Huge thanks to Sam Evans Sexual Health and Pleasure Expert and co founder of jodivine.com for writing this for us.
These are some useful tips which may encourage you to attend your appointment and make it easier and more comfortable to have your smear test.
You may be worried about having your smear test if you experience menopausal symptoms such as vaginal dryness or soreness, lichens sclerosis, vaginal tightness, vulval or vaginal pain or you may have had a less than pleasant experience during a previous smear test.
Firstly, if you have any concerns or worries, ask to speak to the practice nurse or your GP and let them know how you feel.
You can ask your GP or practice nurse to prescribe local oestrogen in the form of a pessary, cream or ring that you use several weeks prior to your appointment. If you are concerned about using HRT it may reassure you to know that topical/local oestrogen gets absorbed locally into the walls of the vagina, not the bloodstream. The dose of all these preparations is very tiny, for example, using Vagifem (a pessary) twice a week is the equivalent of taking 1 HRT tablet each year. It replaces the depleting oestrogen in the walls of the vagina, helping it to become more flexible and healthier too.
You will need to stop using your local oestrogen two days prior to the smear test.
Some women who have had breast cancer may be able to use local oestrogen so speak to your oncologist or GP.
In addition to or as an alternative to local oestrogen using a good pH balanced vaginal moisturiser can help too. Always check the ingredients because many well-known vaginal moisturisers, including products available on prescription, contain irritating ingredients, such as glycerine, glycols and parabens. You can use medical or silicone dilators or a slim sex toy with a pH balanced lubricant to gently stretch the tissues which can help to open the vagina making insertion of the speculum feel more comfortable.
Vaginal speculums come in different sizes so ask your practice nurse to use the smallest one, they can order one for your appointment if they do not have small ones, some women even buy their own online (not that you should have to do this though.) You can ask to insert the speculum yourself, going at your own pace and finding a comfortable position for you.
There seems to be confusion about using lubricant because it may affect the sample, however I’ve asked several practice nurses including my own who said they all use a waterbased lubricant and would never attempt to do a smear test without it.
You can also take your own water-based lubricant to use too. I take YES organic water-based lubricant. As long as the lubricant is used only along the shaft of the speculum and is kept away from the end of the speculum where the sample is being taken it should be fine.
Any nurse/GP that refuses to use lubricant, just refuse to have your smear test. No lubricant, no smear test!
If it feels painful, ask them to stop immediately. Do not allow them multiple attempts as this will cause more anxiety and can lead to constriction of the muscles of the vagina making insertion of the speculum difficult or not possible. From experience I now know there is only one practice nurse I will allow to do my smear test so ask the practice if there is someone else who may be better suited to doing your smear test.
If not, you can ask to be referred to a specialist genital/vulval pain clinic to have your smear taken. Many NHS Trusts offer specialist women’s health clinics designed to ensure you are able to have a cervical screening safely and without pain.
Anyone who may have experienced trauma, female genital mutilation or abuse can be referred to a specialist clinic as mentioned above. Many specialist clinics offer counselling and psychosexual therapy so it is important to talk to your GP.
On a practical note, women who have a disability may not be able to access the room/clinic, get up onto the examination couch or position themselves comfortably due to limited mobility or pain so adaptations need to be in place, such as home testing which is done in some areas of the UK or being referred to a specialist clinic as mentioned above.
- Talk to your GP/practice nurse in person or over the phone.
- Ask the practice if they have a small speculum in stock and if not, ask them to order one for your appointment or purchase your own if you wish to.
- Ask to be prescribed local oestrogen to use for several weeks prior to your appointment.
- Use a vaginal moisturiser for several weeks prior to your appointment.
- It is recommended that you have your smear test mid menstrual cycle.
- You can take a friend or family member with you.
- No sex at least 24 hours before your test as sperm, lubricant, spermicidal gel can impair the sample and make getting a sufficient sample difficult.
- If you have been using vaginal pessaries for an infection, such as thrush, it is advisable to postpone your test for at least a week after completing the treatment.
- If using local oestrogen for menopausal symptoms, stop using for 2 days before your screening and on the day.
- Do not use a tampon for 2 days before screening.
- Do not use feminine hygiene products (not that these are recommended as they disrupt vagina pH and our friendly bacteria) for 2 days before screening.
- You can be covered with a paper towel if you feel embarrassed or keep your skirt on if you are wearing one.
- Take your own water-based lubricant to use if you would like to.
- Insert the speculum yourself.
- The more relaxed you are, the less discomfort you will feel, I tend to chatter all the way through my smear test.
- If it feels painful, ask the nurse to stop and ask to be referred to a specialist clinic.
- You can have a smear test at a sexual health clinic if you do not want to go to your GP surgery if you can find one in your area that is funded to do smear tests.