I came home one evening after work, tired and stumbling, and rifled through the post that lay strewn in the hallway. I found some for me and plucked it up and hopped along to my room, where I dropped my things (gracefully of course), picked up the letter and inspected it. It was adorned with an NHS logo and, after I slid it out of its envelope, I slid it away from me…into the corner you go. Into denial I briefly adventure.
It was my letter inviting me for my first cervical screening. We all know this day will come but we’re just frolicking along, living our twenty-four year old lives (or earlier for some of us) and then bam there it is:
Adulthood.
I decided to write a small article about the feelings that come along with cervical screening for my work blog. I figured, if I was feeling some fear around it, other people probably are too. It is better to talk about it than not; by arming yourself with knowledge you can sometimes disarm the fear of the unknown.
But this article is more about experience, what the actual screening was like and reflections after talking to many different women of different ages who found their screenings more challenging and those who found it a (relative) breeze.
So, I’m on the phone, outside the bus stop as busses will ‘Full’ signs drive right on by and I melt and sweat in the afternoon summer heat,
“Hello, can I book an appointment to see the nurse?”
“Sure, it will be a telephone consultation first.”
That…might be a challenging, yet novel, way to perform a screening, I think to myself.
“It’s for a cervical screening.”
“Oh! Well, that’s different. Let me check her diary.” *insert pause for about 900 years*
“Er…she’s on holiday and it doesn’t say when she’ll be back. Maybe call back in a week?”
“Oh. Okay? Thank you.” I hang up the phone.
Of course, people take annual leave but I couldn’t help but feel a bit deflated; I really did want to get it done and dusted so I didn’t have enough time to panic myself into frenzy. Life decided it didn’t care about my timeline, as it does with most things, and so I wrote about it instead to unwind the potential for worry to coil itself up inside my stomach.
In that time, a week passes and I call the surgery back. They can’t find me a time and they say they will call me back to schedule it which I found a little unusual, but very kind nonetheless. I receive a phone call, able to book me into an appointment and it is in my diary.
The date rolls around and, it turns out, my period has decided that it might come early. I know this because I am experiencing those one/two day pre-menstrual shadow cramps. Typical, honestly. I call the surgery back and they say they will reschedule me, no problem. This answered a previous question I had around if you could get your screening while you were menstruating. Take note folks, no, you cannot. If you can, schedule your screening for the middle of your cycle in case, like me, your period sometimes likes to give you surprise early visit dates (rude).
Then, the surgery calls me back. Four times. To try and book me in for a screening I have an appointment for. Each time they say they will take the note off the system, each time they just call back anyway. Even though it makes me giggle progressively more loudly each time they call which probably makes me seem slightly unhinged (giggling excitement over a screening? Sus behaviour), I admire their persistence. It is clear that booking in for cervical screenings really is a necessity.
So, the day arrives *cue big scary music*. It is sunny and I am desperately trying to choose clothing that will be comfortable and not compressing and suddenly I feel like I have no clothes at all even though I literally built my wardrobe choices based on comfort and lack of restriction. Classic.
I pick a flowy skirt and have taken the day as working from home, just in case it is extremely painful and I can’t bear to walk to work and sit at a hotdesk keeled over and moaning while my co-workers awkwardly fidget in their seats. I didn’t know what to expect on that score. Even if you talk to people about what screening is like, they tell you about the experience in the nurse’s office, which is great, but not much about pain or cramping to expect afterwards. Will there be bleeding? Do I need to get someone to pick me up? Will I immediately flop down onto the floor? (Spoiler, in my case: no, no, and no).
I ride the bus towards the town centre, jittering with the busses own jolted rhythms and arrive at the doctor’s surgery. It is sweltering and smells anti-septic in a way that stings your nose. I approach the front desk and check in and then I place myself down on the squeakiest chair within a 15 mile radius and wait.
And wait. And wait. Aaaaand that’s my appointment time. And I wait some more. And then it is past my appointment time. And then I continue to wait.
I wait so long that a different receptionist comes to the front desk and asks if I remembered to check in since I had been waiting for so long. I feel gaslit, did I check in? I reply, “I think so...I spoke to your colleag-”
My name is called out and the receptionist looks at me with a smile, relived that I had, in fact, checked in. I am slightly less relieved. I stand to go in on slightly wobbly legs and I can feel the cortisol betraying my calm and quiet exterior, swimming around my body.
As I enter the nurse’s office she smiles brightly at me, tells me to sit and asks me if it is my first screening. I reply that it is and she asks me how I am and how I feel about it. I say I am, “Not at terror-levels of scared, but I am nervous.” She laughs at this and replies,
“Of course you are, that is totally normal.”
At those words I feel myself form a small smile and I feel more at ease. We talk for a long time, she answers all my questions while filling in her essential ones. They ask you the general things and then more specific questions around if you are pregnant, could be pregnant, if you are sexually active, the last time you had sex, if it was unprotected if you did. I tell you this so it doesn’t come too much as a shock! The reason they need this information is because if there is a chance you are pregnant and they do the screening you could miscarry, so it is important to know if you could be pregnant or not.
She tells me about the process:
She will insert a speculum, then she needs to see if she can see the cervix. She will take the swab which I thought would be like a long earbud or one of those swabs that come in COVID-19 test packets, right? Nope. You know those double ended wands that you use to brush your brows and the other side takes out the clump in your mascara? Yeah it looks like that and I’m telling you now I nearly fainted.
Maybe I turned a bit green or my pupils dilated in shock because the nurse says in a very matter of fact but gentle way,
“Some people feel it and some people don’t feel it at all.”
Yeah right. Whatever. I won’t feel the equivalent of the brush in a drive through car wash scraping against my cervix? Likely story. Carry on.
It turns out, it was the angle at which I was seated and fear makes your brain do funny things. I cannot find an image that is guaranteed to be not subject to copyright, but here is what the brush looks like up close. Something more akin to like a brush that you use to dip into egg that you swipe over the top of a pie to make it go golden brown. Much less scary. Much more gently. Also reminds me of pie which is nice.
After the swab is inserted, she does five rotations that she will count. She will then remove the swab, the speculum, and I will hop on my merry way and obsess about the result (that last part may have been added by me and not the nurse).
In seriousness, my nurse was fantastic. She went above and beyond and was compassionate throughout. I appreciate that I am lucky to have had her and her empathy and that not all people get that.
They must ask you if you would like a chaperone, so if you would like someone to be with you, you are well within your rights to ask for someone to be there. This isn’t silly or immature or means that you ‘can’t handle it.’ Procedures like these are intimate and put us in vulnerable positions and there are a multitude of reasons why you may be more comfortable having an additional supporter with you. If you would like a chaperone and you have not been offered one, ask for one.
She leads me over to the bed and draws the curtain over while I undress (which, side note, I find a bit hilarious that we are given privacy to undress and then they stare directly, bright lights and all, into our most intimate regions. It’s still appreciated though.)
I lay down and cover myself with the square of paper they provide and tell her to come in. She tells me to shuffle down the bed towards her and I, again, very gracefully, tear the paper as I go — elegance personified. You’ll have to prop your knees up — heels on the bed, knees pointing to the ceiling and then relax your hips so your knees fall outwards.
I felt very nervous about getting a speculum inserted as many people do. When I was getting my coil removed about a year and a bit prior, the doctor I had inserted the speculum and, for some reason, I found it incredibly painful in a way I hadn’t before. It produced almost instinctive tears from my eyes so quickly I didn’t even realise I was crying and I truly probably traumatised the young medical student in the room with us (sorry!). I felt bad and turned to apologise to him and he held my hand the rest of the procedure. The doctor then reminded me in her lovely, comforting Scottish accent that it was fine to go at my pace and that it was me that was in control. Please remember this in all such procedures. If you need to stop, you can say you need to stop. Communicating this can be hard, but it is your body and it tells you what feels okay and what does not. A good medical practitioner will help you through.
So, when I laid down on the bed to get the screening I was nervous I’d feel that sharp, extreme, and out-of-nowhere pain again. ‘Relaxing’ as we need to do is not always easy at the best of times but if speculums are a bit frightening to you then it makes that a whole lot harder.
The speculum itself is lubricated and inserted (it didn’t hurt and I was so relieved). Then they, and I put this indelicately because it is the only way I can think to explain it, do what feels like cranking it open which feels a bit rude but not edging into the realm of pain.
The nurse looks up at me and says she’s going to need to take the speculum out, that she can’t see my cervix from the angle I’m at and I think, Ugh, why do I have a shy, weird cervix? Where is she? On holiday? I then realised I was cervix shaming myself. A new form a shame that I immediately realised was stupid.
She told me I would need to ball my hands up into fists and place them under my lower back/bum area when I laid down on them again. So, I obliged. Then, she inserted the speculum again, rotated it around, and ‘cranked’ it (medical professionals, I am sorry for this term haha). Then she picked up the swab and told me she was going to insert it and she counted the rotations, one…two…three…four…five.
Listen, I was amazed.
There were rotations that I felt, but actually were not painful. There were a couple of rotations where I did not feel it at all. It was over so quickly that the feeling of my surprise outlasted the whole process. I was speculum-free by the time I could articulate that it was actually not horrendous at all…wow.
The nurse allowed me to get my clothes back on in private and asked me if I had any questions. I didn’t feel any cramping at this point or pain. Drawing back the NHS, powder-blue paper curtain I asked,
“How long should I expect to wait for results? One week? Two weeks.”
“That’s a good question,” she said, looking down as she stirred the swab into a solution. “Normally, we say one week, but with the way things are at the moment, results can take up to eight weeks.”
Eight weeks?
Eight weeks.
I was so glad to get my screening done when I did. Imagine having to wait and wait for such a long time had I left my screening later and later.
“Oh wow, okay, thank you for letting me know.”
It is important to know that you usually receive your results in the post. This will give you results of: 1) HPV negative, where no further tests are conducted until your next cervical screening; 2) HPV positive: no abnormal cells, where the sample is positive and you have HPV but no abnormal cells. You may need to go in for screening sooner to check if the body has cleared itself of HPV; 3) HPV positive: abnormal cells found, where your abnormal cells will be given a ‘grade’ according to seriousness that will be explained to you in a letter. Then you will be invited for a colposcopy; 4) Inadequate result. If this happens, you’ll be invited for screening again in three months’ time. The reason for this wait is so there are enough cells from which to collect another sample.
If you hear nothing that is not indicative good news. You should always seek out your results if you do not hear back.
I actually heard back in under two weeks and was very surprised at the speed. I had a HPV negative result, but I know many women who have had a variety of results and needed to go on for colposcopy procedures for example. If this happens to you please don’t feel ashamed or (too) scared. as the NHS website says, “most people will get some type of HPV during their lives. It is very common and nothing to feel ashamed or embarrassed about.” Try and talk to those in your life who have gone through cervical screening and colposcopy, ask to speak to your doctor/nurse, or you can even talk to me if you just want to vent.
I thank the nurse and tell her she made it a really pleasant experience. I feel so light and relieved and grateful as I head home.
When I arrive home, I open a Facebook Group I am a part of, yes a Facebook Group try not to judge, and I see that many other women are posting about getting their letters and their fears. It was wonderful to see older women weighing in with an almost big sister/mentoring energy and able to relate to some more complex queries. For example, some of these concerns related to vaginismus, where the vaginal muscles involuntarily tighten in response to something attempting to be inserted, and having a cervical smear. The NHS website states that “it is the body’s automatic reaction to the fear of some or all types of vaginal penetration.” Vaginismus can make cervical smears quite a distressing, painful, and embarrassing experience for some people. If you experience, or think you might be experiencing, vaginismus you can make an appointment to see a doctor to talk about your options. You can request a female doctor and please be reminded that it does not mean there is something ‘wrong with you.’
The other thing to note was that there was a slightly worrying prevalence of people commenting that you do not need to get a cervical screening if you are not currently sexually active or have not had sex. This is not true. Even if you are not sexually active, you should get a cervical screening. You can get HPV from any kind of skin-to-skin contact of the genital area, including sharing toys, not just from penetrative sex.
I have even seen people say and have been told by a person I know that when they told their doctor they were a lesbian they said they probably wouldn’t need a screening. Horrifying. To clarify, this is not true either.
Tearing myself away from the screen, I realise I still have no pain and I work away for a couple of hours. Then, I start to feel verrrryyy light cramping and I’m like, Oh no, please stay like this and don’t get worse. It doesn’t get worse.
I wake up in the morning and start making my way to work and the cramping does feel worse. It isn’t anywhere close to a period cramp, but it is a little more intense than the night before and I walk slowly so as not to push myself. By the end of the day it was ebbing away, but something to bear in mind. Some people get some light bleeding, and others do not. Some people get cramping for longer, some people have no cramping afterwards, and I was lucky to just get some mild cramping. I interpreted this as my cervix complaining at me for just having let someone poke at her with a swab which, actually, is very fair.
In my head I just say, it’s for your own good.
And then, as the remarkable cervix-havers that we are, we continue on with our lives.
A big thank you to the nurse who performed my cervical screening. You made what could have been a very scary and unpleasant time a very comfortable experience. Also big thank yous to those at my work who acknowledged and contributed their own experiences of the screening process and acted as mentors to us first timers. Thank you to those in the Facebook Group who were there to support the flurry of panicked posts.
