Recent statistics from the NHS show that fewer than 7 in 10 eligible women had their cervical smear test in the last year, with this being the lowest level in a decade. This worrying stat got us thinking…what are the concerns women are having that may put them off booking that all-important screening. Pain? Embarrassment? Fear? Whatever it may be, we’re here to get to the root of your misconceptions by putting our readers’ questions to Gynaecological surgeon, Dr John Butler, in partnership with The Lady Garden Foundation.

The Lady Garden Foundation is a national women’s health charity, that raises awareness and funding for gynaecological health. Since 2014, they’ve been funding groundbreaking research into the treatment of cervical cancers at The Royal Marsden NHS Foundation Trust.

How often should you have a cervical smear?

It is recommended that cervical screening is performed every three years from the ages of 25 to 49 and every five years from ages 50 to 64. If a test is abnormal, the follow-ups will be different.

How painful is the insertion of the speculum and is there anything that makes the procedure less painful?

It is usually very well tolerated and it’s important to talk to your healthcare provider about any concerns you may have as well as any past experiences. There are different sizes of speculums (the instruments we use to see the cervix) and it can be helpful to know which size you find most comfortable.  If women are menopausal, a course of vaginal estrogen treatment can make a big difference to the comfort and efficacy of the examination.

Aside from cervical cancer, what else can a screening find?

It’s not a test for cervical cancer but HPV, this is a virus that may lead to cancer. HPV can also cause other conditions such as warts and sometimes infections like candida or thrush.

Will a cervical screening be more painful if you’ve not been sexually active before? Is it relevant to have one if you’re not sexually active?

Cervical screenings are recommended to all women, regardless of whether they are sexually active. For those who have not been sexually active, screening can be conducted safely with minimal discomfort.

What is the most common age (group) to get cervical cancer? Is it pre or post menopause for instance? 

The highest incidence of cervical cancer is in pre-menopausal women aged 30 to 34.

Do you think women should be more proactive in getting a smear test done privately, earlier than the current NHS recommends which is 25?

The NHS provides free cervical screening for women aged 25 to 65. However, some women may choose to have the extra reassurance of more frequent screening through going private. These additional screenings may help prevent cancer but may also cause unnecessary concern. This is particularly the case for women under 25 where HPV is common. This HPV often clears up on it’s own by the age of the first NHS screen at 25.

Do you stop having cervical screenings after a certain age?

Yes, aged 65

Does a positive HPV test mean you have cancer?

No this is a test for a virus that can cause pre-cancerous changes of the cervix (CIN). Only for a small number of women may this develop into cervical cancer if not treated.

How likely are you to get a false negative?

Modern HPV tests are very unlikely to give false negative results. In fact, it is less than 1% if the sample is correctly taken.

If you have a positive HPV result followed by a negative result does this mean the virus is still in your system but dormant or has it completely cleared?

This is good news! However, dormant HPV could reactivate or reinfect, therefore it is important to still attend your cervical screening.

What should women expect from a colposcopy?

This is a very routine examination that is usually no more uncomfortable than a cervical screening. It involves using a magnifying camera (a colposcope) and a special stain to see if there are any areas of the cervix or vagina that require a biopsy or removal.

I had a bad experience with my 1st cervical screening and found it very painful, is there any advice you can give?

I am sorry to hear this. There are usually lots of things we can do to make things more comfortable, do speak to the team performing the test and let them know what was painful as it may be that a smaller speculum, inserting the speculum yourself, being examined on a gynaecology chair, or taking painkillers before can make this easier.

I’ve been asked to go in for a biopsy, I’ve heard it’s quite painful. Is there anything that can be done to minimise discomfort?

The biopsy is usually part of a colposcopy this is usually no more uncomfortable than a screening test, some women feel no pain and for some there may be tenderness and cramping during or after the biopsy. It’s worthwhile having some simple painkillers such as paracetamol or ibuprofen to hand if you have discomfort.

How does cervical screening work when you have a prolapse?

It is usually unaffected by prolapse if the cervix can still be well visualised.