This is what a cervical screening is really like

It’s awkward, invasive, often uncomfortable, and a third of eligible people don’t actually attend. You guessed it: cervical screenings – still known to many as the dreaded smear test.

The government launched a new campaign in February of this year to increase uptake in cervical screenings – but what actually is a cervical screening, and what is the process like?

This was the question on my lips when, aged 19, I was offered a precautionary smear test after visiting my GP with a range of cervical symptoms that were unusual for me, including irregular bleeding and persistent abdominal cramps. Having heard horror stories of speculums, stirrups and swabs, I was immediately nervous, but the reality of my first cervical screening was quick and painless, if a little awkward.

When I arrived for my screening, I sat in the waiting room like it was any other appointment – though my palms were, admittedly, a little clammier – waiting to be called in. Eventually, a woman appeared to collect me – woman doctors or nurses usually perform cervical screenings, and the same was true for me. If you are uncomfortable with the possibility of a man practitioner, you can request a woman or bring a chaperone.

The doctor sat me down and explained the process. I took this opportunity to express my mild anxiety, which the doctor took in her stride. It’s normal to be nervous, but telling my doctor made her even more accommodating. 

I was eventually sent behind a curtain and told to undress below the waist. I made the mistake of wearing jeans, so had to wriggle my way out of them before lying down on the steel blue examination bed, under the thin sheet of tissue they provide to cover yourself. If you’d like to be a bit more covered, you could wear a dress, skirt or long jumper – something you can leave on during the examination.

I told the doctor I was ready, and she came back behind the curtain where I was lying down. She asked me to bend my knees so my heels were touching my bum, as if I was about to do some sort of ab workout. If you are uncomfortable with the position the practitioner requests, you can ask to lie in a different one – for example, on your side.

The doctor then showed me the speculum – a tube-shaped tool, a couple of centimetres wide and around 12 centimetres long, that they use to see your cervix – and provided plenty of warning before putting it in my vagina. She used lubricant to make the speculum smoother, but it mainly felt like putting a tampon in. Speculums come in a range of sizes, which you can discuss with your doctor beforehand if you are worried. You can also ask the doctor to provide plenty of warning or advise when it is best to take a deep breath.

The silence can be jarring and awkward – especially when only punctuated by equipment being taken out of crinkly plastic packages, and lube being squeezed out of the bottle and onto the speculum – but my doctor did a good job of keeping up the conversation. Like all doctors tend to, she asked me what I do day-to-day to keep my mind occupied, and as I launched into a rant about my current essay crisis, my smear-related anxieties started to slip away.

I already felt less awkward and self-conscious by the time she told me it was time for the speculum to be inserted into my vagina. If you are worried about keeping up conversation, however, you could alternatively bring something to read or listen to if you’d like to distract yourself.

The speculum is inserted into the vagina and then opened to widen the vagina and see the cervix. It sounds much worse than it feels – especially if you try to relax and breathe deeply. Then, a small soft brush is used to collect cells, which is slightly more uncomfortable. For me, it felt like someone was scratching an itch that didn’t need scratching. Other people describe it as a small pinch or a period pain-like cramping. Tell your doctor if you do experience pain, though – the procedure can be stopped at any time.

The brush is then put into a tube to be sent off for examination, the speculum is removed, and you are left to get dressed – the entire examination over in a flash. As I wiggled back into my jeans, relief washed over me: that it was all over, but mostly that it had been such a simple experience. The worst part was honestly the slightly too-cold room. 

Research suggests that nearly all cervical cancer cases are caused by human papillomaviruses – known as HPV – and this is what a cervical screening looks for, as well as any abnormal cells. Good news if you received the HPV vaccination when you were younger: new research indicates that, because of the jab’s 99% effectiveness, vaccinated people might only have to attend one or two cervical screenings in their entire life. In the meantime, eligible people are still being encouraged to attend their screenings if they are invited.

Government research also suggests that 42% of eligible people do not attend their cervical screenings because of embarrassment. Many people also do not realise that they should actually attend. A common misconception, for example, is that only sexually active, straight, cis-gender women need to attend cervical screenings because they have penetrative sex, but HPV can actually be spread through other types of sexual contact, including anal and oral sex.

They’re offered on the NHS to anyone with a cervix, typically every three years between ages 25 and 49, and then every five years until age 64. If you are under 25, your GP might offer you a precautionary smear test (like me) if you present any symptoms of cervical cancer.

Everyone with a cervix should attend upon invitation, regardless of gender identity or sexual orientation, including people who have never had penetrative sex and, at present, those who have received the HPV vaccine. If you are a trans man who hasn’t had a total hysterectomy, registered with your GP as male, you will not receive an automatic invitation and should contact your GP to arrange your first cervical screening.

For more information on cervical screenings, visit the NHS website.

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