Audrey, our Women’s Worker for Glasgow & Clyde, is taking over our blog this week to talk about smear fear! For most women, a smear test will at least be unpleasant, but for those who are survivors of rape and sexual abuse, they can be extremely distressing experiences. Audrey talks us through how specialist services can support you through the process as well as some techniques to try yourself.
From the age of approximately 25-49 women with a cervix are offered a routine smear test every 3 years, with women aged 50-64 being offered a test every 5 years. If a woman has had a history of abnormal smears she may be checked more regularly and up until she is 70. The purpose of this test is to check the cervix (neck of the womb) for the Human Papilloma Virus (HPV) which causes 99% of all cervical cancers.
HPV is a very common virus affecting 4 out of 5 people in Scotland at some point in their life. Many people are unaware of having the virus as there are often no symptoms and the body naturally fights it off. However, approximately 1 in 10 infections create symptoms and may require treatment.
HPV is a sexually transmitted infection, spread by having sexual contact with someone who carries the virus, including oral, vaginal or anal penetration.
Most people show no symptoms of having the virus and it is not until there are other significant health problems eg painful intercourse, bleeding afterwards, that women are tested by way of a smear test.
A smear test does not directly test for the HPV virus but rather it detects cell changes in the cervix, which, if left untreated, could lead to cancer. Currently there are no tests for HPV in the vulva, penis, anus or throat.
So, back to the dreaded smear test! What is it that stirs up all those feelings in us about it?
What does she think? Do I look the same as other women? What if I’m not clean enough? How can she do that? I should have waxed!!!
Believe me, the nurse or doctor carrying out this procedure is not noticing any of the above things, she is taking a small sample of the cells that line your cervix whilst checking the colour, shape and sensitivity of it.
For many women attending for a smear test is at least unpleasant, at most, a very distressing experience that stays with them long after they have left the clinic and closed the door behind them for another 3 years.
For lots of survivors of rape or sexual abuse this is the worst possible thing that they can think of having to do….. ??? you may know it is not painful, you may know the doctor who is going to do it, you may also know that you have managed before, however, what you know is, that from past experience, this can trigger stuff!!!!
Women’s health services are more aware nowadays than ever when it comes to sexual violence and the trauma it leaves, in some areas there may even be specialist services that you can contact to speak to, prior to actually going through with the examination.
One particular service in Glasgow runs a service for women survivors who have concerns or anxiety around having a smear test done, called My Body Back. It is run by the sexual health services within the Sandyford Initiative in partnership with Sandyford Counselling Services and women from anywhere in Scotland can access this service.
What will happen at this clinic will be whatever you are comfortable with. If for the first time, you feel that you can only go as far as the waiting room, they will accommodate this for you. When you arrange your appointment you can have a chat with them and they will arrange for a female support worker to be there to meet up with you and to have a chat about your concerns or anxiety. For some women this gives them enough reassurance for them to be able to go into the room and meet with the doctor. Your doctor will be female, as will any nurses on duty be, you can go in and speak to the doctor and discuss your feelings with her.
If, at this point you feel you have achieved enough for that session, you can leave making a return appointment for another time. If you feel able to, there is the opportunity for you to try out sitting, fully clothed, in the seat you will be examined on. You will have the chance to look at the equipment used for the examination including the speculum (which holds the walls of the vagina open, approximately 2 centimetres to allow the doctor access to the cervix) and the cervix brush used to sweep the cells from the neck of the cervix for testing. Some women even take a speculum home with them so they can practice inserting it before the smear test.
Whilst the clinic can offer to help you get through the process of having a smear test, there are also things that you can do for yourself.
Grounding yourself before, during and after the test may help. Everyone has techniques that work for them so use your own or practice breathing exercises which focus your mind on counting the breaths and alleviate your anxiety at the same time. You will find many breathing exercises and grounding techniques on the internet.
For some women focusing on the ‘here and now’ is good for relaxing. Focus on the sounds and the smells that are going on around you, feel the chair that you are sitting in, feel your feet on the floor, be aware of where your hands are and about what you are feeling inside your body. Mindfulness is something that needs a bit of practice so perhaps learning how to do this prior to going to your appointment would be helpful.
Music or Sounds
If you find it helpful you will be able to listen to music or sounds whilst having the examination. Just ask the doctor to let you pop your earphones in before she starts.
Although there are support people at the clinic to help you get through the test, some women prefer it to be someone they know. This is absolutely fine, the Patients Charter states that you can have a support person with you at any medical appointment, and this is no different. It is your choice, who you bring, whether they stay in the waiting area or whether they accompany you into the examination room. Dignity can be maintained by having them stand close to your head or shoulders so that they can, if you want, give you words of encouragement.
This is about acknowledging that you are feeling anxious but not allowing it to overwhelm you. You know what is going to happen during the exam, you know the doctor will not do anything she has not discussed with you and remember…. STOP, you can tell the doctor to stop the examination at any point!
So, now that you have successfully had your smear test done, you should be feeling rather pleased with yourself and what better excuse to go and do something nice for yourself?