Remove the Doubt
Cervical screening, also known as a smear test, is a free service offered by the NHS that helps to prevent cervical cancer.
Who is it for?
Cervical screening is for anyone with a cervix between the ages of 25 to 64 years old. This may include cisgender women, transgender men, non-binary people registered female at birth, and some people with an intersex variation.
If you are not sure if you have a cervix, speak to your GP.
What does it do?
Cervical screening checks the vagina for high-risk human papillomavirus (HPV). If the test shows that you do have high-risk HPV, the lab will also check to see if you have any abnormal cell changes on your cervix. It is not a test for cancer.
What is a cervix?
The cervix is the lower, narrow part of the uterus (womb) that forms a canal between the uterus and the vagina.
What is HPV?
Human papillomavirus (HPV) is a very common virus.
It is estimated that around 80% of us will have HPV at some point in our lifetime. For most people, the infection is able to naturally resolve and the body clears the virus. However, there are some cases when this does not happen, leading to increased risk of certain cancers.
Certain types of HPV that we call ‘high-risk’ are associated with various cancer types including head and neck, anal, vaginal, vulval, cervical and penile cancers.
Do I need to be screened?
It is your choice whether or not to attend cervical screening.
Is it effective?
It is estimated that cervical screening prevents 70% of cervical cancer deaths, but 83% of deaths could be prevented if everyone who needed screening attended regularly.
When will I be invited?
If you are between the ages of 25 and 64 and are registered as female with your GP, you will be automatically invited to your cervical screening appointment.
If you are registered as male with your GP you will not automatically be invited for cervical screening. You will need to contact your GP, local sexual health service, or a trans specific clinic to request an appointment. Some of these clinics may have a method to invite you the next time you need screening, but at the moment not all clinics provide this service.
What happens during the
When you arrive at the appointment you will be asked to remove your clothing from your waist down. You’ll be able to do this behind a screen and will be given a sheet to put over you.
The doctor or nurse will ask you to lie back on a bed, usually with your legs bent, feet together and knees apart. Sometimes you may need to change position during the test, such as putting your fists under bottom, to make the cervix easier to see.
A smooth, tube-shaped tool called a speculum will be gently inserted into the vagina with a small amount of lubricant.
The doctor or nurse will then open the speculum so they can see the cervix.
Using a soft brush, they will take a sample of cells from the cervix.
Once the cells have been collected, the doctor or nurse will close and remove the speculum and leave you to get dressed.
The doctor or nurse may give a tissue to wipe the lubricant off yourself but if they do not, you can ask for one if you need it.
How often do I need to be screened?
This will depend on the results of your last appointment and where you live in the UK.
In England, Scotland, and Wales your sample undergoes something we call ‘HPV primary screening’. This means that a lab will test your sample for high-risk HPV first. If high-risk HPV is found then the sample will be looked at for any cell changes. This system is due to be adopted by Northern Ireland in the near future.
In England and Northern Ireland cervical screening is offered every 3 years after a person has tested negative for HPV. For those between the ages of 50 and 64, screening is offered every 5 years.
In Scotland and Wales, the test is offered every 5 years after a person has tested negative for HPV.
You may be asked to come back within 3 months to have the test again if the result is unclear. This is known as an “inadequate result”. This doesn’t mean anything is wrong but means there wasn’t a good enough sample taken during your screening appointment.
If you do test positive for high-risk HPV, you may be invited to return every year until the HPV clears.
If you have a high-risk HPV positive result and changes are found in the cells on your cervix, you will be referred to colposcopy for more tests.
What is colposcopy?
Colposcopy is a test that takes a closer look at your cervix using a lighted, magnifying instrument called a colposcope. This is done because cell changes can turn into cervical cancer if left untreated.
The procedure will usually take place at a colposcopy unit at a local hospital or clinic. For the 24 hours before your colposcopy, you should not have penetrative vaginal sex or use any products that you place inside the vagina, such as tampons, vaginal creams or medicines.
During the procedure, a speculum is gently placed into the vagina and opened. The colposcope is then used to look at the cervix in greater detail. The colposcope stays outside your body. The doctor or nurse will put liquids on the cervix that help them see any abnormal cervical cells.
They may also take a small sample of cells for testing. This is called a biopsy.
There may be some minor bleeding after the colposcopy, so it’s a good idea to bring a sanitary pad to the appointment. If this type of product has the potential to trigger any dysphoria, you could use a male incontinence pad.
If you have a coil (IUD, or Mirena coil) it does not usually need to be taken out, but you should tell the person doing the colposcopy that you have one.
Are there any tips for attending an appointment?
Call the clinic
Call the clinic ahead of your appointment to discuss how to make it a better experience
If you are nervous, ask for a double appointment so you have enough time to ask any questions you may have
Ask to bring a friend, partner, or family member with you to your appointment
Let them know which name and pronouns you would like to use for the appointment
Ask to be seen at the beginning or end of a clinic to avoid long stays in the waiting room
Discuss the potential to use topical oestrogen gels before the appointment if you are afraid of pain due to dryness from testosterone use or the menopause
Waiting room displays
If you are anxious about your name appearing on a waiting room display screen, ask them to call you in without using the display
Let the person taking the sample know if you are taking testosterone and if this has affected menstruation. This helps the accuracy of the test.
Ask your GP about pain relief or a medication that can relax you before the test
Ask for a smaller speculum to be used during the procedure
You're in control
Ask if you can insert the speculum yourself
Ask about the amount of lubrication being used
Tell the GP or nurse if the test feels too uncomfortable or if you are in pain
Asking to stop
Remember that you can stop the procedure at any time if you need to
Ask your GP to remind you when you’re next due for a smear test if you do not receive automatic invitations
Tell the person carrying out the screening the language you would like them to use when referring to your body
What if I have been vaccinated?
The HPV vaccine Gardasil is given to protect people from certain types of high-risk HPV that are linked to the development of some cancers. Gardasil can also prevent genital warts.
Children aged 12 to 13 years (who were born after 1st September 2006) are offered the HPV vaccine as part of the NHS vaccination programme.
Gardasil does not have any effect in individuals who already have a persistent infection or disease associated with the HPV types covered by the vaccine. However, because Gardasil offers protection against multiple strains, an infected person receiving the Gardasil vaccine will still gain protection against strains they have not previously been infected with.
Screening is still recommended even if you have been vaccinated because there are multiple types of HPV, some of which the vaccine may not protect against.
Can I still get the HPV vaccine?
Since April 2018, men who have sex with other men (MSM) have been eligible for free HPV vaccination on the NHS when they visit sexual health services and HIV clinics in England, if they are 45 or under.
Trans women are eligible for the HPV vaccine if their risk of HPV is similar to the risk of MSM who are eligible for the HPV vaccine.
Trans men are eligible if they have sex with other men and are aged 45 or under. If they have previously completed a course of HPV vaccination as part of the children’s HPV vaccine programme, no further doses are required.
Opting out of screening invitations
There may be some cases where you do not want to receive screening invitations. This might be the case if you have had a hysterectomy, or are a trans woman, and do not have a cervix. Or, it may be that you have decided that you don’t want to be screened.
If you wish, you can ask your GP to take you off of the cervical screening invitation list. Should you change your mind and you are eligible, you can also ask to be reinstated.
In some cases, you may ask to be removed and still receive a screening invitation. This is due to the way the system invites people registered as female with their GP. Let your GP know if this is the case and that you do not want or need to be screened so that they can remove you again.
If you are not sure about attending for cervical screening, we recommend that you stay registered for reminders so that you can more easily attend at a later date should you change your mind.
If you do not receive invitation letters but think you are due for a cervical screening appointment and are eligible, contact your GP surgery to book an appointment.
What if I have symptoms?
Screening is a test for people without symptoms. If you have symptoms that are causing concern, contact your GP as soon as possible to book an appointment.
These might include:
- vaginal bleeding that is unusual for you (abnormal bleeding)
- vaginal discharge that is unusual for you – it may have a different smell, look or consistency (for example, it may be thicker)
- pain or discomfort during sex
- unexplained lower back pain that lasts a long time.
It’s important to remember that these symptoms can be caused by things other than cancer. However it is better to remove the doubt and get them checked as soon as possible.
Remove the doubt in the community
For Pride Month, we took our Remove the Doubt back to where it all started: Hebden Bridge! Chatting with the attendees of Happy Valley Pride was a fantastic opportunity to share the campaign and let people tell us what they thought about it. Check out what they had to say in our video recap!