Have no fear, get your smear

For many people of childbearing age, the mere mention of the dreaded ‘cervical smear’ is enough to keep our knickers on and bums off of the examination table. Some people worry they’ll be judged for skipping a wax appointment, others fear an uncomfortable experience (which can be particularly difficult for victims of sexual assault). I, admittedly, was one of those people – until I finally worked up the courage to get the smear that may have saved my life.

When I received my invitation for cervical screening in the mail nearly two years ago, I (regrettably) tossed it straight into the bin. My mind whirled with excuses: “A few more months won’t hurt,” “I’m too busy to worry about this,” even “I don’t need one anyway,” but I knew I was allowing my anxiety to drown out the voice inside me that cried, “cervical screening is important!”

Letters from the NHS continued to pile up in my mailbox – they’d be opened with trembling hands, tossed in the bin and forgotten. This pattern continued for years, until my concerned friends and family convinced me to make an appointment with my doctor. And so, reluctantly, I called my local GP surgery and booked my very first NHS smear.

On the morning of my smear, I woke with a start, and I was so nervous about my smear that I couldn’t even stomach a piece of toast or swipe on a bit of lip gloss. When I arrived at the surgery, I was told to sit in the waiting area for what felt like hours until a smiling nurse practitioner (NP) called my name. I stood, feeling dizzy, and asked for a glass of water. The NP placed a hand on my back and said, “Oh dear, you’re as white as a ghost. You must be nervous – this is normal. I’ll fetch you a glass of water.”

The NP continued to calm me. She asked me to lie back, relax and describe my favourite holiday destination (Kyoto, Japan was my destination of choice). She assured me that she had performed “hundreds, if not thousands” of smears, and that she would use the smallest speculum she had on hand. After insertion of the speculum and swabbing for no more than three seconds, just like that my smear was done, and it was infinitely more comfortable than I’d imagined. I scolded myself for waiting so long – cervical smears, in my (newly formed) opinion, are easy!

As I awaited the result of my smear, my anxiety grew once more. When the results letter finally arrived, my heart leaped out of my chest. The envelope was thick, and I knew this meant I should expect a less-than-perfect result. The letter explained that my smear was “abnormal with high grade cell changes” – I was devastated, but my devastation was soon replaced by relief that I had attended my smear when I did, before my situation worsened. As recommended in the letter, I immediately attended my colposcopy, a procedure carried out in hospital to examine the cervix more closely, and take a biopsy of the abnormal tissue.

When I received my biopsy results, my doctor applauded me for attending my smear before waiting any longer – I now had CIN 3, the highest level of cellular abnormality in the cervix before the cells can become cancerous. Although this result is far from ideal, I was able to have the abnormal cervical tissue surgically removed. The doctor explained that if I’d waited much longer, my body could have gone on to develop the big C, and that I’d need to be diligent about attending my cervical screening appointments in the future.

Needless to say, I felt like I’d dodged a bullet, and I’m pleased to report that my abnormal cells haven’t returned. That cervical smear I attended almost a year ago could, quite literally, be the reason I’m still here to tell my story. So, the next time you open your mailbox only to find your cervical screening invitation, take a deep breath and book your smear. I wish I had booked mine sooner – and you still can.

After I essentially became an ‘expert’ at being on the receiving end of cervical screening, I found that educating myself, talking it out, and a bit of self-care went a long way in making cervical screening (and cervical biopsies/surgeries, for that matter) more comfortable. Here’s what I learned:

Why is cervical screening performed?

Cervical screening is performed to check for the presence of HPV (human papillomavirus) and any abnormal changes in your cervical cells. HPV is sexually transmitted, and as the virus is exceedingly common, the number of people with HPV continues to climb. HPV doesn’t typically lead to precancerous or cancerous changes in men, but these changes are relatively common in people with cervixes. It’s important to monitor these changes in order to prevent them from getting worse or turning into cancer. Attending cervical screening is the best way to keep your reproductive system healthy and help prevent cervical cancer.

What happens during a cervical screening?

At your cervical screening appointment, a small sample will be taken from your cervix (the tissue that connects the vagina to the uterus). The test will usually be performed by an experienced female nurse or doctor and the whole appointment will typically take no longer than 10 minutes. You’ll be asked to undress from the waist down and wear a gown, and you’ll then lie back on the examination table, bend your knees and part them slightly. The nurse will insert a small, lubricated speculum into your vagina in order to see you cervix. Once the cervix is visible, the nurse will swab your cervix for a few seconds to collect a cell sample. The speculum will then be removed, you’ll get dressed and you’ll be free to resume your day!

What can I do to make my experience more comfortable?

I’m not going to lie to you – cervical screening isn’t exactly ‘comfortable’ per se, but these few hacks helped me get through my last few cervical procedures:

• Talk it out. Not only does talking to a friend or family member about your fears help ease some anxiety, it also holds you accountable and makes it harder for you to skip your test.
• Wear comfortable, loose-fitting clothing. I like wearing cosy jumpers in winter and maxi dresses in the summer (all you have to do is remove your pants and lift your skirt, no undressing required!).
• Ask for a female practitioner. The NHS will typically provide you with a female practitioner, but if you have a strong preference be sure to mention this when booking your appointment.
• Tell the practitioner you’re nervous. Telling the practitioner I was nervous removed a gargantuan weight from my shoulders, and it led her to give me a bit of TLC with a glass of water, smaller speculum and distraction techniques.
• Ask your practitioner to use a small speculum. Depending on the position of your cervix, your practitioner might be able to use a small speculum (the device used to open the vagina) during your procedure.
• Pop in some headphones and listen to music. Distraction is key – listen to your favourite song and your smear will be finished before you make it to the chorus.
• Try belly breathing. Belly breathing (also known as diaphragmatic breathing) has an immediate calming effect. Try engaging the lower portion of your belly, inhale deeply, and exhale slowly and completely.
• Treat yourself. Give yourself a pat on the back and reward yourself for looking after your reproductive health.

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