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Concern grows over women having smear tests

September 16th, 2006

Dr Petra

Over the past few days there have been a number of reports in the UK, Ireland and US around women and cervical smear tests.

Various studies have indicated women (and young women in particular) either have never had a smear or are not getting regular tests, whilst a survey from the Irish Cancer Society suggested one in five women doesn’t want a smear test by a male doctor.

Further problems arise from a lack of female healthcare staff, problems with accessing centres that offer cervical screening, and women believing that cervical cancer is only a problem for people who have been promiscuous.

Smears are important because, when conducted regularly, they can catch and treat problems early. Experts say that cervical cancer is the only form of cancer that’s up to 90% preventable – but only if we do our bit.

The problem is that women aren’t clearly being told what smears involve, why they are important, and how women can manage smears more effectively. Without campaigns addressing these issues – as well as wider choices in how and where to have smears (not to mention more female staff) – women will continue to put their health at risk by not having smears.

You can do more to help by:
* Identifying what services are available in your area and put pressure on your local health authority or primary care trust to offer more services and more female practitioners.
* Where services exist, encourage them to have wider opening hours (particularly evenings or weekends) to allow for women who are working to have greater access.
* Respond promptly when you’re invited for a smear – and attend the tests you’re asked to attend
* Ask your health care provider and pharmacy to provide more information on smears – leaflets can increase our knowledge, whilst posters can be a helpful reminder that a smear is due.
* Help support charities offering advice, testing or treatment on cervical cancer such as:
Jo’s Trust
Cancerbackup
Cancer Research UK

How you can make smears easier
Find out what a smear involves and what it is for
The guides from patient.co.uk and women’s health explains this.

Identify what might happen if a problem is identified
The NHS and Cancer Research guides to cervical screening also have useful information on what happens during smears, possible problems, and treatment options.

If possible have your smear from someone with a lot of experience
Many family planning clinics or nurses within your doctor’s surgery give smear tests on a daily basis so will be more practiced at smears (so will make it a more comfortable experience for you). Ask for your smear test to be completed at your family planning clinic or by a specialist nurse.

Make it clear if you’d prefer a female practitioner to complete your smear

Some women for cultural, religious or personal reasons need a female practitioner to complete their smear – if this is the case with you let your surgery or clinic know when you register or when you receive a call for your smear test so they can make arrangements. If only a male practitioner is available then a female staff member should attend as a chaperone – you may decide this is acceptable for you. It is okay for you to bring a female friend to accompany you (if you both feel comfortable with this).

Because the vagina is linked to sex, some women and their partners mistakenly believe that a male doctor carrying out a smear will be aroused by the process or interested in a woman sexually. This isn’t true. If you have no personal, cultural or religious reasons to refuse a male doctor don’t let misunderstandings about smears stop you getting treatment. Whilst we need to campaign for more female practitioners, we also need to encourage women who don’t mind who gives them a smear (so long as they’re professional) to have smears from men to reduce demands on services.

Talk through your smear with a practitioner first

Doctors and nurses are aware that some women do find smears embarrassing or uncomfortable. You may find talking about what is about to happen and asking them to explain this to you can remove some of your worries. This might include being shown the speculum that is used in the smear (it’s the device that’s inserted in your vagina to enable the nurse or doctor to look at and take a swab from your cervix – see the links above to women’s health and patient.co.uk for more on what a speculum is). Some women find seeing what will be used in the smear reassuring – others may prefer not to do this – you can choose.

Have your smear at the right time

You should avoid having your smear during or immediately after your period – if in doubt ask your doctor or nurse for more advice on when to have your smear.

Don’t worry about showing your vagina to your doc

Lots of women are concerned about a healthcare practitioner looking at their vagina. Remember, when the doctor or nurse is doing your smear they’re concentrating on the task in hand, and they’ve seen women’s bodies countless times. You may feel more confident if you are wearing clean underwear, clothing you can remove easily for your smear, and if you have washed your genital area before the smear test.

You don’t have to lie back and think of England…..
…..or wherever you’re having your smear.
Some women find smears are more comfortable if they’ve had a wee first (if you’re worried about personal hygiene you might find using a wet-wipe or moisturised toilet tissue to clean yourself up afterwards could be reassuring)

You might find that putting the palms of your hands under your bum whilst you’re having your smear tilts your pelvis and makes things more comfortable (this may or may not suit your practitioner or the position they want you in for a smear – if in doubt, ask first).

Remember that you don’t have to sit or lie in positions that are painful – just because your doctor or nurse asks you to sit or lie in a set way doesn’t mean you can’t say it isn’t comfortable or suggest another way you would like to rest for your smear.

In some countries or clinics stirrups are preferred for smears but you may prefer to lie on a bed with your knees up and legs apart – mention this preference to the doctor or nurse before the smear. Even if you have to use stirrups you don’t have to lie back with them – if you’re more comfortable sitting up slightly tell the practitioner.

Ask about lubricant

A smear without lubricant is never pleasant. If your doc doesn’t appear to be using lubricant, or if they’ve not used enough for your needs then say so – they won’t be embarrassed and it will make things a whole lot more comfortable for you.

Insert the speculum yourself

This is a slightly novel idea but since the new plans for sexual health is ‘self management’ why not give this a go? Instead of the doctor or nurse sliding the speculum into you then you can do this bit first. That way you can relax more and let the practitioner open the speculum once you’ve got it comfortably in place. It’s a good idea if you often find this part of the smear unpleasant. Not all practitioners are okay with this and you might want to tell them this is what you’d like to do before you’re lying back with your knickers off. I recently gave it a go with my doc (an older man) who told me quite firmly that I wasn’t allowed to touch myself there (before dropping the ky jelly on the floor and calling for a chaperone!). However friends have tried this with other practitioners and found it has worked well for them both. You decide what you feel would work well for you.

Ask for a speculum to suit your size and that’s not too hot or cold

Speculums do come in different sizes so you may want to ask for a smaller one if your smear test usually is uncomfortable. Also your doc can warm up the speculum under the tap so you don’t get the cold effect (hopefully it won’t be too hot either).

Remember to breathe!

Some women find smears embarrassing or uncomfortable so they hold their breath. This can make smears even worse. You might find it helps to take deep breaths as the speculum goes in and is opened, as well as when it’s closed and removed.

Ask the doctor or nurse to talk you through what they can see so you get to know more about your anatomy

Years ago during a smear the nurse told me exactly where my cervix was. That has proved invaluable since then as I can now tell new practitioners what angle to put the speculum in at and where to look. Cervixes come in different locations and point in different directions – so knowing where yours is can avoid lots of fumbling about or discomfort if the speculum is put in a place that knocks you by mistake. It takes a bit of courage to tell the practitioner about your body – but they will thank you for it.

Don’t stay silent

Speak out if something feels painful, uncomfortable or just ‘not right’ – it could be really important and your doc or nurse needs to know.

Smear tests aren’t the best things in the world, but they’re quick to do and only happen every few years. And once they’re done you know that any health problems you may have can be quickly identified and treated if necessary.

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