Have you just received your cervical smear letter in the post and having questions about it? Or have you attended you smears a few times but still don’t understand it fully? This article is for you! We will be discussing the principles of cervical smear, what to expect during your appointment and why smears are so important!
The aim of cervical smears is to identify women at risk of cervical cancer and prevent it. To start of let’s explain a bit more about cervical cancer.
What is cervical cancer?
The cervix is the neck of your womb (uterus) and closes the entrance to the womb at the end of the vagina. It is made of different types of cells, with a cell lining a little bit like the inside of your vagina or your mouth - we call these mucosal linings. Sometimes these cells can begin multiplying too much and too fast. They can become abnormal. If this progresses this can turn into cancer and the abnormal cells can spread beyond your cervix.
Most cancers of the cervix are caused by a virus cause the Human Papilloma Virus, or HPV. There are over 100 types of HPV. This virus is extremely common. It is a little bit like virus that causes the common cold- everyone is exposed to these viruses at at some point in their life and they recover because their immune system clears it. HPV is spread by contact so even there is not penetration only skin to skin contact in the genital region, people can be exposed to HPV. Even the use of sex toys can spread HPV. It is important that all people with a cervix atten d for their smear test when called. Although the risk of developing cervical cancer is extremely low in someone who has never had any sexual contact before it is still important to attend the appointment and discuss the benefits and risks of smear testing with their health care provider as an individual so they can make an informed decision on testing.
It is important that people are aware that having HPV is nothing to be ashamed about, it is extremely common and most people’s immune systems are able to clear the body of the virus. Having HPV does not mean you are definitely going to get cancer! Some types of HPV are low risk- these cause genital warts and less likely to cause cancer. Other types are of a higher risk of causing problems in the cervix and these are the ones we test for
As previously mentioned, most people can clear the HPV virus by themselves, however in some people the virus becomes chronic- the virus is not able to be cleared and stays in the cervix for some years. It is this prolonged infection that can make cervical cancer more likely. This is because viruses encourage cells around them to multiply. Doctors cannot give any medication to help one’s cervix clear the virus, however we can monitor people more closely who are known to have the virus.
2. So why a cervical smear? Is it to check if I have cancer?
So the cervical smear does not check if one has cancer, it checks if they have risks of developing it. The older type of smear would look at all samples under the microscope, to check if the cells of the cervix look normal or not. . The new type of smear checks if there is a high risk type of HPV virus present in the sample or not. If the virus is detected only then will the cells be looked at to check for abnormal looking cells. If there is no high risk virus detected, there is no need to look at the cells under the microscope, and this is backed up by the most recent research.
3. What should I expect during my smear?
The smear test is not painful and does not take very long. Anyone due a smear test will be invited in through the post and the nurse or doctor will explain the procedure, answer any questions and check for consent to proceed. The way the smear is done is using a small plastic cone called a speculum inside the vagina to open it so the cervix can be visible. The best position for this examination is lying down on the examination table and opening the knees flat on the side. . The speculum can be a little uncomfortable but it will be inserted slowly and gently, with plenty of jelly to make it more smooth. The healthcare professional performing the smear is here to discuss any concerns, and to help make the procedure as comfortable as possible. Then the nurse of doctor then uses swab in the shape of a tiny brush and lightly brush the cervix, trying to gather some cells from the surface. Some women report this can feel a little uncomfortable like a light period cramp, but will be over very quickly. In less than 5 minutes the smear will be done and the swab will be put in a pot and sent to the lab for analysis.
Some women experience some tiny drops of blood after the smear as some cells have been brushed, but this will go away very quickly and doesn’t cause any problem. After a smear, one can continue with the rest of their day as normal.
4. How often do I need to go for my smear?
The cervical screening programme ran by the NHS starts at age 25. Between the ages of 25 to 49 people with a cervix will be invited for a smear every 3 years. From the ages of 50 to 64 this will be every 5 years. It is important to attend all smears, even if the first few were normal, as there is a good scientific evidence base for these intervals. Having smears more regularly or outside of this age range is not indicated in most women, but may be necessary in certain cases specified by a healthcare professional depending on the person’s medical history. If the test comes back with the presence of HPV or an abnormality the person may need to have more frequent smears or be seen in colposcopy clinic where the specialists can take a closer look at the cervix. . Certain symptoms like any bleeding in between periods, strange discharge, bleeding after sex or pain during or after sex can indicate a problem in the cervix and one should not wait until the smear but go see their doctor. If a smear is due but the person is pregnant, doctors usually advise to wait until 3 months after delivery before having a smear to increase the chance of accurate results.
5. What do the results of my smear mean?
The smear results are usually received through the post and the letter will explain the results, but here is a summary of possible results with explanations:
No HPV virus found in the sample: the risk of cervical cancer is very low and no further tests are needed. However smears due in 3 or 5 years time (depending on age) remain important and should be attended.
HPV virus found in the sample, but no abnormal cells: no further tests are needed at the moment but the smear should be repeated 12 months later to check if the body is clearing the virus. If the virus is still present after 24 months a further test to look directly at the cervix called colposcopy is indicated.
HPV virus found in the sample, with some abnormal cells: a further test is needed in the near future to have a closer look at the cervix (colposcopy). This will happen at the hospital with a doctor specialised in women’s health (gynaecologist).
Disclaimer: Information in our blogs are as accurate and comprehensive as possible. This is general advice and should not be used as a substitute for the individual advice readers might receive from consulting their own doctor. For other medical professionals reading, it is advised to use your own clinical judgement when interpreting the information and deciding how to best apply this to the treatment of their patients. Please see our terms and conditions page for further information on this.
By Marianne Gazet – Purpose Print Blog writer