If you're a UK woman aged 25-64, you're probably well aware of the recommendation to attend smear tests. Assuming you're registered with a GP, you'll receive a letter every few years inviting you to a free cervical screening. (This will occur every three years if you're aged 25-49, or every five if you're 50-64.)
Of course, this invitation may not seem quite as tantalising as some of the others you receive in the post. However, its importance should not be underestimated. According to the charity Jo's Cervical Cancer Trust, skipping your smear test is one of the biggest risk factors for developing cervical cancer.
"Cervical screening is the best protection against cervical cancer as it's a test to detect abnormal cells on the cervix before they have developed into cervical cancer," says Elisabeth Schuetz, spokesperson for the charity. "It prevents 75% of cases from developing and it is estimated that the screening programme saves around 5,000 lives in the UK every year."
Unfortunately, despite this life-saving potential, smear tests are a source of great anxiety to many. Earlier this year, it emerged that around one in four women eligible for a smear test do not take up the invitation, with the figure rising to one in three among 25-29 year-olds. Shockingly, in some parts of the country, attendance among this age group is less than half.
While missing your test is a bad idea at any age, it is particularly troubling in younger women, who are actually at the highest risk of the disease. While cervical cancer is very uncommon in under-25s, rates peak in the 25-29 age group and then slowly drop with age, before rising again (although to a much lower degree) after the age of 65. According to a poll conducted by Jo's Cervical Cancer Trust, 61% of women aged 25-35 were unaware they were in the most susceptible age group.
Why are women skipping their smear test?
The poll also unearthed a wide range of reasons why women weren't attending smear tests. Some had practical concerns - among those who had delayed their test or didn't attend it, a quarter said they found it too hard to make an appointment, and 30% of those who had never attended were unsure where to go for a test. (Most of the time, the screening will take place at the GP's surgery, although in many parts of the UK you can go to a sexual health or family planning clinic instead.)
For others, the issues were more personal. Of all the women polled, 35% were embarrassed to attend because of their weight or body shape, 34% because they didn't like how their vulva looked, and 38% because they were concerned about having a 'normal' smell.
"Reasons why women don't attend their cervical screening are varied and can be complex," says Schuetz. "Some women are embarrassed, some don't know what to expect or what the test is for, and some are scared of the results."
She adds that other women may have had a previous bad experience that put them off. On top of that, those with an experience of sexual violence can find the test very difficult (Jo's Cervical Cancer Trust has an excellent blog post giving practical tips in this scenario), and those with a physical disability may have problems attending an appointment at their GP.
What to expect
So what does the screening actually involve? As Schuetz explains, the appointment itself should take no longer than around 20 minutes, with the procedure itself taking just three minutes. Make sure to leave lots of time to get to your appointment, so that you don't feel rushed.
"In the UK, practice nurses take the majority of cervical screening samples, though sometimes it will be taken by a GP," she says. "You can request a female sample taker if you want. Before the procedure starts the practice nurse should explain what is going to happen and what will happen after the test - do use this opportunity to ask any questions or express any concerns."
First, you will be asked to undress from the waist down (some women prefer to wear a skirt, as it means you only need to remove your knickers) and lie on the examination bed on your back. You can either have your legs bent up, or keep your ankles together and knees apart. A paper sheet will be placed on the lower half of your body.
Dr Sarah Jarvis, GP and clinical director of Patient.info, advises: "I always check with a woman beforehand if she wants me to let her know exactly what I'm doing as I go along. I find some women much prefer to be kept informed, while others tell me knowing the precise details just makes them more nervous."
Do think beforehand about which you'd prefer and let your nurse or doctor know before they start.
"The practice nurse will then insert an instrument called a speculum into the vagina. Some clinicians may use lubricant on the speculum, which will make it easier to insert," says Schuetz. "The speculum will be gently opened inside the vagina, allowing the nurse to see the cervix. says Schuetz. A specially designed brush is used to take a sample of cells from your cervix. These are immersed in a vial of liquid to help preserve them and are then looked at under a microscope in a laboratory."
Although you may experience some slight discomfort, the test should not be painful. Since speculums come in different sizes, you can ask for a smaller one if you're uncomfortable. You can also ask the nurse to stop at any point during the test.
Once the test is over, it's a good idea to ask when your results are expected and what you need to do to get them (as in some cases you may need to contact your GP).
Between 90-94% of results come back normal, but if abnormalities are found, there's no need to worry - the vast majority of women in this position simply have some changes in the cervical cells. In some of these cases, you'll be invited back for an examination called a colposcopy which will help determine whether you need treatment. According to the British Society for Colposcopy and Cervical Pathology, just 1% of women with an abnormal smear test have cervical cancer.
Dealing with your concerns
While your anxieties are likely very individual, the best thing to do is to make the appointment irrespective and then to discuss any concerns with the practice nurse.
"If it is your first time, you're feeling nervous or you have had a bad experience in the past, tell your sample taker," says Schuetz. "The Jo's Cervical Cancer Trust Helpline (0808 802 8000) is also open most days should you want to talk about your test. We also have a film called 'Your Guide to Cervical Screening (smear test)’ that gives more information on what will happen."
If you're especially worried, it's a good idea to bring a relative or friend with you for support, or even to book a double appointment so you've got more time to discuss your fears with the nurse and recover your poise after the test.
While nobody exactly enjoys their smear test, it's the nurse's job to make you as comfortable as possible, preserving your dignity and helping put your mind at rest.