The smear test (or cervical screening) is a routine examination that is used to check for abnormal cell changes in your cervix. The smear test is not a cancer test, but it can help doctors to identify precancerous activity in your cells.
In some cases, the smear test is also used to check for HPV - a family of viruses that are known to change cellular DNA and trigger the development of cervical cancer.
According to the UK’s National Health Service (NHS), smear tests are one of the best ways to protect yourself from cervical cancer. Independent studies show that smear tests can significantly increase the recovery rate of cervical cancers, which means that attending a routine smear test could save your life.
However, figures published by the NHS show that 25-30% of women eligible to have smear tests do not attend smear test appointments because they are:
- embarrassed about their bodies
- frightened of finding out they have cancer
- unsure of what to expect from the screening process
To help you overcome any lingering doubts, this article will walk you through a standard smear test so that you know exactly what to expect on the day.
Why is the smear test important?
In the UK, approximately 3,200 women are diagnosed with cervical cancer every year. This means that eight or nine new cases are diagnosed every day.
Cervical cancer normally develops in the cells which line the surface of your cervix, but it can spread to your lymph nodes and surrounding tissues. Cervical cancer accounts for approximately 1% of all female deaths from cancer. Note that:
- cervical cancer is most common in sexually active women aged 35-44 years
- you may not develop symptoms until the cancer has reached an advanced stage
Cervical cancer can be treated if it is caught at an early stage, hence the importance of cervical screening (or smear tests), where a small sample of cells is gathered from the cervix and examined for signs of precancerous or cancerous activity.
According to research published by the NHS, routine screening for cervical cancer can help to prevent a significant proportion of cervical cancers. And the rate of cervical cancer has fallen since cervical screening tests were first introduced to the UK.
If you are a woman between 25-64 years of age, a routine smear test may be an important way of protecting yourself from cervical cancer.
If you think you are due for a smear test or you’re not sure whether you should have had one, contact your doctor. You can find out if you are due for an exam, and if so, book you in for an appointment.
What happens during a routine smear test?
In the UK, women are invited to attend their first smear test appointment when they turn 25. If you have never had a smear test before, you may find that you are nervous about attending, or unsure of what to expect during your appointment.
Most smear tests take less than five minutes. Your nurse will ask you to go behind a curtain and undress from the waist down. You will then be given a sheet to put over your body, and you will be asked to lie down with your legs bent - feet together and knees apart.
At this point, your nurse will gently insert a speculum (a medical tool) into your vagina using a small amount of lubricant. The speculum will then be opened so that the nurse can see your cervix, and a soft brush will be inserted through the speculum and onto the cervix. The brush will be rotated several times to gather a small sample of cells, and then withdrawn.
After your cell sample has been collected, it will be put into a small specimen pot containing a liquid. You will then be left alone to get dressed.
What about the results?
The results from your smear test will be sent to you in the mail. The NHS tries to send smear test results two or three weeks after your screening. It can sometimes take a little longer, so try not to worry if your results do not show up straight away.
94% of women receive a negative result, which means that no abnormal cells were detected. If you get a negative result, you won’t need to take any further action until your next routine smear test unless other findings, such as an infection, were noted.
Approximately 2% of women receive an ‘inconclusive’ result, which means that the cell sample taken during your smear test couldn’t be analysed properly. This does not necessarily mean there’s anything wrong, but you will have to return for another test.
If you receive an abnormal result, some cell changes were detected. An abnormal result does not always mean that you have cancer.
Your letter should provide detailed information about your next steps, and you can always call your doctor if you would like to discuss your results.
A study carried out by Jo's Cervical Cancer Trust found a significant number of women skip their smear test appointments because they are anxious, embarrassed about being examined, or frightened of the screening process.
These feelings are normal, but there are things you can do to alleviate them. If you have been avoiding your smear test, read this section and then contact your doctor to book an appointment.
Coping with fear
It is perfectly normal to feel frightened or anxious about attending your smear test. Medical exams can be intimidating and a lot of people feel fear at the prospect of being poked and prodded in their most intimate areas.
However, the smear test will be carried out by a health professional who has been trained to perform this procedure. The process may cause a small amount of discomfort, but serious pain is unusual.
Remember: the screening process is normally over in less than five minutes you will be in control of the entire screening process.
You are in control of your smear test, so if it hurts at any point, simply ask your health practitioner to stop.They may be able to adjust their technique, switch to a smaller speculum, use some more lubricant to ease the pain, or help you to relax.
Try deep breathing exercises to combat anxiety. Deep breathing can help you to relax, particularly if you practice them before and during your smear test. Relaxation techniques like deep breathing may also help to improve your experience of having a smear test.
According to the survey published by Jo’s Trust, 35% of women say they would avoid a smear test because they feel embarrassed about the shape of their body, self-conscious about the appearance of their vulva, or concerned about smelling ‘normal’.
These concerns are understandable, but the health professional carrying out the smear test will not pay any attention to your appearance, and they are not likely to remember what your body looked like after the exam is over. Also know that:
- the majority of sample takers are female nurses who understand what it is like to expose the most intimate part of their body to a complete stranger
- you are welcome to take a friend or relative with you
- you will be given a modesty sheet
- you can talk to the health professional about your concerns, and they will do their best to create a comfortable environment
Everyone’s vagina looks different, so there is no reason to be embarrassed about yours. There is also no reason to feel like you have to shave or wax before a smear test. Cervical screening exams are designed to help prevent cancer, and your health professional will be focused on:
- making sure you feel comfortable
- maintaining your dignity
- obtaining a good sample
For additional help or reassurance, contact Jo’s Cervical Cancer Trust. This UK charity offers phone support for women during and after cervical screenings. They also operate a forum where you can read stories from other women, or chat to people who are suffering with similar issues. If you identify as LGBTQ+, you will find helpful support and advice for cervical screening on the LGBT Foundation’s cervical screening page.
Dealing with anxiety about smear test results
It is natural to be fearful of getting a positive result from your smear test, but remember:
- 94% of smear tests give a negative result, which means that no precancerous activity was found
- taking a smear test significantly improves your chances of surviving cervical cancer, particularly if precancerous activity is caught early and treated in good time.
Routine screening is thought to help prevent cervical cancers. Skipping smear test appointments is associated with a decrease in the likelihood of a full recovery, so if you are concerned about cervical cancer, it is always better to attend your cervical screening appointments.
Find further information on the cervical screening test.