Questions and Answers on Cervical Screening

This training session aimed to provide good quality information to staff and volunteers from our partner organisations supporting Turkish and Somali-speaking women. The take-up of cervical screening is lower amongst these groups.

Questions and Answers

Q. What is cervical cancer screening and why should I have it done?

Cervical screening is a free health test available on the NHS.  The screening test helps prevent cervical cancer by checking for a virus called high-risk HPV (human papillomavirus) and cervical cell changes. It is not a test for cancer, but it saves thousands of lives from cervical cancer each year in the UK. 

It is important to identify changes to cervical cells early, so they can be treated before they turn into cancer.  If everyone attended cervical screening regularly, 83% of cervical cancer deaths could be prevented. 

Q. What are the arrangements for women who are not married?

You can opt to have a screen even if you are not sexually active, this option is still available to you.

If you haven’t had sex, if you haven’t had a sexual partner, then you shouldn’t be at risk of getting HPV, and then developing cervical cancer.

You can call your GP surgery and say that you are not sexually active yet and ask them to please take you off the register for cervical screening. However, your GP may not tell the health authority, and you may get a letter inviting you to a screening anyway.

Most cases of cervical cancer are associated with 2 strains of the HPV virus. The HPV virus is carried by boys/men – if you have had a sexual partner (even if you haven’t had penetrative sex), you are at risk of getting HPV and developing cervical cancer.

Nowadays boys are vaccinated, so that should reduce the risk of spreading HPV.

Q. Can men be tested for HPV?

No

Q. Are there any benefits of getting cervical screening done before 25? For example, what if you get married before 25?

Cervical cancer is very slow at progressing.  If you get married before 25 and become sexually active then, then you should definitely attend your appointment when you are invited at 24 and a half. Young women should get their screening done at the age when they are due (from 24 and a half) – unless they have symptoms (bleeding in between periods and/or bleeding after intercourse)

They are not lowering the age for screening because HPV in women can disappear – the body gets rid of it; so we would be getting too many positives that can be rectified by the body. Also as it is a slow progressing cancer, we can keep an eye on it.

Q. Up to what age can women get vaccinated against HPV?

The age of vaccination for women goes up to 25.

Q. What is the process to carry out a smear test? And what happens after you have had one? How are you told of the results?

Cervical screening is usually carried out by a female nurse or doctor. If you want to make sure a woman carries out your test, you can ask for this when you make your appointment.

The test only takes 1 to 2 minutes. The whole appointment usually takes about 10 minutes.

Your nurse or doctor will ask you to undress from your waist down and lie on a bed with your knees bent apart. You will have a paper sheet or towel to cover your stomach and hips.

The nurse or doctor will put a device called a speculum into your vagina and open it gently. This allows them to see your cervix. The speculum is made of plastic and a new one is used for each screening test. The nurse or doctor will then use a small soft brush to take a sample of cells from your cervix. You may feel some slight discomfort, but this should go away quickly. If you feel any pain, tell the nurse or doctor and they will try to make it more comfortable for you. You can ask them to stop at any time.

Suggestion: you may prefer to wear a loose skirt or dress. If you wear a skirt or dress you will only need to remove your underwear.

Your appointment should be on a day when you are not having a period. If you don’t have periods, you can be screened at any time.

Do not use spermicide or oil-based lubricant for 24 hours before the test.

After your appointment, your cervical screening results should arrive by post within 4 weeks. They will be looking to see if you have the HPV virus first. You will then get sent a letter saying whether it was Negative (no HPV virus present) or Positive (HPV Virus was present).

If you don’t have the HPV virus – it doesn’t matter if you have abnormal cells – because they won’t lead to cervical cancer. There are over 200 different strains of HPV. Most cases of cervical cancer are associated with 2 strains.

If the result comes back positive for HPV, then they will check for presence of abnormal cells. This is done at the hospital (not at your surgery) through a colposcopy.

You will get the result of your colposcopy on the same day – they will tell you immediately whether your cells:

• Have remained normal
• or have changed (and are no longer normal), in which case you will need a biopsy. You will get the result in the post and/or a call from the colposcopy clinic inviting you to come in to discuss treatment.

Most people who actually have HPV don’t know about it – by the time they go back for their cervical screening the virus may have gone.

Q. Is HPV an STI (Sexually Transmitted Infection)?

HPV in terms of cervical cancer is not classed as an STI. You cannot go to a sexual health clinic to be tested for HPV for cervical cancer.  You will need to have a smear test and you will need to follow the national screening programme.

HPV is the virus that causes genital herpes and warts, also cold sores. As stated, there are over 200 strains.

Q. How accurate are the HPV tests?

Once you are 24.5 years old, if you come for a smear test it will be 99% correct, whether positive or negative. If you do a smear test when you are younger, the body changes a lot and you may have false positives (this means when the virus goes away by itself). Women can get HPV and then get rid of it without interventions. This is correct for 80% of women who have HPV.

Q. Are all nurses doing smear tests female?

No, most practice nurses are female but not all of them. We have a few practice nurses in Islington that are male. When you book your appointment your GP surgery should tell you if the practice nurse is male and give you the option of booking with a female nurse. If you turn up for your appointment and you find out that the nurse is male, you can leave – you don’t have to go ahead with your appointment.

Q. What about women when they have the menopause?

The menopause can pose challenges for some women who experience vaginal dryness. You can ask for lubrication and also for estrogen pessaries that can be taken before your cervical screening.

Q. What about women who have undergone FGM?

In some instances, if too closed, the nurse may not be able to do a screening; so the nurse will refer them to the hospital to get the screening done. Support is available for women around trauma (they can see a counsellor before they go for their screening).

Q. Are there any specialist clinics for women who have undergone Female Genital Mutilation?

Yes, there is an FGM clinic at Whittington Health called the African Well Woman Clinic. They provide advice on women’s health issues resulting from FGM.

Q. Will taking part in the cervical screening affect my virginity?

Some people worry that having a screening test before they have had sex may mean they are no longer a virgin. However, it is only having had sex that means someone is no longer a virgin. The procedure will break the hymen; but many women break their hymen by riding a bike/horse or taking part in sport/activities.

Q. I have had a bad experience in the past at my surgery and this has put me off from going back for another smear test. What can I do?

First, don’t let a bad experience in the past put you off from attending your smear test. You can request to your GP practice that they book you with another nurse.

• Alternatively, you can ask that they offer you an appointment through the Nurse Hub. The Nurse Hub is an additional nurse appointment service created to allow nurses to be trained. Your GP practice can book you a cervical screening appointment through the Nurse Hub. Clinics are available every weekday except Wednesdays.
• You can also book an appointment through the Islington iHUB Extended Hours service (weekdays 6 to 8 pm and Saturdays).

Q. I have a baby and I have no one to leave the baby with. What can I do?

Bring the baby to the screening appointment, and you can put the baby on your chest.

Q. I am pregnant and I have just received the letter for cervical screening. What should I do?

You shouldn’t have a smear test done when you are pregnant. You should wait three months after having given birth, had a miscarriage or a termination to attend your appointment for screening. This is because we need to wait for your cells to have regenerated after the pregnancy, miscarriage, or termination.

Q. I am HIV positive. What should I do?

If you are HIV+, then you need to have a smear test every year and, generally, this is done at the Sexual Health Clinic. This is because people with HIV+ have a weaker immune system.

Q. When is the best time for a woman to attend their smear test appointment?

As long as you are not having your period on the day of the appointment, it is fine (unless you are pregnant – see above).

Q. I have a problem with my knee and getting on/off the bed is difficult.

Many practices will have beds that can be raised and lowered; if not they may have steps to help you get on to the bed/come down. Please, tell the nurse about your requirements and whether you need help to get on/off the bed.

Q. I have heard that there have been pilots for home testing kits for cervical screening.

Yes, there was a pilot and there is further work being carried out by the Department of Health and NHS England, to understand how home testing kits can be offered at a larger scale. Once more information becomes available, it will be shared widely.