Cervical screening
In this section you can find out about experiences of cervical screening by seeing and hearing people share their personal stories on film. Researchers travelled all...
Experiences of cervical screening
Cervical screening is not a test for cancer. It is a test to check the health of the cervix.
Cervical screening is a method of preventing cancer by detecting and treating cervical abnormalities which if left untreated, could lead to cancer in a person’s cervix (the neck of the womb). Cervical screening is also known as a smear test.
The first stage in cervical screening is taking a sample of cells from the cervix. This is taken using a method known as liquid based cytology (LBC). A doctor or nurse uses a small instrument called a speculum to gently hold open the vagina. A small brush-like device is then used to sweep around the cervix to take a sample of cells. The head of the brush, where the cells are lodged, is broken off into a small container of preservative fluid, or rinsed directly into the preservative fluid. The sample is then sent to the laboratory to be examined under a microscope by a specialist scientist (known as a cytologist), who is trained to identify abnormalities in the cells (for more information see the NHS Cancer Screening Programme’s leaflet ‘The Facts’).
HPV testing
Some types of the human papilloma virus (HPV) can cause abnormal cervical cells. HPV is a very common infection of the cervix.
There are more than 100 different types of HPV. Some types are high risk and some types are low risk. HPV-16 and HPV-18 are considered to be highest risk for cervical cancer. After successful trials, HPV testing has been incorporated into the NHS Cervical Screening Programme.
- If a sample taken during the cervical screening test shows low-grade or borderline cell abnormalities, the sample should automatically be tested for HPV. If HPV is found in your sample, you should be referred for a colposcopy for further investigation and, if necessary, treatment. If no HPV is found, you’ll carry on being routinely screened as normal.
- If your sample shows more significant cell changes, you’ll be referred for colposcopy without HPV testing. In some areas, a test for HPV is the first test on the screening sample. In these cases, the sample is only checked for abnormal cells if HPV is found. If HPV isn’t found, you’ll be offered a screening test again in 3 to 5 years (depending on your age). (NHS Choices 2015)
For more information see ‘Human papilloma virus (HPV)’ in our ‘Cervical abnormalities: CIN3 and CGIN‘ section or ‘Ideas about causes of cervical cancer’ in our ‘Cervical cancer‘ section.
We talked to women who had experienced cervical screening using the previous method (smearing the sample onto a microscope slide) and to women who had experienced cervical screening using liquid based cytology (see above).
Some women found cervical screening an easier procedure than others. Many of the women we interviewed considered the procedure to be only mildly uncomfortable. Some felt the procedure was an intrusion or they felt vulnerable, others found the procedure undignified and unpleasant. Despite these feelings many said it was important to attend for cervical screening to know that their cervix was healthy (see ‘Reasons for attending‘).
Tina describes her experience of having screening using liquid-based cytology.
The nurse told Paula that liquid-based cytology would provide a clearer test result.
Some women said they make their appointment for cervical screening in the morning after they have showered so that they feel fresh and confident. One woman said that being provided with a gown helped to maintain her modesty. Others said that they wore a skirt when they attended for a screening test which enabled them to partly cover themselves and to feel less exposed. Another tried not to think about the procedure too much which helped her to overcome feelings of embarrassment. Some found it helpful to remember that the person taking the test had experience of taking many cervical screening tests and they did not find it embarrassing.
She copes with any embarrassment by realising that doctors and nurses do cervical screening tests…
There are various information leaflets produced by the NHS Screening Programme and other organisations such as Jo’s Cervical Cancer Trust about cervical screening and follow-up (see ‘Resources‘). Leaflets about cervical screening were available at the surgery and were sometimes given to women by the practice nurse, or in other cases, were sent to women with the invitation letter for their screening test.
One young woman explained how she felt less anxious than she might have done about having her first screening test because the nurse had given her a leaflet beforehand and explained to her exactly what the test would involve. Women were often given opportunities during their cervical screening appointment to ask questions about the test. All women should now receive a leaflet with their invitation.
Some of the younger women were given an explanation of the test procedure and the instruments used. One woman explains how she found it helpful to be shown the speculum used to open the vagina during the test.
She found it useful to see the speculum used during cervical screening.
Some older women had been given explanations about the effect of the menopause on hormone levels, and how this can cause dryness and make it more difficult to insert the speculum or cause some bleeding. One woman explains how she was told by the nurse that getting sufficient cervical cells during cervical screening can sometimes be more difficult in women who had gone through the menopause. Liquid based cytology has reduced the number of inadequate test results and these days women are less likely to need to return for a second test.
Some women who had experienced the previous method of cervical screening (smear test) found the test mildly uncomfortable, but not painful. In some cases, women had found it painful when the nurse took the cells or needed to change the size of the speculum, or to readjust the position of the speculum to see the cervix properly. Women we interviewed who had experienced liquid-based cytology said they experienced less discomfort taking the cells, because the procedure is much quicker and a brush-like device is used to gently brush cells from the cervix, but the speculum size may still need to be altered or the position readjusted which can cause discomfort.
Sometimes women found it uncomfortable when the speculum was inserted in to their vagina. Women who find the procedure painful should tell the nurse or doctor straightaway as they may be able to reduce their discomfort.
Tina had no discomfort and did not need to return for a repeat test after liquid-based cytology.
Christine felt liquid-based cytology was a quicker procedure and much more comfortable.
Her cervical screening test was uncomfortable but not painful and she believes if you want to be sure you are…
She describes her experience of a painful test using the conventional method of cervical screening.
Women who had found it easier to relax were more likely to describe the test as slightly uncomfortable rather than painful. Some found that familiarity with the test, or having children, had made the test less unpleasant.
Many commented that although they had experienced embarrassment or painful screening tests in the past they considered it very important to attend for cervical screening.
Encourages others not to be put off by painful cervical screening test experiences.
Tests are usually performed by the practice nurse who is usually a woman but women can always request a female nurse if the practice nurse is male. Although women often said they prefer to have a woman undertake the test, some people had no preference and a few preferred a male doctor. Some said they preferred a doctor rather than a nurse perform the test. Others preferred a nurse because they felt more comfortable or they didn’t have to wait too long for an appointment. One woman who had a previous bad experience preferred to have her screening test undertaken by a doctor or nurse that she trusted.
Cathy prefers having screening with a nurse because she explains what she is doing and makes her…
While some women wanted to have cervical screening taken by someone they were familiar with, others felt that too much familiarity would increase their embarrassment. A practitioner who was sensitive, and provided time for explanation and information was important for many women in their decisions to return a second time for cervical screening.
Reasons for attending cervical screening
In England, Northern Ireland and Wales all women between the ages of 25 and 64 are eligible for a free cervical screening test every 3...