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Ask an expert: a gynaecologist answers your smear test questions

rachel-hines

Reviewed byDr Rachel Hines

causasian blonde woman in waiting room yellow wall and row of black chairs
Got your cervical screening coming up? We chat to gynaecologist Dr Rachel Hines about what to expect and why it really matters.

Summary

1Why do I need a smear test?​

Cervical screening, which used to be called a smear test, is a test to check the health of the cervix and help prevent cervical cancer...

2What is HPV and how contagious is it?​

“HPV (human papillomavirus) is the name of a very common group of viruses – there are lots of different types of it,”...

3I’ve never had sex, should I still have a smear

“Yes, it's sensible to do so – even though it's very unlikely to pick up any changes,” says Dr Hines...

Having a cervical screening – still frequently known as a smear test – can often unleash feelings of anxiety and a throw up a lot of questions, especially if it’s your first. What does it involve? Why do I need one? What if my vulva is weird? And what if my results aren’t normal?

Whatever you're worried about, we've got you covered thanks to Dr Rachel Hines, a GP specialising in women’s health and menopause.

Why do I need a smear test?​

Cervical screening, which used to be called a smear test, is a test to check the health of the cervix and help prevent cervical cancer. Since lots of people still easily understand the term ‘smear test’, we’ll use it sometimes here too.

Screening is offered to women and people with a cervix aged 25 to 64 in the UK.1 Although it helps to find any abnormalities before they can turn into cancer, it's not a test for cancer, it's a test to help prevent it.2

“When you have a smear test, it's looking for HPV as a human papilloma virus because over 99% of cervical cancers are caused by HPV,” explains Dr Hines. “So, when you have a cervical smear, it’s actually a HPV test that’s being done,” she continues. “It picks up signs of abnormalities and therefore should be preventing cervical cancer, hopefully.”

What is HPV and how contagious is it?​

“HPV (human papillomavirus) is the name of a very common group of viruses – there are lots of different types of it,” says Dr Hines. “Some are more likely to cause cell changes than others.”

HPV is passed on by sexual contact, it’s quite contagious. “It’s passed from person to another person quite easily,” says Dr Hines.

But it’s important to remember you don’t need to have penetrative sex to contract HPV. You can get HPV from:3
  • any skin-to-skin contact of the genital area
  • vaginal, anal or oral sex
  • sharing sex toys
There shouldn’t be any shame associated with HPV – as such a contagious disease, around 8 out of 10 people will be infected with HPV at some point in their lives.4 Your body may be able to fight off the infection with time, however HPV usually causes no symptoms and the only way to know is to keep attending cervical screenings.

I’ve never had sex, should I still have a smear test?​

“Yes, it's sensible to do so – even though it's very unlikely to pick up any changes,” says Dr Hines.

Dr Hines mentioned, “If you've never had sex, the chance of cervical cancer is much lower.”

Top view pile of colourful condoms

Does HPV mean I have an STI?​

Although it’s a sexually transmitted infection, having HPV doesn’t mean you have a STI.

“It can be difficult to sort of get your head around… HPV is a viral infection and it’s passed by sexual contact, but it's not a sexually transmitted infection like chlamydia or gonorrhea,” she says.
Unlike other STIs, Dr Hines continues “your body will clear HPV by itself.’

Most HPV infections don’t cause any problems and are cleared by your body within 2 years. Treatment is only needed if HPV causes problems like genital warts or changes to cells in the cervix.3

I’ve had the HPV vaccine, do I still need a smear test?​

Dr Hines response is very clear: “Yes, you do.”

“The HPV vaccination is brilliant and we're starting to really see a drop in numbers of cervical cancer cases, but you still need regular smears,” she says. “The HPV vaccine is given usually from the ages of 12 to 13 – in year eight of school – before you're sexually active,” she continues. 

“When the programme started, it was just given to girls, and they've since extended it to boys in the last couple of years.”

"This is brilliant because there's no point in vaccinating only half our population,” she says. “It prevents the spread further, which is really, really good!”

It's encouraged by the NHS that you do still have the vaccine when you're older if you haven’t already.5, 6 

What if the nurse thinks my vagina isn’t normal?​

"Everyone’s vaginas are different shapes and sizes, and that's really normal," says Dr Hines “It’s important to try not to worry about what you look like when you're being examined.” She continues: “As a nurse or a doctor, you examine so many people that you would never be looking, going: ‘Oh, that looks weird!’”. Phew.

“Of course, a nurse or doctor may notice certain things that you think need to be reviewed, like skin changes, growths or anything that could cause concern,” she says. “But not because of things like different shapes and sizes”.

Something they do keep an eye on are any changes that are causes for concern, such as conditions that can develop as we age. “So actually, it's a really nice opportunity for someone to perform an overall vaginal examination to see if there is anything different,” she says.

What happens during the smear test? ​

When you have the smear test, you'll be asked to remove your lower clothes and lay flat on your back with your knees bent up on the bed. “It's a quick procedure using something called a speculum, which is a plastic device that's put inside the vagina and then opened gently,” explains Dr Hines.
Liquid base cytology set on white background.
“Next, a brush that looks like a long stick with a little wand at the end is used. Your nurse or doctor will insert the speculum and open it up, then they’ll use the brush to take a sample from the cervix,” explains Dr Hines. The cervix is at the base of the womb and the entrance to the uterus. You may feel the brush twisting around a couple of times, collecting cells as a sample. 
After your nurse or doctor has finished taking the sample, they’ll take out the speculum and then you can get dressed (if you want to wear something fuss free, you’ll find some tips below).

Your sample then gets sent off and you should get the results within a couple of weeks.

What does a smear test feel like and will it hurt?​

There’s a big misconception that smear tests will hurt, but there's no reason why they should.

“It can feel odd, and it can feel uncomfortable, but it shouldn't be painful,” says Dr Hines. “It's a slightly odd sensation when you have it done, but if you do feel pain at any point, you need to tell whoever's doing the smear test. It's really important that you don't feel like you must just go along with it. If it's hurting, tell them to stop,” she adds.

Communicating about how you feel is the key to having a more comfortable cervical screening. If you’ve had a bad experience before, tell the nurse or doctor that’s doing the screening, so that they can allow plenty of time if you’re worried or anxious.

“There are different ways and techniques to make it not uncomfortable,” says Dr Hines. She also pointed out there are different sized speculums (because – you've guessed it – there are loads of different sizes and shapes of vaginas...). So, if it doesn’t feel like a good fit, they may try another one.

What happens if my results come back as abnormal?​

“If your results show HPV, then your cervical cells will be looked at for borderline changes and you may be called back for a repeat smear,” says Dr Hines. “If there are more advanced changes, then you might get sent an invitation for a colposcopy.” This looks more closely at the cervix and any changes. You’ll be monitored closely and may need to attend more appointments or begin treatment – it's important you attend any follow-up sessions.

Can I have a smear test on my period? And what about if I’m pregnant or just had sex?​

  • Cervical screenings and periods: “It’s best to wait until after your period, a few days after your period stops,” says Dr Hines.
  • Cervical screenings and pregnancy: “We don't normally perform cervical screenings in pregnancy, and you should be waiting until at least three months after having a baby because there might be changes in the cells,” she says.
  • Cervical screenings and sex: It’s also recommended that you don't have sex in the 24 hours before your test, as sperm, lubricant, and the chemicals used in barrier or spermicidal contraception, may affect the test results.7. 8

Is there anything I should or shouldn’t do to prepare for a smear test?​

Smear tests are performed every day, so Dr Hines says there’s no need to panic about it. Nevertheless, she has some top tips on how you could prepare for your smear.
Dr Rachel Hine’s top tips for your smear test:
  • give yourself plenty of time
  • go for a wee before to empty your bladder
  • take someone in with you if you’re feeling worried or anxious
  • breathe deeply and focus as you inhale and exhale
  • think about being elsewhere and concentrate on something in the room, like a picture
  • wear a skirt or dress so you can just pull it up and take your knickers off
She says you could also take a pad or liner with you, “in case you experience a bit of bleeding or spotting.”

The final say

Cervical screenings (smear tests) are a routine part of life with a vagina.

They may be a bit unsettling if you’ve never had one before, but it’s worth it when you consider their vital role in preventing cancer.

With Dr Rachel Hine’s knowledge and top tips, you can feel confident and ready for your next appointment. Want more ways to take care of yourself? Check out our healthy vagina tips.

Sources

  1. National Health Service. Overview - Cervical screening [Internet]. NHS. 2019. Available from: https://www.nhs.uk/conditions/cervical-screening/
  2. NHS. Why cervical screening is important [Internet]. nhs.uk. 2019. Available from: https://www.nhs.uk/conditions/cervical-screening/why-its-important/
  3. NHS. Human papillomavirus (HPV) [Internet]. NHS. 2022. Available from: https://www.nhs.uk/conditions/human-papilloma-virus-hpv/
  4. Cancer Research UK. Does HPV cause cancer? [Internet]. Cancer Research UK. CRUK; 2019. Available from: https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/infections-eg-hpv-and-cancer/does-hpv-cause-cancer
  5. NHS. HPV vaccine [Internet]. nhs.uk. 2024. Available from: https://www.nhs.uk/vaccinations/hpv-vaccine/
  6. NHS England» Thousands more young people urged to take up HPV vaccine to meet NHS cervical cancer elimination goal [Internet]. www.england.nhs.uk. [cited 2024 Jun 19]. Available from: https://www.england.nhs.uk/2024/01/thousands-more-young-people-urged-to-take-up-hpv-vaccine/#:~:text=We%20urge%20everyone%20who%20is
  7. Cervical Screening [Internet]. Women’s Health Concern. Women’s Health Concern; 2011 [cited 2024 Jun 19]. Available from: https://www.womens-health-concern.org/wp-content/uploads/2015/02/WHC_FS_CervicalScreening.pdf
  8. The Cedars - Cervical Screening Facts [Internet]. www.cedarssurgery.co.uk. Available from: https://www.cedarssurgery.co.uk/pages/Cervical-Screening-Facts
 

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