Cervical screening - a vital test in decline

Posted 5 February 2018 in Womens health

Cervical screening is a quick but potentially life-saving procedure. However, a quarter of women invited annually don’t attend. In light of recent survey results, it seems that embarrassment and fear of judgement are among common reasons not to show up. (1)

Ladies for cervical screening. Picture courtesy pixabay.com

What is cervical screening?

Once referred to as a ‘smear test’, cervical screening is a procedure during which a sample of cells is taken from the cervix, which is located at the upper end of the vagina and is deemed the opening to the uterus (womb). The cell sample is then examined for any abnormalities. For 95% of women, no abnormalities will be present. But for the remaining 5%, further testing will need to be done. Abnormal cells are sometimes at risk of becoming cancerous, in which case they need to be extracted from the cervix. But usually these cells resolve by themselves and cause no problems, therefore it is important to note that cervical screening is not a test for cancer. (1, 2)

Cervical screening exists to lower the number of cervical cancer cases and cervical cancer-related deaths. (2)

What happens during cervical screening?

Firstly, as long as you’re registered with a GP, you’ll have a letter posted to you inviting you to attend cervical screening. It will tell you who you need to make your appointment with, usually your GP surgery. If you don’t respond to the letter initially, you’ll be sent reminder letters at later dates. All women should have received a letter by the time they turn 25, and may be as early as 6 months before this. You may book the appointment as soon as you receive the letter. (2, 3)

It’s best to schedule your appointment for the middle of your menstrual cycle if you can, as this is when the clearest samples can be taken. If not, at least make sure you don’t book it for when you’re on your period as this will almost certainly make the sample unreadable. (2)

When you book, you are welcome to request a female doctor or nurse to carry out the procedure. (2)

In the 24 hours before your appointment, make sure you don’t use any spermicides, barrier contraceptives (e.g. condoms) or personal lubricant as this may interfere with the quality of the sample. (2)

At the appointment, which usually lasts about 5 minutes, the doctor or nurse will allow you some privacy to remove clothing from the waist down, although if you’re wearing a loose skirt or dress you should be able to keep it on. You’ll then need to lie on a couch for the procedure to be carried out. The doctor or nurse will then return and carefully insert a speculum into your vagina. A speculum is a piece of equipment designed to keep the vagina open, allowing easy access to the cervix. A sample of cells is then taken from the cervix using a small soft brush. It shouldn’t hurt, but if it does, let the person carrying out the procedure know so they can try to reduce the pain. Once the sample is taken, the procedure is done. The sample will be sent for testing and you should receive a letter in the post informing you of your results within 14 days. (2)

After this, you’ll be called back for cervical screening every three years up to the age of 50, unless you have an unclear result, in which case you’ll need to arrange another appointment after 3 months. Abnormal results may also require the procedure to be repeated. After your 50th birthday, you’ll be invited every five years up until the age of 65, when testing is no longer offered unless you haven’t had screening since you were 50 or your last result was abnormal. (2, 4)

Abnormal results may call for a repeat screening or a colposcopy (cervical examination). Occasionally, abnormal cells may need to be removed before they have the chance to develop into cancer. (2)

The link between HPV and cervical cell abnormalities

A common cause of abnormalities in cervical cells is the human papilloma virus (HPV). HPV is a group of viruses that can infect the skin and mucous membranes including the cervix. It is very easily transmitted, with 80% of all people catching it at some stage in their life. Most strains are harmless and resolve of their own accord. But some of the strains which infect the cervix can lead to possible pre-cancerous changes in the cells. These strains are passed from one person to the other via sexual contact, such as penetrative sex, genital skin to skin contact, and sharing sex toys. Using condoms may lower the chance of catching HPV from a sexual partner, but will not eliminate it entirely since they only cover part of the genital area. (5)

The alarming fact that the strains of HPV which cause abnormalities don’t actually cause any symptoms demonstrates the importance of keeping up to date with cervical screening (5) or you can test for the presence of these strains of HPV.

We can provide an HPV test that will report any high risk HPV(Just click here).

It can detect HPV infections before abnormal cell changes are evident, and before any treatment for cell changes is needed.

Since 2008, vaccines have been available in the UK that protect against at least two of the HPV strains that can cause abnormal changes in cervical cells. Girls aged 12 and above can be given a vaccine for free on the NHS. However, even with the vaccine, you’re not completely immune to HPV and there are other strains which can cause abnormalities, so cervical screening remains crucial. (5)

Why is attendance falling for cervical screening?

Since 2011, attendance at cervical screening appointments has dropped year by year. By 2016-2017, just 72% of women invited for an appointment attended, a 3.7% drop on 2011 figures. Many of the non-attending women were those in the youngest age bracket of 25-29 - a third of women this age do not show up year on year. The startling figure drop led Jo’s Cervical Cancer Trust to carry out a survey on over 2000 women in Britain, to try to discover the reasons why cervical screening is being shunned. The overwhelming message was that embarrassment over the appearance and odour of their genital area or of their body overall was the main factor in preventing women from taking up the offer. Younger women in particular seemed to fear judgement from the person carrying out the screening, giving reasons for missing appointments such as the appearance of their vulva or vagina giving away how much sex they’d had (this is a common misconception - there is in fact no link) and not having removed pubic hair beforehand. (1)

It’s understandable that having such an intimate part of your body visible to a person unfamiliar to you might seem embarrassing, but you must remember that doctors and nurses are healthcare professionals who carry out such procedures day in, day out and are there not to judge, but to safeguard your health and wellbeing. They will listen to your concerns and try to make the procedure as comfortable as possible for you. Now is the time for women to recognise this, take control of their health and get the attendance figures on the rise again!

For further information and support, visit www.nhs.uk/conditions/cervical-screening or www.jostrust.org.uk.


  1. Silver K (2018). ‘Embarrassment makes women avoid smear tests, charity says’, BBC News. Available at: http://www.bbc.co.uk/news/health-42747892
  2. NHS Choices. Overview [cited 26 January 2018]. Available at: https://www.nhs.uk/conditions/cervical-screening/
  3. NHS Choices. When it’s offered [cited 26 January 2018]. Available at: https://www.nhs.uk/conditions/cervical-screening/when-its-offered/
  4. NHS Choices. Results [cited 26 January 2018]. Available at: https://www.nhs.uk/conditions/cervical-screening/results/
  5. NHS Choices. Why it’s offered [cited 26 January 2018]. Available at: https://www.nhs.uk/conditions/cervical-screening/why-its-offered/

Author: Gabby Gallagher MPharm

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 05/02/18

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