important as tests can help detect anything unusual as early as possible.
Dr. Pandelis Athanasias, a consultant gynaecologist and obstetrician at London Women’s Centre, adds that a smear test can also detect cancer itself. “That’s not why we do it though,” he says. “We do it to prevent cancer, as by detecting changes to the cells early we can follow them up and treat it before it leads to cancer.”
What age do I need to go and get a smear test and how will I know when to go?
“You should have your first cervical screening test when you’re 25,” says Dr. Tuckey. “After this you’ll be screened every three years until you reach 49. You will then be offered screening every five years until you’re 64.”
Typically, you will receive a letter from your GP surgery when you turn 25 inviting you to make an appointment for a smear test. “This will include the details of the place you need to contact for the appointment,” says Dr. Tuckey. “You can alternatively find lots of information about cervical screening on the internet. If you’re nervous, you should ring up your local GP surgery and explain how you’re feeling. They can offer advice and help reassure you before your first.”
Can I go for my smear test when I’m on my period?
Dr. Tuckey advises that you should make your appointment for a time when you’re not on your period. “The best time is halfway between one period and the next,” she says. “This is because it gives the best chance of a good sample as if you’re bleeding at the time of the test it might make the sample unclear.” If the sample is unclear you may need to come back to the clinic and have the test done again.
Dr. Tuckey adds that it is best to avoid having sex using lubricating jelly, or a barrier method of contraception, like a condom, for 24 hours before the screening, as the chemicals in these can sometimes affect the test.
However, Dr. Athanasias adds that while the above was true for the older cervical smear tests, with newer tests they don’t seem to be affected by periods. “The modern one, which is a liquid based thin layer preparation, is shown not to be affected by periods. There is no study about sexual intercourse, and how long before having the smear you should avoid it.”
Obviously, however, you should follow the advice given in the letter you get before your smear test, which may stipulate the best time in your cycle to arrange the test. If you have any concerns, then you can always call your surgery for clarification.
I’m scared about what to expect. What will actually happen during my appointment?
Dr Tuckey says it’s perfectly normal to feel nervous before your first smear test, so there’s no need to worry. “You’ll have the test at your local GP clinic and a healthcare professional that’s trained in cervical screening will do your test,” she adds. After a discussion with the person doing the smear, in which you will be asked some general questions about your health, and be talked through the process that will follow, you will then have to undress from the waist down and lie with your legs supported and apart.
“You might feel more comfortable wearing clothes that you can change out of easily,” says Dr. Tuckey. “The healthcare professional will then use a device called a speculum to gently hold open your vagina so they can see your cervix. Using a small brush, they will take a sample of the cells in your cervix and then send them to the laboratory for testing.” Once they have the sample, the speculum is removed, and that’s that. You will receive the results in the post a few weeks later.
I’m worried about having the speculum put in – will it hurt?
“It isn’t so much the smear test itself that women say hurts,” says Dr. Athanasias, “but rather having the speculum put in can be uncomfortable for some women.” Because of this, he advises that the smallest possible speculum that allows the health practitioner to see the cervix is the best one to use. “Another way to help with discomfort can be to use some anaesthetic gel on the speculum,” he adds.
Dr. Tuckey advises that women breathe normally and relax, as although the test can be uncomfortable, it doesn’t normally hurt. “Make sure you let your nurse or GP know at the time if it is painful, because they might be able to reduce your discomfort,” she says.
I’m worried it will be too invasive and I’m scared about showing my vulva to the nurse — what if it’s not normal?
“It’s completely normal to feel embarrassed and apprehensive about having a smear test, particularly as it’s an intimate procedure,” says Dr. Tuckey. “It’s important to remember that this test is designed to prevent you from getting ill, and it’s there for your benefit. The procedure itself only usually lasts a few minutes and in many cases will be over before you know it, and you won’t need another one for three years.” She advises chatting to your friends or family if you’re worried, and mention to the person carrying out the test that you’re worried as they can reassure you and make you feel more comfortable.
“As for looking normal, it’s important to remember that in most cases it will be normal,” she adds. “Every vagina is different, so no two will ever really look the same. If you are worried it’s not ‘normal’ you should speak to your GP.”
Dr. Athanasias adds that it is important to see the test as an opportunity for a health practitioner to assess your overall health and perhaps answer any other queries you may have about your gynaecological health. “I know younger women particularly can be quite shy when they go to have a smear test,” he says. However, he says that many women who come for their smear actually feel they have the opportunity to mention any other concerns they have, which they haven’t gone to the doctor about because they don’t want to be examined.
“During the smear test it is actually an advantage that the person doing the test has to inspect your vulva and vagina,” he says. “By doing that you can rule out any other conditions, and that’s an additional benefit.”
Why aren’t smear tests offered to people younger than 25?
Different countries have different age policies, so what exactly is the rationale of starting at 25? “It has obviously been the source of a lot of discussion and controversy,” says Dr. Athanasias. “However, if you do smear tests when someone is younger than 25, there is a higher chance that you will detect low grade abnormalities. Most of these will disappear on their own in the vast majority of patients, so by not testing before the age of 25 you avoid unnecessary colposcopies and examinations.”
The counter-argument to this though, Dr. Athanasias adds, is that the age people are becoming sexually active has changed in the last 40 years. Cervical cancer is caused by infection with the HPV virus which is often passed on through sex, so if someone is sexually active at 14 or 15, and the smear test is at age 25, there is a risk that a woman may be infected by high risk HPV, and the virus will have had 10 years to act on the cervix and cause changes.
However, Dr. Tuckey points out that cervical cancer is still extremely rare in women under the age of 25, and now girls are offered a vaccine before they are sexually active to help protect them from HPV.
If you do develop any symptoms before the age of 25 that may indicate cervical cancer you should go straight to your doctor.
Are there any symptoms of cervical cancer that I should be aware of?
“It’s common that you won’t have any symptoms in the early stages of cervical cancer,” says Dr. Tuckey. “But if you’re experiencing symptoms such as pain in your pelvis or back, pain during sex, abnormal bleeding or vaginal discharge that has blood in it you should contact your GP as soon as possible. If you’re having unusually heavy periods it’s important to get this checked out too. These symptoms might not always be caused by cervical cancer, but you should speak to your GP anyway.”
“What I will always say,” adds Dr. Athanasias, “Is that if you do develop any symptoms before the age of 25 that can indicate or suspect cervical cancer, you should go straight to your doctor. So what are those symptoms? Post-coital bleeding is one, so any bleeding during or straight after intercourse. If anyone under the age of 25 develops post coital bleeding they should be seen and be examined either by their doctor or a gynaecologist.”