What to expect from NHS cervical screening

If you live in the UK and have a cervix, chances are you’ll either have already been invited to visit your GP for cervical screening (also known as a ‘smear test’), or you will be aware that you’ll be getting a letter once you reach the age of 25. It’s also likely that you will have at some point moaned about this procedure, or even put off making the appointment. I think you should never avoid a smear, but I do understand that it can be scary so I’m writing this post to share my own experiences and hopefully reassure you.

I last wrote to encourage my readers not to miss a smear appointment way back in 2011, after discussing my own experiences with abnormal results. Despite having been through another long cycle of abnormal results and treatment again recently, it was only when I saw blogger Sade mention on Twitter that she was going for her first appointment that I realised I had to write about it again, just so there’s more information out there. First things first though, I thought it would be useful to share this quote from the NHS Choices website as it’s something I didn’t know for a long time:

Cervical screening isn’t a test for cancer, it’s a test to check the health of the cells of the cervix. Most women’s* test results show that everything is normal, but for around 1 in 20 women the test shows some abnormal changes in the cells of the cervix. Most of these changes won’t lead to cervical cancer and the cells may go back to normal on their own. But in some cases, the abnormal cells need to be removed so they can’t become cancerous.

The main reason this routine health check is rarely discussed is probably down to the part of the body that’s involved, but thankfully people seem far less prudish these days. It’s far less ‘down there’ and much more ‘the entrance to the womb, at the top of the vagina’. The thought of letting someone you don’t know get a close look at it can be scary, but once you’ve been a few times you start to realise that it’s pretty mundane really. Healthcare professionals are here to look after you and there’s really no need to be embarrassed. As a 40-something who has experienced various parts of the screening in a few different areas of the country, I thought I’d share a bit about what to expect at each stage.

1) The ‘Smear’
This happens once every three years and is usually done by a nurse at your GP surgery, although I once had one done at a sexual health clinic in central London. The doctor was chatting away and asked when my next smear was due. I said I’d received a letter but hadn’t made the appointment, and she replied “I can do it now, if you like… while I’m down here.” That made me giggle, and being relaxed is exactly what you need for the screening. It’s not easy at first, and some medical professionals are better than others at putting patients at ease, but it should get easier when you know what to expect. As the nurse/doctor needs to get to your cervix, a speculum is used to keep the vagina open so that a soft brush can be used to collect cells that are then sent to the lab. Blood can obscure the results, so it’s best to book an appointment for when you’re not on your period. It only takes about five minutes, and there’s lots more useful information on the NHS website about what to expect.

  • Tip: Wear a loose dress/skirt, or clothing that it’s easy to remove the bottom half of.

2) The Colposcopy
You’ll get a letter about this if your smear results show any changes to the cells in the cervix that need a closer look. Most of the time, these changes go back to normal by themselves, but the NHS is lovely and keeps an eye on things for you just in case. A colposcopy appointment happens at your local hospital and it’s pretty much the same as a smear, although the doctor will also wipe your cervix with a liquid that helps abnormal cells to show up and will then take a look using something called a colposcope (don’t worry, this doesn’t go inside!). If you ever wanted to see what your cervix looks like up close, you can see what the doctor is viewing on a screen and they will explain what you’re seeing. This is not compulsory though. Sometimes the doctor will take a biopsy, which feels like a small pinch, but this will be explained to you if needed. You’ll usually get invited back in a year, to see if the changes have gone back to normal by themselves. In my lifetime, I think I’ve now had more colposcopy than smear appointments!

  • Tip: Try not to worry. Although this is in the hospital, it’s still just a heath check. I’ve had these done at three different hospitals and have had really lovely staff 99.99% of the time.

3) LLETZ Treatment
You may get a letter about this after a colposcopy and, if so, please don’t worry. I’ve had this done twice now and it’s a relatively minor procedure to remove abnormal cells – being invited for this treatment does not mean you have cancer. You’ll return to the colposcopy clinic at your local hospital, and the procedure is reasonably similar to having a biopsy, except the pinch you’ll feel is the local anaesthetic going in. If you’re not happy with a local, it can be done under general anaesthetic, so talk to the doctor beforehand. Once you’re numb, the doctor will use a thin heated wire loop to remove the abnormal cells. I had this done less than a month ago and didn’t feel a thing – the nurse and I were chatting about whether we were going to watch the fireworks and then, all of a sudden, the doctor said she was finished! There’s more information about treatment on the NHS website.

  • Tip: Take someone with you to the hospital, just in case you feel unwell following treatment. It’ll probably be no worse than mild period cramps, but good to have someone there to make sure you get home OK.

So, there you have it… the highlights of what I’ve learned from 18 years of GP and hospital visits. Hopefully it’s been helpful, but do share any other useful tips in the comments. The only other thing that’s perhaps worth mentioning is that the sexual health clinic who did my smear that one time was in a different NHS Trust area to where I live, and so the hospital I got referred to was a long way away (London is a big place)! Not really a problem when the results come back fine, but worth bearing in mind if you’ve got a history of visiting the colposcopy clinic.

*I know it’s not just women who will need cervical screening. Some trans men will too and, in addition to the NHS information, I’ve also found a helpful article by Mitch Kellaway.

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