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Painful Smear Tests

It’s cervical screening awareness week , and with 3064 new cases of cervical cancer every year, it is becoming increasingly important that we attend our smear tests to detect the changes to cells on our cervix that might develop into cancer in the future as it is estimated that cervical screening can prevent up to 75% of cervical cancers from developing.

Around 5 million women in the UK are invited for cervical screening each year but unfortunately 1/4 of women don’t attend theirs. A large proportion of these non-attenders are women over 50  (32% of over 50 year olds) who do not feel a smear test is relevant to them, but need to be reminded that 1 in 3 cervical cancer cases are in women over 50.

However the remainder of people who don’t go for their smear tests often have other excuses like not having the time or it being too painful. I’d therefore like to address the latter and give women some hints and tips to try and manage the pain for their next smear:

1. The majority of pain that people experience is often related to anxiety which causes your muscles to contract, making it more difficult to insert and open up the speculum. One way of managing this is through breathing and relaxation techniques. Practice your abdominal breathing for two weeks prior to your smear test, and think of a place that you find peaceful like the beach or a lake and envisage yourself there. Some people find that talking during their smear test helps keep their mind off the tension and in those that are particularly anxious, I sometimes recommend they listen to their favourite tunes on their iPods.
2. If the pain is related to the smear taker not usually being able to find your cervix initially and having to spend longer to do so, then it is worth explaining this to the doctor/nurse, and they may want to examine you a bit more thoroughly initially to ensure they can locate the cervix and its angle before putting the speculum in. In some cases it can be easier to find if you place your hands under your bottom to help tilt the pelvis.
3. We are all  built in different ways and some people have smaller vaginas than others, and we have a lot of different sized speculums to match. Your doctor/nurse could try using a smaller speculum if you have previously suffered with a lot of pain with the larger ones. It may be worth taking a simple pain killer like paracetamol before your smear to help.
4. In menopausal women the low levels of oestrogen can cause the vagina to be dry and/or inflamed, and this in turn can make the smear test more uncomfortable than usual. This can be corrected by using an oestrogen cream inside the vagina, so please discuss with your GP whether this may be an appropriate management for you.
5. Remember that just because it was painful on one occasion, it doesn’t mean it always will be, and if you had a bad experience with one smear taker, you can certainly ask to have your smear test done by someone else the next time.
6. Failing all of the above, another option is trialling medications like diazepam which is a muscle relaxant and  helps with anxiety disorders. However it does have some unwanted side effects and contraindications, so it should only be considered if you really can’t face your smear test otherwise and you would need to discuss with your GP whether this is appropriate for you.