A-Z

Cervical Screening

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.
 

diagram of the cervix

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 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. 

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.

Tina describes her experience of having screening using liquid-based cytology.

Age at interview: 41
Sex: Female
SHOW TEXT VERSION
PRINT TRANSCRIPT
The actual sort of facts of getting undressed and things like that are a bit awkward, because it’s a quite tiny room and there’s no curtain and things like that. But she was very good, she sort of left me in there to sort myself out and gave me something to cover my lower half over and get comfortable, and then sort of knocked and came back in. So that was, at least your dignity is sort of there. The actual procedure, well, the actual speculum they use feels quite cold to touch. They’ve obviously lubricated it with something beforehand, so the actual insertion and things like that is not too bad. As much as they tell you to relax, it’s still quite difficult to relax. But they need you to be as relaxed and spread really, spread your legs as much as possible. And then the actual procedure itself, it has normally hurt in the past. I’ve normally felt some discomfort, not pain, but discomfort. And I have previously had to go back. But this occasion it was absolutely no problems whatsoever, no discomfort at all, and a clear sample taken. And it’s all done and dusted within two minutes of being in there. And then the nurse allows you time to get dressed etc, in private again. And then that’s it, and she explains when the results are going to be back and how to ring and get them and whether you’ll be written to and things like that.
 
The procedure itself I think is absolutely fine. I don’t think there’s anything that they need to warn you about as long as it’s not your first smear. They need to definitely tell you what they’re going to be doing on your first one. It would have been nice to know that it was a different procedure I suppose than the previous one. But knowing what the difference is between the two, it’s minute anyway. So, but the fact that, about the dignity side, I think that’s the big thing, is to make sure that you are left to disrobe and put your clothes back on in private, and that they give you something to put over your lower half. So at least you’ve got some sort of dignity, because it’s a very personal procedure. So I think the dignity is the main thing really.
 

The nurse told Paula that liquid-based cytology would provide a clearer test result.

The nurse told Paula that liquid-based cytology would provide a clearer test result.

Age at interview: 32
Sex: Female
Age at diagnosis: 31
SHOW TEXT VERSION
PRINT TRANSCRIPT
When I had my, just my first general smear it was just the conventional smear with the glass and the spatula. When I went back to the colposcopy clinic it was the liquid based one and I didn’t notice any difference. It didn’t feel any different at all. The only time I realised there was anything different was when she actually popped the thing in the liquid rather than putting it on the slide. So as far as feeling it is concerned it didn’t feel any different. But I did ask the nurse why it was different and she just said, “Actually it makes it much, much clearer to read the tests.” And she said, “Especially in my case with me have the CGIN cells. It would be really good for them to get a good clear indication, a good clear smear test result from it.”

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...

She copes with any embarrassment by realising that doctors and nurses do cervical screening tests...

Age at interview: 34
Sex: Female
Age at diagnosis: 34
SHOW TEXT VERSION
PRINT TRANSCRIPT

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.

She found it useful to see the speculum used during cervical screening.

Age at interview: 31
Sex: Female
Age at diagnosis: 31
SHOW TEXT VERSION
PRINT TRANSCRIPT

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.

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.

Tina had no discomfort and did not need to return for a repeat test after liquid-based cytology.

Age at interview: 41
Sex: Female
SHOW TEXT VERSION
PRINT TRANSCRIPT
I have had inadequate ones before, quite a number of them previously. But this time absolutely no problems at all. Inadequate ones, you just have to go through the procedure again. So it’s no hassle. It just means that they haven’t taken enough sample or it was, you know, there was some slight contamination or whatever. So you just have another one.
 
And this time you had liquid-based cytology compared to traditional smears in the past? And you didn’t have to go back this time?
 
No. So I think that was possibly why the actual discomfort maybe wasn’t there, because it’s a slightly different method. And also the fact that obviously having a normal result meant that maybe they got the sample. It was a better method for me because the sample was taken, I didn’t get discomfort and the sample seemed to be enough and it came back normal. So I would say it’s a successful procedure really.
 

Christine felt liquid-based cytology was a quicker procedure and much more comfortable.

Text only
Read below

Christine felt liquid-based cytology was a quicker procedure and much more comfortable.

Age at interview: 57
Sex: Female
HIDE TEXT
PRINT TRANSCRIPT
And with it being liquid-based cytology, did you actually notice anything different when they were doing the smear?
 
It’s a lot quicker, a lot more comfortable. I think it’s just a lot quicker. You’re not messing about with getting things sterilised and then putting it on to those little [slides], because that’s where sometimes the error is made isn’t it? There’s not enough of that put onto the slide and then you’ve got to put it into them little plastic containers which are, yeah it was very fiddly wasn’t it that?
 
And what did they do? Did you see that what they did?
 
It’s a little pot and they actually take the smear and then take the head off and put it into the liquid pot. The whole pot is sent away, sealed so nobody can get into it. And it’s done straightaway. As soon as they’ve taken it, that’s the first thing they do is put it into that pot.
 
 

Her cervical screening test was uncomfortable but not painful and she believes if you want to be sure you are...

Her cervical screening test was uncomfortable but not painful and she believes if you want to be sure you are...

Age at interview: 31
Sex: Female
Age at diagnosis: 31
SHOW TEXT VERSION
PRINT TRANSCRIPT

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.

Text only
Read below

She describes her experience of a painful test using the conventional method of cervical screening.

Age at interview: 53
Sex: Female
HIDE TEXT
PRINT TRANSCRIPT

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.

Encourages others not to be put off by painful cervical screening test experiences.

Age at interview: 53
Sex: Female
SHOW TEXT VERSION
PRINT TRANSCRIPT

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...

Cathy prefers having screening with a nurse because she explains what she is doing and makes her...

Age at interview: 43
Sex: Female
SHOW TEXT VERSION
PRINT TRANSCRIPT
Personally I think it’s easier to have a smear done with a nurse rather than one of the doctors. We do have female doctors, but it’s not very easy to get appointments with them. I feel more comfortable with a nurse. And they always tell you what they’re going to do and explain. But once you’ve had one you know what to expect anyway. So they do try and set you at your ease. And as I said before we’ve talked about all sorts of thing while she’s taking the test just to kind of keep it relaxed.

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.

Donate to healthtalk.org

Last reviewed October 2015.

Last updated October 2015.

donate
Previous Page
Next Page