The real reason so many women avoid smear tests...
and it’s NOT embarrassment
FOR more than 30 years, the smear test has been the main defence against the scourge of cervical cancer, picking up early warning signs of the killer disease which affects more than 3,000 women a year.
Since screening began in the 1980s, the number of cases has dropped by an average of seven per cent a year.
But alarming new figures reveal screening uptake is now at an all-time low, a slump experts blame on body-conscious young women feeling too embarrassed to have the test.
It means ten years after TV reality star Jade Goody died from the disease at 27 – triggering a huge rise in smear test attendance – the impact of her death appears to have faded completely.
But is it just embarrassment that deters women from turning up for screening checks?
Not always, according to experts. Many women are put off because they find the process painful and even traumatic.
An estimated one woman in five has what’s called a tilted uterus, also known as a retroverted or tipped uterus, which can make smear tests extremely painful.
It means the uterus, or womb, is t i pped backwards, pointing towards the lower back rather than the belly, as it should.
This can be due to a variety of reasons, i ncluding weakening of the pelvic muscles – often due to childbirth – an enlarged uterus or simply genetics.
A tilted uterus may be picked up by routine scans during pregnancy, or during other examination, including sexual health appointments. But, as this anatomical difference does not typically cause other problems, many women have no idea that they are affected – and this could be the reason some report extreme discomfort during a smear test.
The procedure, also known as a cervical screen test, is offered every three years to all women aged 25 to 49, and every five years to those aged 50 to 64.
During the test, a doctor or nurse gently inserts an instrument called a speculum into the vagina to hold it open and view the cervix.
With a small, soft brush, they then collect cells from the surface of the cervix to be sent off for testing.
It is not a test for cancer, but for abnormal cells on the cervix that indicate a problem.
If abnormal cells are detected, women may be recalled for a repeat smear or referred for a colposcopy examination, during which the cervix itself is examined closely and, if needed, biopsies of tissue can be taken and tested for cancer.
The NHS concedes that some women do find the cervical screen test uncomfortable, but this can usually be overcome by trying to relax. Official advice states: ‘Taking slow, deep breaths might help.’
Yet for women with a tilted uterus, cervical swabs may have to be taken differently in order to avoid causing discomfort, says Dr Tracie Miles, a gynaecology cancer nurse specialist at The Eve Appeal, a charity funding research i nto gynaecological cancer prevention.
‘It can sometimes be difficult for the doctor or nurse doing the test to see the cervix when they first put the speculum in,’ she says.
‘This means the device has to be moved around until the cervix can be seen, and this can cause discomfort or pain.’
Recent research from Jo’s Cervical Cancer Trust, which campaigns for excellence in cervical cancer treatment and prevention, found 36 per cent of women who regularly attend their cervical screening fear it will hurt. The charity’s online forum is awash with posts from women sharing negative experience.
‘The test was so painful I was left in tears,’ writes one. Another says: ‘My first two smears were awful due to the fact that the nurse couldn’t find my cervix so took a number of attempts to find it, leaving me feeling uncomfortable and anxious. It put me off going for another and I left it six years.’
Hayley Smith, from London, knows all about the discomfort having a tilted uterus can cause during a smear test. For her, smear tests have ‘always been uncomfortable’ and have often left her in a ‘considerable amount of pain afterwards’.
It wasn’t until she was told about her tilted uterus by a nurse last year that Hayley, 30, had more of an understanding. ‘I thought the pain was a given, but now I know there is something causing it, I can make sure doctors are aware and prevent ongoing discomfort.’
So what can women who have a tilted uterus do to reduce the risk of pain and discomfort? Dr Miles suggests a few simple steps could have a dramatic effect.
She says: ‘If a woman has had a traumatic or painful experience in a previous smear test, she should go to her next one – or if she’s missed one, make an appointment for one straight away – and tell the nurse or doctor what happened.
‘ She should make sure this is recorded in her medical notes to help guide tests in the future. The practitioner will then be aware and able to carry out the procedure with more care, helping the woman to feel more comfortable.
‘Some women say they feel more comfortable by simply placing their hands under their bottom or back, in order to tilt the pelvis upward helping to align with the speculum. The nurse will also be able to tell the patient for sure if they have a tilted uterus.’
A small recent study found using lubricant during the examination reduced pain and had no harmful effects on the samples.
Dr Miles adds: ‘The message is, even if you find it uncomfortable, when armed with knowledge about your own body, cervical screening needn’t be so traumatic.
‘ And the test really can make the difference between life and death – I would urge you to attend your screening.’
It was so awful, it put me off having another ... I left it six years