Smear tests: 19 common questions answered by a female doctor
Why exactly are smear tests SO important? Do I need one? Will it hurt? Can I request a female doctor? These and more of your questions answered by Dr Philippa Kaye...
As part of Cervical Cancer Prevention Week (21-27 Jan 2019), we thought we would ask our favourite GP, Dr Philippa Kaye (read more about Philippa on her dedicated website) to answer some of your common questions and fears about smear tests as well as to give us a comprehensive answer on what the results actually mean.
If you've not had one yet (or if you have but aren't sure how soon to go for your next one after having a baby) there are probably a few questions floating around that you're not sure who to ask.
Hopefully - we've got them all covered here. If not, let us know in the comments below or on Facebook and we'll do our best to ask Dr Philippa and find an answer for you.
1. Why are smear tests so important?
Smear tests, or cervical screening tests are part of a screening programme which aims to pick up changes in your cervix before they turn into cervical cancer.
The test itself doesn’t tell you if you have cancer, rather it detects abnormal cells in the cervix which could cause a problem later on if left untreated.
The reason smear tests are so vital is that, if abnormal cells are found, there are treatments available before they cause a problem.
2. At what age should you go for a smear test and how often should you have one?
Women in the UK are currently invited to attend cervical screening on the NHS between the ages of 25 and 65.
If you are registered with an NHS GP you will receive a letter inviting you to attend for a smear every 3 years between the ages of 25 and 49 and then every 5 years between the age of 50 and 64, and only after the age of 65 if you've recently had an abnormal test.
It is possible that the age of the screening programme will be increased to up to age 75 in the future. If you get the letter before you turn 25, you can book your appointment as long as you will be 25 within the next 6 months.
3. How do I book a smear test/where should I have it?
Once you receive your letter in the post simply ring your GP surgery and say you are due for your smear test. They will then offer you an appointment, generally with a nurse.
2. Can I request that a female doctor/nurse does it?
You can request a female carries out the test. A surgery cannot guarantee this, but will generally try to accommodate the request.
3. Should I have a shower before I get a smear test?
Up to you! You don’t have to, there is no medical reason that you should. Showering or not showering will not affect the test in any way. If it makes you feel better, though, then go ahead.
4. Can I have sex the night before / will that affect the results?
You can have sex the night before the test, it won’t affect the results. However, if you generally use spermicide or lubricants during sex then please avoid these in the previous 24 hours as they can affect the test.
5. How long does a smear test take?
You are likely to be given a 10-15 minute appointment with the nurse, but the test itself only takes a few minutes. Most of the rest of the appointment is filled with you getting dressed and undressed and filling in the relevant forms!
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6. What actually happens at a smear test?
You will be asked to go behind a curtain or screen and take off your lower clothes and knickers and then lie down on the couch on your back.
You then bend your knees and bring your heels up towards your bottom before letting your knees flop apart.
The healthcare professional then uses a plastic speculum to hold back the sides of the vagina so they can see your cervix.
A small brush is then used to collect a sample of cells from the cervix which are then placed in a pot filled with liquid. The speculum is removed and you are all done.
7. Does it hurt?
Some people say that the speculum feels like a sort of stretching discomfort, others feel that the part where the brush is used to take the sample of cells from the cervix brings on a momentary 'period pain' type of pain.
However, many women say that there is no discomfort at all. Focus on keeping your bottom down on the bed and breathing slowly to stop you tensing up and it is over in about a minute or two.
8. Should I go for a smear when I’m pregnant / what if I had one then found out I was pregnant - is it dangerous?
It is recommended that you don’t have your routine, screening smear test when you are pregnant, though if you do later find out you were pregnant it is unlikely to have caused any harm.
However, if you are being recalled for a smear test because you have had a previous abnormal smear, or treatment then you should still attend.
The best time for this is generally between 3 and 6 months of pregnancy: just let your medical team know you are pregnant, it isn’t always obvious!
9. Can I have a smear test if I'm on my period?
It is better to avoid having your smear test when you are on your period as a large amount of blood in the sample can affect the test. However, if you bleed very irregularly, or are spotting, a small amount of blood may be ok.
10. Will a smear test make me bleed?
The test itself doesn’t generally cause bleeding. However if your cervix is friable, slightly soft and more prone to bleeding, or if you have a cervical ectropion (a benign condition in which cells of the cervix have moved slightly, often caused by the contraceptive pill) the brush can cause a bit of bleeding.
So you may notice a blood stained discharge for a day or so. However the test should not cause significant bleeding.
11. How soon after having a baby should I get a smear test?
For routine cervical screening you should wait 3 months after the baby is born to have your smear test. If, however, you are being called early because of a previously abnormal result or treatment, then please attend at the appropriate time, just let the medical team know.
12. Can I go for a smear test if I’m breastfeeding?
Yes, please do.
13. What do the results of my smear test mean?
Most people will have a normal result, generally received within about 2 weeks after the test by post. It simply says that no abnormalities were found and that you will be recalled at the appropriate time.
About 1 in 20 people will receive a result which is abnormal, and this can range from an inadequate sample (not enough cells collected), to interpret the result, the letter will tell you when you will next be recalled.
An abnormal result may also show borderline or low grade changes, now these changes are very small, and close to normal and may return to normal on their own.
Depending on where you live in the UK currently you will either be asked to return for another test after an appropriate interval or your sample may have been tested for high risk HPV (human papilloma virus).
If HPV has been seen you will be invited to attend colposcopy (see below), but if you were HPV negative you will go back to the routine, normal screening programme.
Alternatively, an abnormal result may be moderate/severe, or high grade changes, if this is the case you will be invited for colposcopy.
However during the course of 2019, all areas will be moving to first test the sample for high risk HPV. The process of taking the test will be the same but you will get one of the following results.
- HPV unavailable – result not able to be given, generally you will be recalled after 3 months.
- HPV negative – if you are found to be high risk HPV negative the sample won’t be tested further as there is no need to look at the cells as it is highly unlikely you will have any changes, or will develop changes. You will be recalled in the normal screening programme.
- HPV positive or found but inadequate – HPV has been found but not enough cells to read the sample properly – here you will be recalled after three months.
- HPV found but no cell changes found – HPV infection is common and your body’s immune system often gets rid of it on its own. You will be recalled after 1 year to check it has gone. If you have 3 positive HPV results but no cell changes are found you will be invited to colposcopy.
- HPV and cell changes - you will be invited to attend colposcopy.
I know it seems complicated and is a change from what is currently done but primary HPV testing is actually more accurate!
14. If my smear test is abnormal - what does it mean and what should I do next?
Depending on what the abnormality is you will be recalled as per the above information or will be invited to colposcopy.
Colpsocopy is carried out at your local hospital and involves sitting on a bed, generally with your legs in stirrups so the doctor can have a closer look at your cervix using a special microscope called a colposcope.
Just as with a smear test, the speculum is inserted and then the doctor looks through the colposcope at the cervix. Various solutions such as iodine are applied to the cervix to check the cells.
15. I am embarrassed about how I look and smell down there - what should I do?
Please don’t be embarrassed - your practice nurse or doctor will have carried out hundreds if not thousands of smear tests and therefore will have seen many many sets of genitals.
They all look slightly different, and as health professionals, it makes absolutely no difference to the test if you have shaved or waxed or anything, we are simply focused on carrying out the test.
We aren’t embarrassed, which hopefully will help you be less embarrassed.
16. I have been sexually assaulted, I just can’t go through with it. Do I have to have one?
Of course we understand that in some situations, the idea of having a smear can trigger all sorts of emotions and reactions and that it may be particularly hard if you have been assaulted.
Please talk to your medical team so that they can give you extra time to allow you be as comfortable as possible, and of course you can have someone with you if you feel more comfortable doing so.
17. I have only ever had same-sex intercourse, do I still need to have a smear?
Yes you do, if you have been sexually active at all and by this we mean anal, vaginal or oral sex, sharing sex toys, or genital touching then you could have got the HPV virus and therefore need screening.
Only if you have never had any form of sexual contact can you not attend screening.
18. What is human papilloma virus?
Human papilloma virus (HPV) is an extremely common virus of which there are many subtypes, some cause warts or verrucas and others genital warts.
Four out of 5 of us will contract at least one type of HPV at some point in our lives and our immune systems are generally good at getting rid of the virus.
There are 13 high risk types of HPV, two of which types 16 and 18 cause 70% of cervical cancers, though the body’s immune system can still clear even these higher risk viruses.
The move towards HPV testing in cervical screening will make screening more accurate. Smoking cigarettes makes the body’s immune system less able to clear the virus, so increases your risk of developing cervical cancer.
19. I have had the HPV vaccine, will I still need screening for cervical cancer?
Yes you will. The vaccine protects against some but not all of the high risk viruses which cause cervical cancer so there is still a risk.
No vaccine is 100% effective so you will still need to attend. However the combination of the HPV vaccine and attending regular screening will decrease the number of people diagnosed with cervical cancer. Due to this combination it could be a preventable condition.
Dr Philippa Kaye practises in London and is Jo's Cervical Cancer Trust's GP Ambassador. She has written several books on pregnancy and childcare including The First Five Years. Take a look at her website and follow her on twitter @drphilippakaye
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