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 woman'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').
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 three to five 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.
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...
Right well to start with obviously it's not a pleasant experience but its something that should be done to save any further problems which could occur. And also I can understand why some women are embarrassed but the way I dealt with it was I just cast aside the embarrassing part of it because at the end of the day these, it's a job to these doctors, they're doing their job and after all it's, it's your health you've got to think of, not so much how the doctor, from the doctor's point of view because I mean it's a job to him, he sees thousands of women and it's just a procedure to him. And without this doctor you're taking a risk really.
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.
I remember one of my very first smear tests, I think it was about my second one I hadn't really paid attention the first time round, I was just deeply embarrassed and uncomfortable the first time I had a cervical smear and around the second time I went or the third whoever it was that was giving me the smear test actually showed me the speculum. And I remember looking at it and thinking it's like a double shoe horn or something, it's quite a remarkable piece of instrumentation. And actually seeing it did make a difference for me because I understood really what it was doing. It was opening up the walls so that a proper scraping could be taken and it did actually help to see it and I don't know why they can't make them out of plastic but, but it did help to see.
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.
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...
If I could say anything to encourage a woman to go and have their first cervical smear it would be that it would be a compromising situation, put your legs up there and think of something else just for a couple of minutes. It's slightly uncomfortable, there's a metal instrument that is inserted in you, it's merely to keep your vagina open but that it's necessary so that the test can be done. And it's uncomfortable but it doesn't really hurt and so it's just one of those things that if you want to be sure you're well you've just got to do it.
She describes her experience of a painful test using the conventional method of cervical screening.
The last time I had one done, very nice the nurse, it's nothing to do with the nurse herself but she had a great difficulty in inserting the instrument, so much so that I was left for quite a, well it seemed like ages but I'm sure it was only a minute or two. And she said "Well I haven't quite got it right but I want to do it, get it right because I don't want it to have to come back and say you've got to go and have another one done. So she did insert it higher and it was an awful, very, very painful experience for me, very painful. And I should say the most painful one I've had done. And, anyway when it was finished she said "Well I hope I've taken enough," and then it wasn't that long afterwards, probably only 2 or 3 weeks afterwards I got a letter back from the hospital saying that there wasn't enough cells taken would I make an appointment to have another one done. Meanwhile after having the one done with the nurse I bled for about 2 to 3 days afterwards. Again an experience I've never had before when I've had them done. I have to say that I don't find them pleasant, I normally find them painful but nothing like this last one or I don't normally bleed afterwards because I've finished my periods now.
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.
It just I think pulls you up short to say "Well you're, no one is really that safe," and how important whatever your experience of having a smear test done, how important it is to go and have them done and get over that fear, you've got to get over that fear if it's, because you're only going to be worried if it's, supposing one comes back you might have thought to yourself if I'd have gone a year earlier may be that wouldn't have happened to me. So I think whatever the experiences women do need to say, explain the circumstances to your doctor, your clinic, wherever you're going if you've had a bad experience and just be reassured before you have the next one done that they are looking at you when you're telling them and that they're really taking it on board but don't let it stop you going to have one done because it's just not worth it, the worry just is not worth it. I've seen her go through it and it's, and she had regular ones. Nobody is exempt, I realise that but I think my advice to other women who've gone through a bad experience is don't let it put you off because you just don't want to be in a position of a result coming back just because you may have delayed it and you could have stopped it.
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 women 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.
Last reviewed October 2015.
Last updated October 2015.