Despite what your Instagram feed may look like, we are still in the middle of a global pandemic. The impact of COVID-19 has led to changes to a lot of services, including cervical screenings.
What is a cervix?
The cervix is the opening to the uterus from the vagina, it joins the top of the vagina to the lower part of the uterus.
What does it do?
It plays an important role in the reproductive system. During menstruation, the cervix opens slightly to allow blood and tissue to flow out of the vagina. Throughout the menstrual cycle, the glandular cells in the cervix secrete a fluid called mucus (most commonly known as vaginal discharge). Cervical mucus keeps the reproductive system healthy and helps protect the body from bacteria that could cause infection. During pregnancy, the cervix closes to help protect the baby until it is ready to be born. Once the baby is ready to be born, the cervix stretches and softens to allow the baby to move from uterus to vagina.
The cervix can feel different during each stage of the menstrual cycle. There’s a whole section in my book dedicated to this!
What is a cervical screening?
A cervical screening (or smear test) is a test that checks the health of the cervix. It’s a test designed to help prevent cervical cancer as it is an effective way of detecting abnormal cervical cells.
In the UK, the NHS cervical screening programme begins at 25. You should receive a request to make an appointment by letter. Appointments are every three years between the ages of 25 and 49, then every five years until 64.
If somebody receives abnormal results, or requires treatment, they are then referred to colposcopy for diagnostic tests. If treatment is required, a follow-up colposcopy at six months happens and then typically they return to routine screening if all if well.
You should get your results by letter usually within two weeks and it will explain what happens next.
What happens during the screening?
- Behind a screen, you’ll undress from the waist down. You’ll be given a sheet to put over you.
- You will then be asked to lie back on a bed with your legs bent, feet together, hands under your butt and knees apart.
- A smooth, tube-shaped tool (a speculum) is inserted into the vagina and opened so the cervix can be seen.
- A small brush is used to take a small sample of cells from the cervix.
- The speculum is then closed and removed, leaving you get dressed.
How has the pandemic impacted cervical screenings?
At the start of the pandemic, most non-urgent appointments were moved to telephone or video calls. The cervical screening programme was officially paused in Scotland, Wales and Northern Ireland. Back in June, NHS England called for cervical screening appointments and reminder letters to be sent out as normal. As things came to a halt, this led to an inevitable backlog of tests to catch up with.
Jo’s Cervical Cancer Trust also reported that many have been put off getting their screening done during this time too. They surveyed 851 women between 29 May and 9 June and concerns included shielding or protecting others and not wanting to add to strain on the NHS.
In addition to this, there are many reports of trans, non-binary and intersex people facing barriers pre-COVID that prevent them from access to cervical screenings. I can’t imagine this has improved greatly during the pandemic.
Other barriers include GPs not having the appropriate equipment to accommodate disabled people as well as a lack of adequate compassion and care for those who have suffered trauma as well as survivors of sexual assault. There are a ton of reasons why people are not getting their cervical screenings, we need to improve access.
Will my cervical screening appointment be any different to my previous tests?
I had my cervical screening appointment in September and it was a little different, but mostly fine! My GP has a new system in place where you wait outside the building until you’re called in. Instead of going straight into reception, I waited in front of a window in the hallway where the receptionist then took my temperature before letting me in. The waiting room had been completely cleared out, there were chairs stacked everywhere and about three chairs available to sit on.
The actual appointment itself wasn’t that different from before. It was quick and we both wore masks. The only thing that had changed was my circumstances. I now suffer with pelvic pain that makes insertion quite painful. So, I made a point of letting the nurse know this. I requested we take it slow and use a smaller speculum.
Cervical screening tips
- If you menstruate, book whilst on your period to avoid booking at the wrong time
- Mention any issues or concerns and ask them to add to your file
- You can ask for smaller instruments, extra lube and you can tell them you’d rather insert it yourself
- You can take it at your own speed and try a different position if needed
- If they refuse any treatment, tell them you want it on record
