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Barriers to cervical screening in women who have experienced sexual abuse

October 3rd, 2012

Dr Petra

The current edition of The Journal of Family Planning and Reproductive Health Care has two very interesting (and more importantly open access) papers that tackle the issue of women who have been sexually abused and cervical screening.

The first paper ‘Barriers to cervical screening in women who have experienced sexual abuse: an exploratory study’ by Cadman et al details how women who have been sexually abused as children are less likely to use cervical screening services, and outlines how services could be made more accessible to women. The second paper ‘The effects of childhood sexual abuse on women’s lives and their attitudes to cervical screening’ is an editorial by Sarah Kelly discusses the Cadman paper and signposts to additional sources of help. It also provides suggestions on how smear tests can be made more comforting and accessible to women with experiences of abuse.

These suggestions include:

The survivor having time and space to talk about their fears and anxieties of having the test.

A friend or supporter being present during the test.

The smear taker having an understanding and insight into the issues of childhood abuse and the legacy of issues that adult survivors can face.

A discussion of words/responses which would trigger anxiety or flashbacks for a survivor and finding alternative ‘safe’ words to replace these. For example, many smear takers would tell the woman to try to relax during the test. The word ‘relax’ is often used by abusers and can be very frightening for survivors; an alternative is to agree a word in advance to use in discussions with the patient.

A private and comfortable environment for undressing and for the smear test to be taken.

A clear signal agreed beforehand for the woman to be able to halt the test if she needs to at any stage.

These papers may be of use if you are a reproductive health practitioner or work in obstetrics/midwifery. Although these papers focus on cervical screening, similar reactions have been observed in women during child birth. Discussing ways to make smear tests more accessible for those with a possible history of abuse (assuming that in many cases you won’t know a patient’s history) could well improve the experience of having a smear test for all women.

If you are a survivor of childhood abuse you may find the papers upsetting but also useful. The second paper by Kelly contains useful resources to support you should you need it. It may be if you have not discussed your abuse experiences with your practitioner that you could use this research to begin a conversation about your healthcare needs. If you are in the UK and have experience of abuse your GP may be able to refer you to psychosexual therapy on the NHS.

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