A comprehensive guide to smear tests

Screening for cervical cancer plays a crucial role in women’s lives, contributing to cervical cancer prevention. Distinguished consultant in sexual and reproductive health Dr Emily Lord explains everything you need to know about smear tests, answering your frequently asked questions about the programme.

What is a smear test?

The cervical cancer screening programme plays a pivotal role in women's healthcare.  ‘Having your smear test’ taken involves a speculum examination, where a small plastic device is inserted into the vagina to visualise the cervix. A brush sample is taken, sent to a special lab to check for any evidence of human papillomavirus (HPV). Detecting HPV early allows for timely treatment, often preventing cancer development.

What is HPV?

HPV is a group of sexually transmitted viruses, highly prevalent with over 70% of sexually active individuals experiencing infection, most people clear the virus on their own within months. There are over 200 strains; while some types of HPV cause harmless skin warts, other “high-risk” strains may cause changes in the cells. Persistent high-risk HPV types can lead to cervical cancer (and cancers within the oropharynx and anogenital regions). Over 99% of cervical cancer cases are caused by persistent HPV infection, (Okunade 2020).

HPV types affecting the genitals can be classified into high-risk (oncogenic) and low-risk (non-oncogenic) categories, based on their association with the development of cervical cancer and its early-stage lesions.

Low-Risk types: 6, 11, 42, 43, and 44

High-Risk types: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, and 82. Types 16  and 18, account for 70% of cervical cancer cases.

The UK smear programme

Cisgender women and trans-males aged 25 to 64 are invited for smear tests regularly. Testing frequency varies by age: every 3 years for ages 25 to 49, and every 5 years for ages 50 to 64. Samples are initially tested for high-risk HPV, with cytology performed if detected. Treatment involves a colposcopy examination, where the clinician can look closely at the cervix using a special microscope (which stays outside of your body). If needed, a small biopsy may be taken to further assess areas that look abnormal.

FAQ

I am a virgin – do I need a smear?

If somebody has never had any form of sex or sexual contact - their risk of developing cervical cancer is very low. However, ‘low risk’ is not ‘no risk’.  HPV can also be passed on from oral sex, genital touching or sharing sex toys. Talk to your clinician to discuss the best option for you.

I suffer from vulval pain and really struggle with a speculum, what can be done to help me with my smear?

Having a speculum and a smear can be uncomfortable, but if you suffer from vulval pain already (including vaginismus and vulvodynia) it can be especially challenging and may mean you delay having it done. It is important you discuss your worries with your doctor, there are lots of things that can be done to help the process, for example ensuring your clinician uses a small speculum, a small amount of lubrication, or even sometimes a little bit of local anaesthetic gel. They key is helping you be as relaxed as possible, taking time and ensuring you feel in control of the procedure.

I do not identify as female, but have a cervix – do I need a smear?

Trans men and non-binary people assigned female at birth still need to have their smear test taken. A few important things to note – if you have changed your gender with your GP, then you will not get your automatic invite (which only goes out to individuals registered as female) – so speak to your GP surgery to ensure that you are still on the recall. Also, if you are taking testosterone, you may have vaginal dryness and this may make the process a little more uncomfortable – speak to your clinician before the test to ensure they do everything possible to make it as easy as possible.

Do I need to go for a smear test if I’ve had the HPV vaccine?

Yes. The vaccine does not protect you from all types of HPV, so it is important to still go for your smear when you are called.

Can I still go for a cervical screening if I’m pregnant?

It is best to not have your smear when you are pregnant, as it can make the results harder to interpret. If you are planning a pregnancy, make sure you have your smear, (if it is due) before you conceive. 

Can you get tested for all the HPV types?

On the NHS programme, they test for the most common types of high-risk HPV (16,18). This is because they are the most likely to cause cervical cancer. It is possible to have a private smear test taken, which can assess for all high risk (and low risk) HPV subtypes. You should discuss this option with your clinician.

Resources and references

NHS population screening: information for trans and non-binary people - GOV.UK (www.gov.uk)

What is cervical screening? - NHS (www.nhs.uk)

Cervical screening and smear test FAQs - Evergreen Life (evergreen-life.co.uk)

If you would like to book a consultation with Dr Lord, do not hesitate to visit her Top Doctors profile today