What is cervical screening?
Cervical screening is also known as the ‘smear test’ or ‘pap smear’. It is a test for high risk strains of Human Papillomavirus (HPV). Infection with HPV is very common and in most cases the immune system will clear the virus within about 18 months without it causing any harm. But if the virus is not cleared, over time it can cause changes to the cells of the cervix and eventually cause cervical cancer. This takes about 5-10 years or sometimes longer, meaning that regular cervical screening can detect HPV that isn’t going away and monitor for any cell changes so treatment can be started early.
What does a cervical screening test show?
If high risk HPV is not found during cervical screening it is highly unlikely for cervical cancer to develop. You will then be invited to repeat cervical screening every three or five years depending on your age.
If high risk HPV is found a further test is used in the lab to check for any abnormal cells. If no abnormal cells are found, an earlier follow up screen is arranged for 12 months’ time to ensure that the HPV has cleared.
If abnormal cells are found, you will be invited for another test, called a colposcopy. Having a colposcopy is similar to having cervical screening but the cervix can be examined in much closer detail to detect any abnormal areas and investigate or treat them through a biopsy or removal of abnormal cells (LLETZ procedure).
What happens during cervical screening?
During a screening test a trained nurse or doctor will use a speculum to look inside your vagina and see your cervix. They will use a small brush to collect cells from your cervix and send them to a lab. It can be uncomfortable but is not usually painful.
The examination will only take around 5 minutes but you should allow 30 minutes to 1 hour in total for your appointment.
Who is eligible for a cervical screening?
Everyone with a cervix aged 25-64 is recommended to have cervical screening. You should receive your first invitation just before your 25th birthday. Screening is usually recommended every 3 years until aged 50 (every 5 years in Wales and Scotland) and then every 5 years until 64.
We can only provide this service for you if your cervical screening is due, or overdue, for routine or follow up screening and/or you have had a letter inviting you to attend for the test. This is because samples taken prior to the correct due date will not be processed by the laboratory.
How do I book an appointment for cervical screening at SHAC?
We offer a limited number of routine cervical smear tests within our dedicated smear clinic on a Thursday mornings. This clinic is only for cervical smears and it is not possible to address other contraception and sexual health issues during these appointments – for this you will need to book a separate appointment.
You can book by telephoning on 01273 523 388. Alternatively, please book an appointment online in our Smear (‘Cervical Screening’) Clinic (Thursday mornings at SHAC East). Trans and non-binary individuals can also book an appointment at Clinic T (every 2nd Wednesday evening of the month at SHAC East).
Information for trans masculine people about cervical screening
Everyone with a cervix aged 25-64 is recommended to have cervical screening. Unfortunately, if you are registered as male with your GP you won’t automatically be invited for screening. But if you speak to your GP practice they can often set up a recall on their electronic system to remind you when it is due. We understand that, for some trans people, cervical screening can be distressing especially for folks who experience dysphoria related to that part of the body. If you are taking testosterone you might experience dryness or soreness of the vagina which can make cervical screening more uncomfortable.
Everybody is welcome to have cervical screening at SHAC and all our staff are used to working with trans people. We will make sure your name and pronouns are respected and aim to make the experience as pleasant as possible, working with you to meet your needs.
If you prefer a dedicated trans service we are also pleased to be able to offer cervical screening at Clinic-T, our specialist sexual health clinic for trans and non-binary people. You can book an appointment for your cervical screening at Clinic-T by calling 01273 523 388 (option 1), or by using our contact form.
There are lots of ways cervical screening can be made easier for trans folks. If you would like to book an appointment in Clinic-T to discuss cervical screening as a trans person before having the screening appointment you are very welcome.
You may also find it helpful to watch this short video:
Fox: How are we gonna start this video? Um, you might be This is a weird one because, okay, so, one of us has a cervix.
Owl: Guess who?
Fox: Okay, suspense over. I have a cervix.
Owl: And I don’t.
Fox: So if you’re a trans person with a cervix, registered with a GP in the UK, aged between 25 and 64, please, please, please, get yourself checked on a regular basis.
I don’t think anyone actually enjoys the process. Regardless of being trans or not. I do find it really, really invasive, and I know it could really save my life, which is why I’m gonna go do it.
Two people die of cervical cancer every day in England.
Owl: Most of it can actually be prevented if people regularly go have a cervical screening.
Fox: You should go get a cervical screening every three to five years. I have booked an appointment to go get a cervical screening and I will be taking you through the process today. I am going to go see a doctor who runs a clinic called Clinic T.
Owl: Cue video.
Fox: Cue video.
We’re off to the hospital, and I have been seriously putting this off, I really did not want to do this at all, but, you know, for the sake of my health. I’m actually going to see someone who is a trans woman. And, uh, she runs a health clinic. So, she’s offered to help out and give me a cervical screening today.
So, here I am, in the room where it’s all gonna happen. I know at some point when I had a cervical screening, there were abnormal cells that were found. I hope that everything’s okay now. I’m not looking forward to it, like, you know, having to go through the actual process, but it’s a necessary evil, so, that’s why I’m here.
Dr. Nambiar: …from the waist down, just lie down on the bed. Put something to cover you over, um, and then, I’ll, pull the curtains to give you a little bit of privacy and then just open it up and then have a look for the cervix.
Fox: Okay
Dr. Nambiar: When I can see the cervix then we’ll just use this soft brush to take a sample.
I’m just going to fill in some details on here and then we’ll get out of your way and give you some space and some privacy just to go.
Fox: Thank you. I’m going to strip off from the waist down, take my trousers off. I’ve chosen to keep my socks on.
Dr. Nambiar: So, if any time you want to stop, just let me know.
Fox: Sure.
Dr. Nambiar: Are you okay like that?
Fox: Yeah, it’s okay. It’s a little bit tight and uncomfortable, but that’s okay.
Yeah, so that wasn’t so bad. It only lasted like 30 seconds and, I feel like I was treated with dignity and respect, which is huge.
Dr. Nambiar: The letters come directly from the screening service.
Either it can come back completely normal, in which case we would just do another screen again in three years time. That’s a routine. You remember when you have that done, it’s important that we let your GP know.
The other outcome is that cervical screen could come back showing an inadequate number of cells there.
And sometimes that’s the case, and it’s a little bit more likely in trans guys, unfortunately. And that’s just an effect of being on testosterone. If that’s the case, then you need to come back for a repeat, um, test. And you should leave it about three months. Just let the cells recover.
It could come back showing the abnormal cells. And those abnormal cells, would need to be looked at in a bit more detail and we’ll get a letter to go over to the colposcopy department and they do some more detailed tests to try and figure out what’s going on there.
Fox: Thank you so much, I really appreciate it. Yeah, you made it just a really, um, I wouldn’t say pleasant experience, but you made it a lot better, so yeah, I really appreciate it. Thank you very much.
So, a number of trans people may not actually receive a letter about getting a cervical screening. I did happen to receive one a few weeks ago, and it was addressed to a Mr. Fox. I think the language was slightly clunky, but I was kind of surprised to actually receive one.
Owl: But if you’ve changed your details with your GP and you’re no longer registered as female, it’s very unlikely that you’ll actually get an invite. So you have to specifically contact your GP and ask that you get an invitation regularly.
Fox: So you actually receive letters to go get cervical screening, don’t you?
Owl: I do, because anybody that’s registered female will get that regardless of whether they’re trans or not. Even though it might seem quite obvious it’s important to mention that people who’ve had a vaginoplasty don’t actually have a cervix. So you don’t actually need a cervical screening. I do however encourage you to check with your GP and make sure you’re healthy.
So even if you missed the invite or even if you ignored it for a while, it’s never too late to actually go get a cervical screening. So definitely, please, please, please go get it checked.
Fox: It could end up being the most important five minutes that you spend this year, and the benefits really outweigh the, the uncomfortableness that you might experience for a short while.
Owl: Cervical screenings aren’t actually a test for cancer, but they are a test to check the general health of your cervix and to check if there are any abnormal cells forming that might later lead to cancer. So if there’s any detection of abnormal cells, your GP will send you on further to get that checked properly.
So it is a very preventative method to make sure that you’re actually healthy.
Fox: I know it could be kind of an uncomfortable time for anyone. Perhaps you could bring along a friend or a family member to hold your hand. I brought Owl along with me, which was very helpful. You can also talk to your nurse about it, talk to your GP and they can make sure that they can go the extra mile to make you feel comfortable by going slower, or talking you through the process a bit more.
Owl: There’s also breathing exercises you can do. You can listen to music, you can listen to podcasts. And you can generally just try to make the experience a bit more comfortable.
Fox: And I think that people often think it’s a bigger thing than it actually is. If you do it on a regular basis, then you can just know that everything’s working fine. And yeah, you can just get on with your life, basically. And this will prevent anything bad from actually accelerating.
Owl: If you’re worried that your GP or your surgery might not respect you or your needs, there are specific trans clinics that deal with trans people.
Fox: We’re talking about Clinic T that’s based in Brighton, Clinic Q that’s based in London.
We’ll put details in the box below.
Owl: And those are really, really great services that you can access as a trans person.
Fox: If you’re having a particularly difficult time with your GP, you can actually move GPs. Perhaps you could talk to other trans people around and find out what GP best supports them. So I’m also going to put links in the box below with information on the NHS cervical screening.
To make sure that everybody gets this information, we’re using the hashtag #cervicalscreeningsaveslives. So don’t delay, book an appointment to get your cervix screened as soon as possible. It could literally save your life. This public service announcement has been brought to you today by myself, Fox
Owl: and Owl.
How to prepare for cervical screening
It’s normal to feel a little anxious about your cervical screening appointment, especially if its your first one or you’ve had a bad experience before. Although cervical screening can be a little uncomfortable, it shouldn’t be painful. However we understand that, for lots of reasons, people can find cervical screening difficult.
Sometimes it can be helpful to think beforehand about things that you would like to happen at your appointment so that you can let us know what you need in advance.
For example:
- You might prefer your appointment to be with a clinician of a certain gender. Whilst this is not always possible we will try to accommodate this. It’s best to contact us in advance in this case. You may also want a chaperone (a trained healthcare worker) to be present during your examination
- You might want to bring a trusted friend or family member with you for support. We will ask them to wait in the waiting area while we talk to you. This is clinic policy for everyone, and it gives you a space to ask any questions or discuss anything you may want to keep confidential. If you wish, we can then ask them to sit with you during the procedure. However, it is important that they do not obstruct the area the clinician is working in
- You will be given a paper sheet to cover up your lower half during the exam but you might like to bring a blanket or choose loose clothing like a skirt or long shirt to cover up instead
- Some people like the clinician to talk them through each stage of the examination whereas other people prefer that the clinician talked to them about something else, or didn’t talk at all. All of these approaches are valid, just let us know what you prefer. Some people find grounding or distraction techniques useful during the procedure – this might include square breathing , listening to music with headphones, a fiddle toy or exercises like the 5,4,3,2,1 technique
Square breathing
Starting on one side of the square.
Breathe in, 2, 3, 4. Hold, 2, 3, 4. Breathe out all the way, 3, 4. And hold your breath, 2, 3, 4.
Breathe in, 2, 3, 4. Hold, 2, 3, 4. Breathe out all the way, 3, 4. And hold your breath, 2, 3, 4.
Breathe in, 2, 3, 4. Hold, 2, 3, 4. Breathe out all the way, 3, 4. And hold your breath, 2, 3, 4.
Breathe in, 2, 3, 4. Hold, 2, 3, 4. Three, four. Breathe out all the way. Three, four. And hold your breath. 2, 3, 4.
Breathe in. 2, 3, 4. Hold, 2, 3, 4. Breathe out all the way. Three, four. And hold your breath. 2, 3, 4.
Breathe in. 2, 3, 4. Hold. 2, 3, 4. Breathe out all the way. Three. Four. And hold your breath. Two. Three. Four.
In
And hold.
Breathe out.
And hold.
Breathe in.
If you’d like to keep going, keep pressing repeat.
Now let’s go back to breathing naturally. You can put your hand on your tummy or over your heart to feel your breath move in and out.
Remember – you can always do square breathing whenever you need help to focus or calm down.
- Remember that you are in control of your body and of the procedure and you can stop the examination at any point. It may be useful to agree a word or hand signal in advance which will let the clinician know they need to stop
- Some people feel more comfortable or in control if they are able to insert the speculum to start with. Speak to your clinician if you would like to do this
- You might want to plan in advance how you are going to get home afterwards e.g. are you going to use public transport, drive, ask a friend for a lift?