Pap test, pap smear, smear test, HPV test, cervical cancer screening: somewhere along the way, something as important as preventing cervical cancer has been mystified.
For younger people or those who have never had a screening before—or those who have had a negative experience in the past—the prospect of any type of gynaecological check can feel scary. Luckily a cervical cancer screening, sometimes called a smear test, is one of the easiest, quickest checks you can have. It also makes cervical cancer one of the most preventable cancers there is.
In the UK, anyone with a uterus aged 25 to 64 is invited by letter to get a cervical screening. A cervical screening checks the health of your cervix (the opening of your womb) by collecting a small sample of cells. This is done by inserting a speculum into your vagina to help your doctor see your cervix, and then inserting a soft brush to take a small sample. The test itself usually takes less than five minutes, and is typically done by a female doctor or nurse.
One common misconception about cervical cancer screening is that it tests for cancer, when in fact it’s a preventative test. A screening tests for certain types of human papillomavirus (HPV) that cause cells in your cervix to change, known as ‘high risk’ HPV. If found, the sample is checked for changes to your cervix cells which can then be treated before they get the chance to develop into cervical cancer. This makes a cervical cancer screening one of the most important preventative procedures you can undergo for your gynaecological health.
What is HPV?
The link between certain types of HPV and cervical cancer has received increased research in recent years. HPV is a highly common virus and in the majority of cases, does not cause complications and tends to go away on its own. In all cases, it is nothing to be ashamed of: about 80% of sexually active people will contract it at some point in their lives, and most people never know they have it. There are around 100 types of HPV, with 30 of them affecting the genitals including the vulva, vagina, cervix, scrotum and penis. Of these 30 types, about 14 are considered the ‘high risk’ kind that can lead to cervical cancer.
You can get HPV from any skin-to-skin contact of the genital area, not just penetrative sex. This includes oral, anal and vaginal sex, as well as sharing sex toys. Symptoms are rare, but the most common symptom is genital warts, which may not appear until months or even years after a person has been infected. Using condoms and getting an HPV vaccination as a pre-teen or teen help to protect against the virus, but they are not 100% preventative.
HPV is usually diagnosed by a pap test, sometimes called a pap smear, wherein a sample of cells are taken from the cervix. In some cases, a colposcopy is done. This involves an instrument called a colposcope which shines a light to enlarge your doctor’s view of the cervix. A vinegar solution is then placed in the cervix, which is able to identify abnormal cells that have been infected by HPV.
Unfortunately, as with many sexually transmitted infections (STIs), lots of people experience shame or embarrassment around an HPV diagnosis. It’s also common to hear HPV conflated with human immunodeficiency virus (HIV) and herpes (also known as HSV, herpes simplex virus). They are not the same. There is also a common belief that if you receive an STI like HPV and you’re in a relationship, your partner must have cheated on you. This also is not the case, as you can get HPV even if you haven’t been sexually active or had a partner for many years. These misconceptions and stigmas surrounding something as commonplace as HPV demonstrate how important it is to spread accurate information on sexual health.
Pap smear vs HPV test
In the UK today, HPV tests are the most common way to test for cervical cancer, and are what you will receive a letter invite to. Pap tests are slightly different. They look for abnormal or precancerous cells in the cervix, also known as cervical dysplasia. Most of the time, these changes occur due to ‘high risk’ HPV. If these abnormalities are discovered, it does not mean that you will get cervical cancer. It does mean that a doctor will monitor you regularly to prevent further cell changes that could become cancerous.
An HPV test, like the ones administered during a routine cervical cancer screening, differ slightly. This tests for the presence of those ‘high risk’ HPV types that have the potential to cause those cell changes that can lead to cervical cancer. An HPV test used to be done in conjunction with a pap test, but now is commonly done on its own. Some studies have found that HPV tests are better than pap tests at assessing cervical cancer risk, since they detect the strains of HPV that are responsible for the majority of cervical cancer cases. Two ‘high risk’ strains of HPV— genotypes HPV16 and HPV18—are responsible for 70% of cervical cancer, so detecting these early on is incredibly important. The NHS is currently trialling HPV home-testing kits in an attempt to increase uptake of cervical cancer screening.
How to prepare for your cervical cancer screening
You have a lot of freedom when it comes to scheduling your cervical cancer screening. Try to schedule it on a day when you know you won’t be on your period. If you have an irregular period or your period starts unexpectedly in time for your appointment, you can always reschedule. You should also avoid using any vaginal lubricants or creams for the two days prior to your appointment, as these could affect the results of the test.
There are also things you can do to make the appointment more comfortable. While most screenings are done by female nurses or doctors, you can request one while booking the appointment to be sure. You can also request a longer appointment if you’re worried about discomfort or feeling rushed. If menopause has made the test more difficult for you, let your doctor know and you can be prescribed a vaginal estrogen cream or pessary prior to your appointment.
If you feel uncomfortable being undressed, wear a long top or skirt to the appointment that you can keep on during the screening. And remember that communication is key: your nurse or doctor will have administered these screenings many times before, so there is nothing to be embarrassed about. They will be able to give you advice such as breathing exercises and different positions to try, and can even use a smaller speculum for your comfort.
After the screening, you might experience some light bleeding or spotting. This should go away after a few hours. You should contact your GP if you experience heavy bleeding or spotting that continues for more than a few hours.
Alternative clinics and tests
If you prefer, there are even specialist clinics where you can get your screening done for a variety of reasons. CliniQ is a holistic sexual health clinic specialising in trans health, with a trans-led team. There are also services such as My Body Back that provide cervical cancer screenings and sexual health care for survivors of sexual abuse, led by women who are trained to work with those who have experienced sexual violence. Syrona also offers an HPV test you can take in the privacy of your own home. If gender identity, sexuality, or sexual trauma make navigating sexual healthcare daunting for you, know that there are alternatives to make sure you can access this highly important procedure.
Your GP or nurse will tell you when to expect your results, which you’ll usually receive in a letter.
The most common result is HPV negative, meaning that HPV was not found in your cell sample. This means your risk for cervical cancer is very low and you do not need to undergo any further tests.
If you receive an HPV positive result, meaning HPV was found in the sample, the letter will explain what to do next. If HPV was found in the sample but no abnormal cells were found, you’ll be invited for another screening in one year. If after three years HPV is still found in your sample, you may need to have a colposcopy.
In some cases, the results will be inconclusive and you’ll be asked to come back in three months for another screening. This just means that the results were unclear, and does not mean there was anything ‘wrong’ with your sample or that you should be worried.
Cervical cancer screenings save thousands of lives each year in the UK, so you should not put off booking your screening or purchasing a test kit to do at home. Coronavirus temporarily delayed invitations for some, but are now being sent out. If you are due a screening but have not received a letter, do not hesitate to contact your GP and ask.