8 things you need to know now about your smear test


With recent changes to how often cervical screenings are offered, Laura Andrades looks at everything you need to know about smear tests

Illustration of doctor talking to woman about smear test

If it’s been a while since your last cervical screening, you’re not alone – the pandemic meant a drop in uptake, for understandable reasons.

However, cervical screening remains as crucial as ever, so as we look to get back on track with regular health check-ups, we explain how the process has changed recently.

The good news is that, thanks to scientific advances, medics can now pinpoint who is most at risk of cervical cancer by using a new method called HPV primary screening, and manage appointments accordingly, so patients can feel confident that any worrying signs will be picked up early.

It’s now more accurate

Previously, after a smear test, samples were sent off to be analysed for cell changes.

Now, with HPV primary screening, they are tested for the high-risk human papillomavirus (HPV).

That’s because 99.7% of all cervical cancers are linked to these high-risk strains of HPV. If you test negative for high-risk HPV, you’ll be invited for your next screening in either three or five years (more on this later), because your risk of cervical cancer is very low.

If you test positive for high-risk HPV, you will be informed and your cells will then be analysed to look for any abnormalities.

If these are present, you’ll be referred for a colposcopy, a gentle procedure where cells are inspected with a microscope. If the result of your colposcopy is normal, you won’t need any immediate treatment and will return to routine screening programmes.

If not, any abnormal cells will need to be removed. The new HPV primary screening method is more accurate, so better at detecting cell changes overall, as well as detecting them earlier, which is good news for cancer prevention.

Having HPV isn’t embarrassing

Because HPV is a sexually transmitted infection, it can carry stigma, says Sexual Health Consultant Dr Naomi Sutton.

But HPV is an incredibly common family of viruses and the majority of sexually active adults will carry a type of this virus at some point in their lives.

Around eight in 10 of us will be infected at some point, so it isn’t embarrassing or unusual. Usually your body clears HPV completely without ever realising it was there, which is why the screening only looks for the high-risk types.

The actual screening feels the same

None of these changes will affect your appointment; it will still be carried out by a nurse or doctor and will only take a few minutes. Here’s what to expect:

  • You need to take off your clothes from the waist down, including your underwear but the nurse can give you a paper sheet to cover your hip area. Or you can wear loose-fitting skirt or dress if you prefer and just lift it up.
  • Put the soles of your feet together and allow your knees to drop open to the sides, then the nurse will gently slide a plastic speculum into your vagina to see the cervix clearly.
  • They will then use a soft brush to take some samples of cells from the surface of your cervix, which is put into a small container of liquid to send to the lab.
  • They’ll then gently take out the speculum and the test is over. You should get your results two to six weeks later by post.

It’s best not to book a cervical screening when you are on your period because it can make it harder to get a clear result. Around one week after your last bleed is often recommended, although don’t worry if you can’t get an appointment at the ideal time as a smear can still be taken so long as you are not bleeding (and even then it’s not impossible, but may mean you don’t get a clear result).

To make it easier to know when the best time would be to book an appointment, it’s a good idea to use a cycle mapping app, such as Jennis, created by Jessica Ennis-Hill, which can be more convenient than remembering to write dates down.

You can make it more comfortable

Worried about embarrassment or pain?

It’s totally normal to be nervous, and you’re not alone, says Samantha Dixon, Chief Executive of Jo’s Cervical Cancer Trust. She has the following advice to help make you feel more reassured:

  • You might feel better knowing what to expect, so you could ask a friend or family member what it was like for them, speak to your nurse or doctor, or you can call our free, confidential Helpline (0808 802 8000).
  • Think about things you can do that might help during the test; for example, bringing headphones to listen to music, or practising some breathing exercises.
  • In addition, do speak up if you’re worried or have had a bad experience before.
  • You can bring a friend, partner or family member with you for support.
  • You don’t need to be lying down flat if that makes you feel vulnerable.
  • If you’d rather have a female medic, just ask, and take your time.
  • Consider doing some breathing exercises if you feel yourself tensing up – ask to pause as you take some breaths and relax. You can stop at any time.

It’s common to experience some light bleeding, spotting or cramping after having a smear test. If these don’t improve after a few hours, or the symptoms are severe, contact your GP.

The HPV vaccine doesn’t mean you don’t need a smear test

The HPV vaccine is a huge success – a 2021 study found a 97% drop in pre-cancerous changes to cells in girls vaccinated between the ages of 12 and 13, and it has cut cases of cervical cancer by nearly 90% – but we still need to attend screenings.

The HPV vaccine is very effective at preventing cervical cancer, which is fantastic news for the future as it means we will see fewer diagnoses, says Samantha.

However, it does not protect against every single strain of HPV. That’s why attending cervical screening is still really important. If you have not had the HPV vaccine, screening remains your best protection against cervical cancer.

The test is moving from every three years to five

Because the new test detects the people at higher risk of developing cervical cancer more accurately, the intervals between screening tests can be safely extended for people who are not at high risk.

That’s happened in Wales and Scotland already, with screenings every five years. England will follow, but for now, if you’re aged 25 to 49, it’s every three years and if you’re between 50 and 64, it’s every five years.

The Department of Health And Social Care hasn't yet said when the change will come into effect in England, but when it does there will be a public announcement, and women and people with a cervix will be notified of what it means for them. young woman patient with a senior gynecologist during the consultation in the gynecological officeThe change is based on a wealth of scientific evidence. It’s also important to know that although HPV can make cells change, this happens very slowly, over many years, so if abnormal cells in the cervix develop between tests, they can be picked up at the next one.

When your appointment is due, you'll be sent an invitation letter in the post telling you how to book and where you can go – it’s usually at your GP surgery or a local sexual health clinic.

There are symptoms to be aware of

Some people who are diagnosed with cervical cancer have no symptoms, which is why it's so crucial to attend your cervical screening when called, but it’s also worth being aware of the most common signs:

  • abnormal bleeding, such as bleeding between periods
  • vaginal discharge that smells unpleasant
  • pain in the pelvis and pain during sex

Most of the time these symptoms will be caused by something else, but you should never ignore them.

It’s as crucial as ever

Unsurprisingly, cervical screening uptake dipped last year compared to pre-pandemic levels.

At the very start of the pandemic all routine care was suspended, explains Dr Naomi.

Home schooling and working from home undoubtedly added an extra layer of complexity for some women, too.

Other factors can also mean some people miss their screening. Around one in three women and people with a cervix don’t attend when they are invited.

It can be hard for many reasons – busy lifestyles, previous trauma, and fear and embarrassment are just a few of them – but cervical screening means we can find out who is at higher risk of developing cervical cancer, and manage this with either monitoring or treatment, says Samantha.

It saves thousands of lives every year.

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