Saturday, 27 January 2018

A Honest Chat About Smear Tests

Smear tests. Cervical screenings. Pap smears. Probably ones of the most heavily dreaded medical procedures. They've been mentioned a lot in the news recently as the percentage of young people going for smear tests is at a new low. The Jade Goody affect, as it's being referred to as, is wearing off. 

I turn 27 in 2 weeks and I’ve had 1 smear test in my life. Well, sort of. I don’t know if you could count it as a full-blown smear test. Here in Scotland, the NHS starts offering smear tests from the age of 20 and every 5 years after that. So really, by their guidelines, I should have had 2 by now. I use the words ‘should have’ with hesitation because I don’t believe there’s any ‘shoulds’ when it comes to adults making their own decisions regarding their bodies and their health. So, yeah, I’ve had 1 smear test in my life. 

As I was approaching 20, I knew that the letter would inevitably drop through the letter box sooner or later and I was quite adamant that I wouldn’t be one of those people who put it off and never got round to booking it. When the letter finally did arrive, I phoned promptly and proudly proclaimed to the GP’s receptionist that I wanted to be an appointment. I read, and naive took as gospel, the leaflet they enclose and I felt relaxed about it. How bad could it be, I thought. So I went to the doctors. 

It was a week day I believe, and it was after uni, my sister drove me there and waited outside. I wore a black dress with white polka dots so I could easily remove my tights. As I walked into the doctors office, it was a nurse I’d never met before. She didn’t introduce herself, so I didn’t either. She barely said anything in fact. I sat awkwardly on the side of the bed until prompted to undress. She asked me the usual questions regarding my sex life. Well, I say ‘the usual’, but to be more specific, she said ‘I assume you are sexually active?’ I was quite taken aback by this. I’d never been discussed my sex life with anyone but partners or close friends. I was, for my age, fairly inexperienced and hadn’t had the most pleasant or consensual experiences with sex. Both the sex itself and the people involved. 
Retrospectively, I now realise that when medical professionals ask ‘are you sexually active?’, what they are usually asking is ‘is there any likelihood you could be pregnant?’ - hence the follow-up questions regarding birth control and contraception. Anyway, she asked if I was sexually active, which I wasn’t really, but felt backed into a corner so said yes. 

She told me to lie on my back on the bed with my knees bent and my legs open. Considering my age and my, I’m sure, outwardly anxious presence, I expected at least a short briefing as to what she was going to do or for her to explain it as she went. But nope, you could hear a pin drop. It’s only until recently that I discovered lube is commonly used during smear tests. I’d never had known as she made no mention of it to me. Likewise, the rather ironically named modesty blanket. Not a peep about that either. So I lay there, in silence, my whole body clenched in anticipation as I waited for...something, I still wasn’t quite sure what exactly, to happen. She began. She poked and prodded And without any prior warning, she rammed some medical instrument right on in there. And I screamed. I literally screamed out in both agony and shock at the sheer force she had used. ‘Keep your voice down!’ she said. So I did. I shut up. I lay there silently trying to stop myself from whimpering as she tried again. The same thing. ‘Look, you’re going to need to keep your voice down, there’s other patients in other rooms!’ I was completely dumbfounded by her lack of sympathy and tact. ‘You can leave and come back another time if you want?’ she said reluctantly, clearly irritate that I had wasted her time. So I did. I pulled my tights back, slipped on my shoes and left as fast as I could. And I’ve never been back. Hence whether I would even count that as a full smear test.

There's two things I want to stress. Number 1 : I know my experience is not reflective of how most people's smear tests go. This is not the norm and I am well aware of this. Number 2 : comparitive to medical trauma that many people face, I realise this experience is nothing in comparison. But even with these two things in mind, I am put off going back. And you know what I've came to realise? That's perfectly okay.

Like I said, as a grown adult, I can make my own decisions about my body and my health. I decide what I wear, what I eat, how much or little exercise I do, how much alcohol I drink, if I smoke or do drugs, how much or little I sleep, my body hair, my sex life, my body modifications. I can make all of those decisions for myself. However, I can't help but feel that smear test propaganda is moving into dangerous territory and downplaying the element of choice. In a social and political landscape whereby rich, cishet, white men in suits make decisions every day that limit women's choices about their bodies, the rhetoric surrounding smear tests seems to focus ever more on scaremongering rather than educating and I, for one, am not really okay with that.

The main messages we are given regarding smear tests are that it's over before you know it, it doesn't hurt, it's not embarassing and, sadly, that it's barely even optional any more, but rather a requirement. All of these things are inaccurate and in many cases, outright untrue. For queer people, trans people, women without cervixes and people of other genders with cervixes, victims of sexual assault, people with body confidence issues and survivors of medical truama, smear tests can be lengthy, painful (sometimes excuriatingly so) and humiliating, therefore not always an option. I'm not telling you not to go for a smear test if you have been calling up for one (what awful terminaology, it's not the army?!), but if you can't go, don't want to go or have reservations, doubts or special requests that you'd like your doctor or nurse to accomidate, thats okay too.

There are a number of ways we can help change this problematic rhetoric, both in regards to your own confidence in going for a smear test and in how we talk to others about it. If you're going for one, like I said, lube. Lube is your friend. Like, generally speaking in life, lube is your friend, but in a smear test context, especially so. Use it before hand, take it with you, ask the doctor or nurse for some. If you need a lot of it, that's perfectly okay too. Don't be embarassed. If you feel it would help you feel more at ease, book a doctor's appointment before the actual smear test itself to ask any questions you have. That's totally okay too. Doctors are there as much for advice as for actual procedures so fully utalise their knowledge. Take someone with you. Like I said, I went with my sister, and although she waited outside in the car, it's comforting knowing there's someone there. Or better yet, take someone into the room with you. It's allowed, trust me, I've checked. Do your research, read about people experiences, especially people who identify the same way as you do and who've experienced similar things to you. Ask your friends or family who've had smear tests questions if they're cool with that. When talking to others about smear tests, try and avoided gendered terminology as much as possible. Not all women have cervixes. Not everyone with a cervix identifies as a women. Likewise when talking about sex, birth control and contraception, remember that people of all sexual orientations have both sex and cervixes. Don't just talk about sex in terms of a penis in a vagina (apparently that's what all the straight kids are doing these days, who knew, eh?) and for the love of all that is holy, remember that contraception is just as much for the purpose of preventing the spread of STI's as it is for preventing pregnancy. 

Ultimately, there are a million reasons why a smear test might be hard or even impossible. If you've had an easy ride of it, that's fantastic and I'm happy for you, but it's important to acknowledge that not everyone does or will and it's important not to erase their voices. But most importantly, remember, it's your choice. Educate yourself, yes, educate others, of course, but don't shame anyone for the choice they make regarding their own body. 


  1. What a wonderfully honest post!

    It's genuinely such a relief to read something about smear tests that isn't essentially just shouting at other people to just get it done and that it is super easy. I feel like on Twitter recently that's all I have saw and if anything, that sort of peer pressuring behaviour is gonna have the opposite effect on me.

    I should have booked mine a year ago, and everyone likes to constantly remind you to get it done but I just can't seem to find it as simple as that. I'm sure I will book it in soon but I think it is a pretty big deal and not many people are talking about that.

    Thank you for reminding us that we still have a choice and for sharing such a personal experience x

  2. Lube is your friend. Valium is also your friend. And you can ask for a smaller speculum if you need one - they'll tell you they might not necessarily get an accurate reading, but it worked fine for me.

    I hated my first smear so much that I put off my next for seven years, so I've convinced myself that the abnormalities they found when I finally sucked it up and went again were god's way of punishing me. Since then, I've been on a fairly regular six-monthly cycle - god knows what's going on down there, so I'll take the advice and hope it keeps me as safe as possible. But it's NOT painless for everyone, it's NOT easy for everyone, and it's good to read a post that acknowledges that.

    And sensitive, sympathetic medical professionals are a must. I'm sorry you weren't even granted that.

    Here to talk, if and when you decide to bite the bullet again.


  3. I'm sorry to hear of your experience. I was fortunate to have my first (and currently only) smear done by my regular female doctor whom I know and get on with well. She explained everything at each point and was very gentle.
    My advice to everyone is to try and relax, the more you tense, the worse it will be (easier said than done I know)
    You can ask the doctor or nurse to talk you through it first. Also if you are more susceptible to pain, have a couple of paracetamol 40 mins or so before hand.

    I hope your next experience is much gentler, and that you never have to go through that again xx

  4. Thanks so much for share by Sophie!

    I’m so upset by your experience, and aged 27 I’ve not had one yet. I’ve been advised not to currently due to some fistulas I have and that it could make them worse, so I do feel like people try to shame me!

    I do feel if people could, they should, but there are so many reasons why people can’t.

    Much love xx