I’m scared of having a smear test

Okay, cervical smear tests are a bit invasive and uncomfortable and it can be nerve-wracking waiting for the results. But there’s no escaping these facts: women who have regular cervical smear tests can reduce their chances of developing cervical cancer by up to 90%. In New Zealand, women are advised to have a cervical smear test (also known as a pap smear) every three years.

Smear tests help prevent cervical cancer

Cervical cancer is one of the most preventable and curable of all cancers. According to the NZ Ministry of Health, mortality from cervical cancer has dropped by nearly two-thirds since the introduction of the national screening programme.

Who should have regular smear tests?

People who:

  • are a woman or trans or non-binary person with a cervix
  • are aged between 20 and 70
  • have ever had sex

What does a smear test feel like?

The procedure is quite quick but, yes, it does require inserting a speculum into the vagina to allow the person doing the test to see the area of the cervix where they need to sample the cells.

The cells are gained by rotating a sampling spatula or brush over the cervix. You may feel some dull pressure while this is being done. While some women can feel a little embarrassed by the procedure , it’s worth remembering the for the person doing the test, it’s part of their everyday work.

What if it hurts?

While a smear can be uncomfortable, it should not hurt. There are various ways to make the procedure more comfortable.

Some women find using relaxation techniques like deep breathing, guided visualisation or meditation useful. If you’ve had problems in the past, talk to the practitioner about your difficulties and discuss what may make the process more comfortable for you.

Each woman is the best expert on her own body, and any information you can share with the smear test provider will help them in making the experience more comfortable for you. Factors that may make the procedure more uncomfortable include:

  • vaginal dryness, particularly in post-menopausal women
  • anxiety, which can cause tensing of the muscles
  • a retroverted (tilting backwards or upwards) uterus, which can make the cervix difficult to reach if a woman is lying in a particular position.

Worried about the results of your smear test?

While about one in 10 smear results will come back with a comment attached or an indication of a problem, this doesn’t necessarily mean cancer. It just means that there is something which requires a re-check or some action.

According to the NZ Ministry of Health information site, timetoscreen.co.nz, results may include:

Normal Results

No atypical or abnormal changes were detected.

Unsatisfactory results

Unsatisfactory results mean that the test could not be read at the laboratory because not enough cells were on the slide, or blood or mucus hid most of the cells. In this case, you will need to have another smear within three months.

Inflammation or infection

Occasionally your smear may show that inflammation or infection is present. Discuss this result with your smear taker or doctor. Often no treatment is required.

Atypical changes

These changes are borderline between normal and abnormal. They are called atypical squamous cells of undetermined significance (ASC-US).

Mild (low-grade) changes

These mildly abnormal cells are called low-grade squamous intraepithelial lesions (LSIL). This means changes in the surface cells of the cervix. LSIL is the lowest grade of change. If have atypical or mild (low-grade) changes, your smear taker may advise you to have another smear in 6-12 months. Quite often, the next smear will be normal. You may be referred to see a specialist (colposcopist). If you are over 30 years old, your smear taker may recommend you have an HPV test.

Moderate to severe (high-grade) changes

These more serious abnormal cell changes are called high-grade squamous intraepithelial lesions (HSIL). In some women, they may develop into cancer if they are not treated. You will be referred for colposcopy. It is important that you attend your colposcopy appointment. Your smear taker will discuss with you having an HPV test, if you have had a high grade result.

Glandular cell changes or adenocarcinoma-in-situ (AIS)

Although the cervical smear test is not designed to detect glandular cell changes, such changes are sometimes found. You will be referred for a colposcopy, and it is important for you to go to your appointment.

Cancer

If your smear test shows any changes suggestive of cervical cancer, you will be referred to a specialist within 1 week. The sooner this is treated, the better the chances of success. It’s important for you to go to your appointment.

Doctor’s tips

Jean Hailes GP, Dr Amanda Newman, says no matter how long it’s been between smears, it’s “better late than never”. She says doctors are not there to judge you or reprimand for not maintaining a two-year schedule.

“Just make having a pap smear your top priority today. It’s one of those great tests because it’s simple and so highly effective at detecting even the smallest changes within cells on the cervix,” she says.

Dr Newman says the biennial smear is also a great chance to book in a full health check with your doctor or nurse. “Just make sure you schedule a double appointment,” she advises.

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This article was written by Fiona Baker and edited for Kidspot New Zealand. Sources include The Jean Hailes Foundation for Women’s Health and Time To Screen (NZ Ministry of Health)

This article contains general information only and is not intended to replace advice from a qualified health professional.

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