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What is a smear test?

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Smear tests: what to expect at a cervical screening (pap test) - results and what they mean

Known as a pap smear or pap test, a smear test is a cervical screening test that detects abnormal cells on the entrance to your womb from your vagina (the cervix). Discovering and removing these abnormal cervical cells can prevent cervical cancer.

What do they test for in a smear test?

Cervical screening is not a test to find cancer; instead the test looks at the cervix and the health of the cells within it. If abnormalities are detected this does not mean that cervical cancer will develop, and many cells return to normal on their own. A test for the human papilloma virus (HPV) has also been added to the cervical screening test. HPV is a virus which can affect the skin and the membranes that line the body, in your cervix, anus, mouth and throat. HPV can cause abnormal tissue growth within your cervix, along with other changes to the cells – these can be detected by a cervical smear test.

How often do you have to have a smear test?

As part of the NHS Cervical Screening Programme, every woman in the UK, who is registered with a GP, will be invited for cervical screenings. How often you are invited to a smear test will depend on your age:

  • Aged 25-49 – every three years
  • Aged 50-64 – every five years
  • Over 65 – only women who haven’t been screened since they were 50 or if they have recently had abnormal test results

Regularly attending cervical screening tests will mean that any abnormal changes in the cells of the cervix will be detected at an early stage, and this would stop cancer from developing. However cervical tests are voluntary and it is your decision whether you attend them or not.

When should you go for a smear test?

If you’re registered to a GP in the UK, you will be invited by letter to attend a cervical screen test. Once you have the letter you’ll need to book an appointment for the test at your GP surgery. Make sure to book your appointment on a day when you won't be on your period. If you don't have periods you can be screened at any time that is convenient to you.

If you’re overdue a test and haven’t had a letter you’ll need to contact your GP surgery, they may have incorrect contact details for you.

How do they perform a smear test?

Your appointment should take no more than 20 minutes and the screening itself takes around five minutes to complete. Firstly you’ll be asked to undress from the waist down and lie on your back on a couch or bed. Once you’re comfortable the doctor or nurse will ask you to either bend your legs up or place your ankles together and your knees apart, these positions allow them to easily insert the speculum into your vagina. The speculum holds the walls of the vagina open so your cervix can be seen the healthcare practitioner may use lubricant as well to make insertion easier. A specially designed brush is then used to collect some cells from the surface of your cervix. Once the sample has been collected it is sent off for analysis at a laboratory and you’ll receive the test results.

Cervical screening results

The results of your test will be sent to you in the post, this can take up to two weeks. The results also depend upon whether the test for HPV was carried out first and whether the cells were tested for other abnormalities.

There are three results options for the test:

  • Normal – No abnormal cell changes have been found. You don’t need to do anything except for attend your next cervical smear test when it is due
  • Inadequate - If you have an inadequate result this could be because not enough cells were taken, the cells couldn’t be seen clearly enough or that an infection is present. You’ll be asked to go back for another test so that some more cells can be collected.
  • Abnormal – If you have an abnormal test result you will be told whether you results are borderline or low-grade changes, or moderate or severe.

If your results are low grade this means that although abnormal cell changes are present, they are almost normal and may disappear without treatment. You’ll be invited back for routine screenings like normal, and will need to attend the next screening you are invited to.

If your results are high-grade dyskaryosis, you’ll be offered a colposcopy to examine the cervix in more depth and check for any other changes in the cervical cells. This doesn’t mean that you have cervical cancer or will develop cancer; it means that you have abnormal cells that need more investigation.

Can smear tests detect pregnancy?

No, a cervical screening test detects abnormal changes to the cells within your cervix. It can’t detect pregnancy, however if you are pregnant smear tests are not recommended.

Does a smear test hurt?

Feeling pain during a cervical screening test is very rare, however many women will feel slight discomfort. Remember that the more relaxed you are the less the muscles in your vagina will contract and the easier the test will be. Many women may also feel embarrassed during a smear test, as the procedure means you will need to be naked from the waist down, unless you are wearing a loose skirt. There is no need to feel anxious or embarrassed as is the test is private and the nurse is there to help you, reassure you and more importantly not to judge you.

When in your cycle should you have a smear test?

If you can, it’s best to book an appointment during the middle of your menstrual cycle, this tends to be two weeks from the start of your last period. Having a test at this time can ensure a better sample of cells is collected and you also won’t be on your period during the smear test.