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What actually happens during a smear test? A doctor answers our questions

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Sarah Biddlecombe
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Although the NHS’ cervical screening programme was put on hold at the beginning of the coronavirus pandemic, services in England are now beginning to reopen with safety procedures in place. If you’re worried about booking your smear test, we’ve pulled together everything you need to know – and asked a doctor to answer some of our most common questions.

When the coronavirus pandemic first hit the UK in March, cervical screening programmes across Scotland, Wales and Northern Ireland were paused, while in England, many GP practices greatly reduced or completely stopped their appointments.

Let’s be honest: having a smear test probably doesn’t rank very highly on your list of favourite activities (and you probably haven’t realised smear tests haven’t been taking place unless you’ve had an appointment cancelled or changed). But as screenings across England begin to be offered again (plans to restart screenings are underway in Scotland, Wales and Northern Ireland), it’s important that we don’t let our fears – both of coronavirus and of the procedure itself – stop us from booking these all important tests. 

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Cervical screening (which is offered for free on the NHS to all women over the age of 25) is the best protection against cervical cancer. A smear test detects cell changes which, if untreated, could go on to develop into cancer. As such, this awkward, five-minute procedure is estimated to save around 5,000 lives a year in the UK, making it a more-than-important item on our to-do list.

But new statistics from Jo’s Cervical Cancer Trust have revealed many of us might put off our tests for fears of the coronavirus. The research, which was released to mark Cervical Screening Awareness Week, found that while 40% of women would feel relieved to be able to go to a smear test appointment, around one in eight women (12%) say they feel less likely to attend than before the Covid-19 pandemic. Similar numbers (13%) think it is best to put off going for cervical screening for the time being. 

Low cervical screening attendance was already a concern before the pandemic (in 2018, screening rates were at their lowest for two decades), so the idea that the coronavirus pandemic could make this worse is worrying. 

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To take some of the worry away from this often feared procedure, we’ve collated this guide to everything you need to know about going for and having a smear test – and asked an experienced doctor some of the most commonly asked questions. So whether you’ve had numerous smear tests before or are booking in your first one, here’s everything you need to know.

Smear tests: what has changed during the coronavirus pandemic?

A face mask
Smear tests: at your appointment, doctors and nurses will be wearing PPE.

Although the test itself will be the same as before the pandemic (more on that below), the GP surgery will have safety measures in place to keep you and the health workers safe. According to Jo’s Cervical Cancer Trust, changes you should expect include: “your nurse or doctor wearing personal protective equipment (PPE) and being asked to follow certain instructions, such as waiting outside until it’s time for your appointment or using a particular door”.

If you live in England, you should now be able to book an appointment with your GP surgery, but if you live in Wales, Northern Ireland or Scotland, you won’t be able to do this just yet.

For more information on attending smear test appointments during the pandemic, including what to do if you’re shielding and whether you can bring someone along to attend the test, you can check out Jo’s Cervical Cancer Trust’s ‘How It Works Now’ guide. 

Smear tests: the facts

Smear tests:
Smear tests: an example of the cervix brush used during a smear test.

Cervical screening isn’t a test for cancer: rather, it tests the health of the cells in the cervix. 

Around 3,000 women are diagnosed with cervical cancer in the UK every year, and the condition is most common in sexually active women aged 30 to 45. However, it is possible for women of any age to develop cervical cancer.

All women who are over the age of 25 and registered with a GP will be invited to have a cervical screening test. This will happen via a letter containing all the information needed to book a test. The screening will usually be performed by a practice nurse, and you can request a female or male nurse.

The frequency of screening depends on your age:

• aged 25 to 49 – invited for a test every three years

• aged 50 to 64 – invited for a test every five years

• over 65 – only women who haven’t been screened since age 50 or those who have recently had abnormal tests are invited for a test

Most women will have “normal” results from the screening, while around one in 20 will be told they have “abnormal changes” in the cells of their cervix. 

When asked if we should worry about “abnormal changes”, Dr Vanessa Mackay, spokesperson for the Royal College of Obstetricians and Gynaecologists (RCOG), tells Stylist, “An abnormal test result does not mean a woman has or will get cancer, it just means some of the cells are abnormal. The cells may go back to normal on their own, however, in some cases the abnormal cells need to be removed so they don’t become cancerous.”

The NHS recommends that you book your appointment for the middle of your menstrual cycle, around 14 days after the start of your last period, to get the best sample of cells possible.

It also recommends that you should avoid using barrier methods of contraception (such as a condom or diaphragm) or spermicide or lubricant jelly, in the 24 hours before you take the test.

Smear tests: what happens during cervical screening?

The screening will take around five minutes to perform, and you will need to remove the clothes on the lower half of your body, including your underwear.

You will then lie down on the couch and the procedure will take place. Dr Mackay describes this as follows: “During the test the doctor or nurse will gently put a lubricated speculum into the vagina so the cervix can be seen. A small soft brush will then be used to gently collect some cells from the surface of the cervix.”

When asked whether the screening might be painful, Dr Mackay adds, “Some women may find the procedure a bit uncomfortable or embarrassing, but for most it’s not painful. If a woman does experience pain, she should tell the doctor or nurse who may be able to reduce her discomfort. Being tense also makes the test more difficult to carry out, so women are advised to try to relax as much as possible by taking slow, deep breaths.”

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After the screening, the cell sample is sent for analysis, and you should be told the results within two weeks.

The procedure now also incorporates HPV (human papilloma virus) testing, which the NHS describes as the following:

“Changes in the cells of the cervix are often caused by the human papilloma virus (HPV). 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 the highest risk for cervical cancer.

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 (a simple test to look at the cervix, the lower part of the womb) 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 a 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).”

This piece was originally published in June 2018 and has been updated throughout

If you have any more questions about smear tests, or would like to do some further research, you can head to the NHS information page here or browse the facts compiled by British charity Jo’s Cervical Cancer Trust here.

For more information about cervical cancer, including the symptoms and treatment, head to the NHS information page here.

Images: Getty, iStock, Jodi Jakobson

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Sarah Biddlecombe

Sarah Biddlecombe is an award-winning journalist and Digital Commissioning Editor at Stylist. Follow her on Twitter

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