Many people put off cervical screenings due to feelings of anxiety or embarrassment. In this feature, we spoke to two obstetrician-gynecologists to find out what you should know and do to feel prepared and let go of the anxiety.
Cervical screening — also known as a smear test or Pap smear — is an important part of looking after the health of female bodies.
Other causes of anxiety relate to body image and the psychological discomfort of being in a vulnerable position in front of a stranger.
Medical News Today spoke with Dr. Zahra Ameen, a consultant obstetrician-gynecologist (OB-GYN) at the Cadogan Clinic, and Dr. Apurva Shah, an OB-GYN at Women’s Wellness Associates at Saint Vincent Hospital and a member of the Mira medical advisory board, to learn more about what goes on during a screening and how to prepare for one with confidence.
“Fear and anxiety of having a pelvic exam is probably the single most common reason that people avoid cervical screenings,” Dr. Shah told us. “Other reasons are lack of knowledge of the purpose of screening, lack of resources, past history of physical abuse. It is a very intimate exam and can feel like an invasion of privacy for many.”
Yet it is crucial to overcome the anxiety to minimize the risks of cervical cancer and other gynecological health problems.
“The most important thing for women to understand is that cervical screening is a potentially life saving test and is the very best protection against developing cancer,” Dr. Ameen emphasized.
“The test detects infection with HPV and whether there are any abnormal, precancerous cells in the cervix, at an early stage, before it develops into cancer. If everybody attended their regular tests, 83% of cervical cancers could be prevented. It’s over very quickly, and 93% of cervical smears are normal,” she noted.
During the appointment, you undress from the waist down behind a screen and use a disposable sheet to cover your pelvic area.
The medical professional conducting the screening then asks you to lie on an examination table in a position that allows access to your vagina — usually with your knees apart, though this may vary, depending on what is most comfortable for you.
They then use a tool called a speculum to gently open the vaginal walls and gain access to the cervix. Many people worry about the size of the speculum, but this should not be a concern, Dr. Ameen told MNT.
“The size of the speculum differs from person to person and is dependent on your age and the size of your vaginal opening,” she explained. “It will usually only need to be opened to 2.0 to 2.5 centimeters wide in order to perform a smear test.”
The healthcare professional conducting the screening then uses a soft brush to collect cell samples from the cervix. They send the samples to a laboratory for analysis.
The entire process should only last a few minutes.
“It’s also very important to remember that the medical professionals conducting the smear tests are experts and have conducted numerous cervical screening tests before,” said Dr. Ameen.
It is only natural to feel discomfort at the thought of having your intimate parts checked by a stranger. But it is worth keeping in mind that this person knows what they are doing — and they are not there to judge your body.
Moreover, since they have conducted this procedure so many times, the health professional will understand any worries you may have, so it is worth communicating openly about any anxiety or discomfort.
“If you are really concerned or anxious about any part of the test, it’s advisable to speak with the doctor or nurse in advance, as they can help make the test more comfortable for you and talk through any of your concerns,” Dr. Ameen also suggested.
“Smear tests should not be painful. You may experience a little discomfort in your pelvic area and some pressure, but this [is] momentary,” Dr. Ameen explained.
She recommended asking to change positions on the consultation table to see if it helps ease any discomfort:
“Some people find that different positions reduce discomfort, such as putting your hands under your bottom to tilt your pelvis up and allow [your] legs to gently open and relax, allowing a more comfortable clinical examination.”
“Using a lubricant can also help with the insertion of the speculum,” she added.
Dr. Shah noted that it is important to find a healthcare professional whom you trust, in order to prevent physical as well as emotional discomfort during a cervical screening.
“Feeling in control and seeing a provider you can trust is key,” he told MNT, explaining that “Once you are in a position of trust, it really impacts how your body and your pelvic floor responds to an exam.”
The more relaxed and in control you feel, the less likely it is to have discomfort during the screening, he said, because, “The pelvic floor which would otherwise resist the speculum will relax and allow for a much gentler exam and an overall better experience.”
Part of establishing trust with the healthcare professional, Dr. Shah added, involves communicating openly with them about what the screening entails and your own worries about it.
You could also ask to take a more hand-on approach. “If you feel more comfortable inserting the speculum yourself, go ahead and ask to do that. You would be surprised how much easier it is for you,” he suggested.
Bringing a friend for moral support could also help, said Dr. Shah.
Both Dr. Ameen and Dr. Shah shared some tips for keeping calm during the appointment, if anxiety feels like it is starting to take over.
Ahead of their first smear test, many people wonder what is best to wear. Dr. Shah suggested wearing whatever makes you feel most comfortable, not just to make it easier to undress and dress, but also to help you feel more confident and relaxed.
“I believe much of our confidence and control emanates from our image, and whatever attire provides comfort and confidence is the way to go,” he said.
During the appointment, Dr. Ameen said, “Remember to take deep breaths, which will help calm you — don’t hold your breath, as this will make your muscles tense and increase discomfort.”
If it is difficult to clear your mind, you may want to use something distracting to help shift your focus. “I have had patients play music, some watch Netflix, others talk about their hobbies,” said Dr. Shah.
Dr. Ameen also noted that, for people who are really sensitive to physical discomfort, taking over-the-counter pain relief medication, such as acetaminophen (Tylenol) half an hour before the appointment might help prevent any painful sensations.
“It’s important to remember that you have complete control, and you can ask the medical professional to stop at any point, especially if you are in pain.”
– Dr. Zahra Ameen
MNT also asked the OB-GYNs if it is likely for pain or bleeding to develop after a smear test. Usually, they said, smear tests do not induce any further discomfort or bleeding, though occasionally light spotting may occur, as the brush used to collect cell samples may sometimes irritate the cervix.
“Some people may experience spotting or very light bleeding following a smear test as the blood vessels of the cervix are irritated, and this is not uncommon and not usually any cause for concern,” Dr. Ameen told us.
Heavy bleeding after a smear test is not common, and anyone who experiences this or other symptoms should seek a doctor’s advice as soon as possible.
“If you experience heavy bleeding which is not your period, severe cramps, or blood clots following a smear test, it’s important to speak with your doctor to rule out other health conditions. You know your own body, and it’s important to listen to it,” said Dr. Ameen.
It usually takes 1–3 weeks to process a smear test sample and receive the results. In most cases, the results come back clear, but sometimes the laboratory analysis picks up on abnormalities in the cells. Still, this is not a reason to worry, explained Dr. Ameen.
“If the smear test comes back as positive for HPV or abnormal cells on the cervix, it is important to remember that this does not mean that you have cervical cancer,” she noted. “It means that you would need a review with a specialist gynecologist, where they will carry out a colposcopy to get a closer look at your cervix, and they may need to take targeted biopsies.”
Also, in some cases, the lab finds the sample unclear. You should avoid scheduling a smear test on a day when you are likely to have your period, as blood cells could interfere with the sample, making it unreadable, and you may need to reschedule the test.
For the same reason, you should avoid using any creams on your vagina for 2–3 days before the test.
Perhaps the most important thing to remember about cervical screenings is that by scheduling and attending them regularly as advised, you are taking control of your own health.
“It is not uncommon to feel the anxiety [about smear tests], but you can fight the anxiety with knowledge,” said Dr. Shah.
“Educate yourself as to what to expect, communicate your feelings with your provider, develop situational awareness while in the exam room, and feel free to speak up,” he urged.
“It is your body, and no one gets to treat you in a way that you don’t like. I believe that once you develop that feeling of control, the anxiety will melt away.”
– Dr. Apurva Shah