Cervical Screening (Smears)

Cervical screening helps prevent cancer by looking for certain types of human papillomavirus (HPV) that can cause changes to the cells on the cervix.

If these ‘high risk’ HPV types are not found your sample is not tested further.

If these ‘high risk’ HPV types are found your sample will be checked further, looking for changes in the cells of the cervix. If changes are found, these can be treated early so that cancer does not develop.

Cervical screening is important as it detects changes in the cervix before cancer develops, enabling early treatment.

All women registered with a GP are invited by letter to attend cervical screening:

• Every 3 years at ages 25 to 49
• Every 5 years at ages 50 to 64
• 65 or older – only 1 further test if 1 of last 3 tests were abnormal

Sometimes this interval is shortened if the doctors want to monitor you more closely for a while. This is as a precaution and most people will then go back to routine screening intervals.

You can book your appointment as soon as you receive your letter.

If you are concerned about having symptoms of cervical cancer do not wait for or book a cervical screening appointment, please make an appointment with your GP.

Symptoms of early cervical cancer may include:

• Bleeding between periods, during or after sexual intercourse, or bleeding after you have completed the menopause
• Vaginal discharge that is different to your usual discharge
• Pain in the lower back or pelvis

Vaginal bleeding is a very common symptom and has lots of causes, it does not necessarily mean that you have cervical cancer. However, unusual bleeding (bleeding outside of your usual pattern), does need to be discussed with and investigated by your GP.

HPV is the name given to a common group of viruses.

Most people come into contact with some type of HPV during their lives, from any kind of skin-to-skin contact of the genital area. It is therefore nothing to be embarrassed about.

In most cases your body will get rid of the HPV over time, but sometimes HPV can stay in your body for a long time. Some types of HPV (‘high risk’ types) are associated with causing cervical cancer. If a ‘high risk’ type stays for a long time, it can cause changes in the cells in your cervix, which if left untreated can become cancer.

If you don’t have a ‘high risk’ type of HPV it is very unlikely you will get cervical cancer, even if you had abnormal cell changes in your cervix before.

You are at risk of cervical cancer if you have a cervix and if you have had any kind of sexual contact with a man or a woman. This is because cervical cancers are caused by infection with ‘high risk’ types of HPV which are transmitted through:

• Vaginal, oral or anal sex
• Any skin-to-skin contact of the genital area
• Sharing of sex toys

You are still at risk of cervical cancer if:

• You have had the HPV vaccine – the Gardasil vaccine offered in the UK protects you against HPV types 6,11,16 and 18. Types 6 and 11 cause 90% of genital warts. Types 16 and 18 cause 70% of cervical cancers. However, there are approximately 40 types of HPV that affect the genital area, so although the vaccination helps it is still important to attend for screening.
• You have only had 1 sexual partner – you can get HPV the first time you are sexually active, and so even if you have only ever had one partner you still need screening.
• You have only 1 partner or have not had sex for a long time – you can have HPV for a long time without knowing it.
• You are lesbian or bisexual – any sexual contact puts you at risk.
• You are a trans man with a cervix – if you have a cervix, you should still attend for cervical screening, however, if you are registered at your surgery as male, you may not receive automatic invitations. It is therefore important for you to contact your GP and let them know that you still require screening.
• You had a partial hysterectomy that did not remove all of your cervix.

If you have never had any form of sexual contact, you may decide not to attend for a test when invited. However, you can still have a test if you want one.

Cervical screening is one of the best ways of protecting you from cervical cancer, but everyone has a choice whether to attend for screening or not. If you decide to opt out of screening you can ask your GP to remove you from the cervical screening list. If you change your mind in the future, you can ask to be put back on the list at any time.

Risks of screening

If abnormal cells are found and you need treatment, there are some risks, such as:

• It is possible that, if left untreated, the cells would have returned to normal by themselves
• Bleeding or infection from the treatment Rarely, you may be more likely to have a baby earlier should you get pregnant in the future.

Cervical screening can be booked through contacting your local GP surgery. You may also be able to book an appointment online.

Some local sexual health clinics offer a cervical screening clinic.

Cervical screening appointment usually take approximately 15 minutes.

Usually, you will be seen by a female nurse or doctor. She will check your details and explain what will happen during the test and answer any questions that you may have.

1. The nurse will ask you to undress below the waist and will give you a sheet to cover your lower half.
2. She will ask you to lie back with your legs bent, feet together and knees apart.
3. She will gently put a small plastic tube-shaped tool (speculum) inside the vagina, which may have a small amount of lubricant on it to make it more comfortable.
4. She will slowly open the speculum up to enable her to see your cervix.
5. She will then use a soft brush to take a small sample of cells from your cervix.
6. She will then gently close and remove the speculum and leave you to get dressed in private.

• It may make you feel more comfortable to wear loose / long clothing during the test such as a skirt.
• You can bring someone with you for support.
• Breathing exercises or listening to music may help.
• If you find the test uncomfortable let the nurse know and she may be able to change the size of the speculum or suggest changing position to one that is more comfortable for you.

It is important to remember that at all times you are in control and you can ask the nurse / doctor to pause or to stop. It is important to tell the nurse how you are feeling so that they can help support you.

You may get some light spotting / bleeding, this should go away after a few hours.

Contact your GP if you have heavy bleeding following a smear or bleeding that does not stop after a few hours.

You will get your results by a letter. It usually takes about 2 weeks to get your results. The letter will explain what happens next.

Most people receive a negative result. This means that HPV was not found in the sample. They will be asked to re-attend in 3-5 years (depending on their age).

If HPV was found, then your sample will have been examined further:

• If HPV was found but there are no abnormal cells, then you will be asked to have a repeat smear in 1year. If HPV is still present, you will be asked to have a further smear at year 2. If HPV is still present after 3 years, you may need a colposcopy (please see below).
• If HPV was found and abnormal cells were found, you will be asked to have a colposcopy (please see below).

A colposcopy is a similar procedure to having a smear test. It takes approximately 15-20 minutes but is usually carried out in a hospital clinic.

Like the smear test, a speculum will need to be used to enable the doctor to look at the cervix. A liquid is then painted onto the cervix and a microscope with a light is used to help the doctor see any abnormal areas (this does not touch or enter your body).

During the colposcopy you may have treatment to treat any areas that are obviously abnormal. The doctor may also decide that a biopsy is required (this may be a little uncomfortable).