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The S Word. Or what the hell is a speculum anyway

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Look! Cute kitties! OK, now go read about speculums...

Speculum. It’s a word that tends to induce sub-conscious knee-locking in most women. And to be honest, that’s no surprise. How many of us have ever even seen a speculum, let alone handled one? For most of us, the only sight we ever get of a speculum is when we catch sight of it glinting metallically in a drawer in a doctor’s office. Or, of course, a fleeting glance in the hand of a nurse before it um, disappears…

My new fun fact of the day? Speculums have actually been used way back since ancient Greek and Roman times. Seriously. They were found at Pompeii. The word ‘speculum’ actually means ‘mirror’ in Latin, which makes sense as using one allows you to see clearly. I guess one of the problems of being a woman is that so much of our anatomy is not exactly easy to view! Some women’s groups even encourage women to try using a speculum at home as a way of self-discovery and self-examination, teamed with a torch and a mirror, it’s probably the only chance you’ll have of seeing your own cervix, if, y’know, you really wanted to look.

I’d always known that speculums come in at least two sizes. My last smear test, three years ago, the nurse simply couldn’t get a fix on my cervix! After a couple of minutes with her wiggling the speculum around, she declared that due to my ’tilted cervix’ she was going to have to use a ‘long speculum’.

“Er, is that normal?’ I asked?

“Absolutely.” she replied.

I mean it makes sense. Why should a speculum be a one-size-fits all device? We all come in different shapes and sizes, and so do they. So don’t get weirded out if you need a big or small or long one.

Metal speculum - warning! May be a little cold - ask for a warm one...

So, yes, what the hell is a speculum anyway? Well, it looks a little like the bill of a duck, and it’s there to help the nurse or doctor see more clearly inside your body during your smear test. Mostly speculums tend to be stainless steel, but they can be single-use plastic too. Your nurse or doctor will apply some lube to the speculum, so it easily slides inside your vagina. And yes, it will be a little cold!

This is what my mate Debs recommends - less chilly, single-use plastic.

Once inside, your doctor or nurse will open up the ‘bill’ which then locks in place to dilate the walls of your vagina so that it’s easier to examine your cervix and take a sample of cells to send to the lab to be tested. Once the sample has been taken, the speculum is unlocked and then easily slides out of your vagina. And that’s it! The mystery of the speculum solved.

PS – Oh – and yes, I plan a post about tilting cervixes… you haven’t heard the last of mine!

PPS – here’s another  cure kitty picture for being good & getting to the end of the post…

Awwwwwwww!

Find out more:

Jo’s Cervical Cancer Trust

Helpline: 0808 802 8000 open Monday – Friday providing information and support on a range of topics including screening concerns, screening results, cervical abnormalities, cervical cancer, treatments and survivorship issues.

The NHS cervical screening website

Whatever happens in your smear test, it won’t be as embarrassing as this…

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Never ask your mum for a stamp...

I asked my girlfriends to share a few of their embarrassing smear test stories, but promised them full anonymity to get the real scoop!

“This actually happened to my mum. She’d taken a fresh pair of knickers to wear in the smear test(!), so went to change in the loos at the doctors. When she was lying on the couch, her doctor came in and she got into position, so far, so normal. That’s when the doctor started laughing and said, “That’s an interesting place to keep them…”.  Somehow she’d managed to transfer a loose postage stamp into her fresh pants and then onto herself! Luckily she saw the funny side and burst out laughing too! I genuinely don’t know how she did it, but if you’d seen her handbag, that might explain a lot.”

“It was about three smear tests ago, and there I was, lying down on the couch and the nurse said that I had a shy cervix, well, my mate had been told that she had one too a few weeks earlier, so I just laughed. Then the nurse changed her mind, “Oh, no,” she said, “Sorry – it’s not shy, it’s just huge!” and she went and got the biggest speculum there was. I was mortified,

“Er, do you mean I’ve basically got my own echo chamber up there?” I asked, and she just laughed.

So I had this massive cervix! All my mates were doing, ‘does your cervix look big in this?’ jokes!  The next test I had, I told the nurse that she’s need to super-size the speculum but she tried the regular one and said no. Everything was completely regular-sized. That was when I learned that your cervix changes. I was so fascinated that I bought a book, I mean, do you even know what an os looks like? I do!”

Check the blinds to avoid window cleaners...

“I was laying on the couch, legs akimbo, everything on show, with the nurse chatting away to me. All of a sudden, the window cleaner appeared at the window! The nurse had forgotten to shut the blinds! The window cleaner nearly fell off his ladder, although he did stand there open-mouthed for a while, our eyes did meet in one horrible, embarrassing moment, until he had the good grace to hurriedly get down and save my blushes! I nearly died.”

“Many years ago, when I was a student having my first-ever smear test, the young nurse grumbled, ‘You probably know that you have an unusual amount of cervical mucus’.

Er, I didn’t know! Why on earth would I know that? Who would I have been comparing myself with? I spent the next UMPTEEN years feeling embarrassed about my weirdo insides – until, that is, I started trying to conceive in my thirties, when I found out that the amounts of discharge you have vary according to your cycle – sometimes it’s light, sometimes it’s heavy – and that’s QUITE NORMAL. Lesson learned? Don’t want to be embarrassed? Get informed… ”

If you have a more embarrassing story than a postage stamp on your mum’s, er,  lu-lu then, A) I don’t believe it and B) tell me now! Post anonymously if you like, but please post!

The gals went on the record (different ones!) about their top tips for smear tests.

Also – get the low-down on exactly what happens in a test.

Booking a smear test: when is the right time of the month?

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"Hi, I'd like to book my smear test, please..."

Like so many things in life, from eating chocolate cake for breakfast (only when you really have to), to wearing overly-complicated underwear (only when you really need to), there is a right time and wrong time for everything.

And the same applies for calling up to book your smear test. Don’t go during your period, basically try to avoid the three days before and after that. The best time is mid-cycle; if you get muddled by when that is, just remember to start by counting the first day of your last period as day one and then book in for a test between days 10-20.

Once you’ve worked that out, give the the clinic a call, then put it in your diary and set a reminder on your phone too, so no forgetting this time!

For more info:

What happens during a smear test

Having a test? Essential do’s and don’ts from my girlfriends

I bled when I had my smear test — what does that mean?

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Don't worry...

It’s happened to me, and I know how much I freaked out about it at the time, but after talking with an NHS spokesperson, I’ve found out that you don’t need to get anxiousif it happens to you.

“If you bleed in a test, yes, of course, you might panic, but remember, the cervical smear test is a pre-cancer screening, not a cancer test. Many women do bleed when they get tested, but it’s usually only a very light spotting. This can happen as your cervix has a multi-layered tissue that meets with the inside of the cervical canal that is more delicate and only one cell layer thick, and when this area is sampled it sometimes bleeds. If you imagine it is a bit like your lips pouting out to show the inside of the mouth. This is why it sometimes bleeds. Nothing to worry about at all.”

What actually happens in a cervical smear test?

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Here's the leaflet I got along with the invitation

If you’ve never been to a smear test then prepare to have all the mystery removed! It’s a pretty simple procedure, you’ll be in and out before you know it.

1. You’ll receive an invite from your primary care trust to come and be screened. You need to call up and make an appointment with your GP, or at a contraceptive sexual health service. It’s difficult to get an accurate reading during your period, so don’t book the test three days before or after your period. When you ring, you can ask in advance for a female sample taker, the majority of people who work in this area are women, but just to be sure, if it’s important to you, you can always ask.

2. Don’t use spermicide barrier contraception or lube for 24 hours beforehand as the chemicals can affect the test. If you’re coming to the test after work, and worried about taking a shower, don’t be! Bathing or showering pre-test is not necessary.

3. Once you arrive and you’re called in, your clinician will explain the procedure. You should have received a ‘facts’ leaflet in the invitation too, which tells you everything you need to know. If you’ve had a bad experience before, or if you’re anxious, now is the time to tell your sample-taker. They want to know your anxieties so that they can put you at your ease. There’s no need to feel vulnerable, you’re in control of this situation.

4. You need to undress from your waist down, so if you’ve got a skirt on, just lift it up. You’ll not be exposed, you’ll always have some couch roll as a ‘modesty cover’. You’ll be asked to lie down with your knees gently falling apart. The speculum is put into your vagina and opened so that the sample-taker can see your cervix.

5. The nurse or doctor will use a small, very soft brush to take the cell sample. The brush goes around and sweeps the cervix five times to remove the cells from the surface of the cervix. It’s very quick and for most women, it’s absolutely fine. The results of the test will be sent to you in the post and they aim to have the results back to you in 2 weeks.”

Find out more: from Jo’s cervical cancer trust.

That’s it! It’s as simple as that.
A quick reminder of why this is so important: with 80 per cent of women in the target age group (25 to 64) attending for cervical screening,  the evidence suggests that a reduction in death rates of around 95 per cent is possible in the long term.
Put simply, if you go and attend regular smear tests it can save your life. So make that call, and go get that test!

Find out more: At the NHS screening site

Smear test do’s and don’ts…

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'Jeans? Not today.' says Sarzie.

If it’s your first time having a smear test, or even if you are an old-hand, it’s never too late to pick up some good advice from other women. I asked around my girlfriends and here’s their top smear test tips.

I always wear a dress or a tunic, never go in jeans and a t-shirt, you feel vulnerable with your belly poking out. Also when you get up, you’re covered, so there’s no need to rely on a bit of blue paper towel which might blow off!” – Sarzie.

I always request a plastic speculum. I’ve been shocked by a cold metal one too many times! They might try and convince you they’ve heated it up but nothing makes you jump more.” – Debs

Have a good wash down there (seriously, some people don’t!) and always wear something easy to get in/out of. Don’t be nervous, it’ll make it worse if you get uptight.” – Cathy

I’ve always had my smear test with a doctor or nurse that I know. It’s so much easier if you’re already relaxed with someone. Make sure you ask when you book the test.” – Caroline

Got any great tips to share? Let me know…

And relax… Getting a smear test and keeping calm

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Go to your happy place: here's mine.

I’ll come clean. I had a not-so-great experience with a smear test a few years ago. It was, in fact, the test that discovered I have a tilted cervix! The nurse was very sweet, but after clicking the speculum open, she frowned, and then after an uncomfortable minute or so fiddling around, she announced that she couldn’t get a fix on my cervix — which was when I learned all about tilted cervixes.

My nurse then switched to a longer speculum and the test was over in an instant, but all that adjusting had caused a bit of a bleed…which led to a recall as the test was unreadable, which is why you don’t get your test during your period! So – when I went back for that next test I did feel a little uptight, and as I hopped on the couch, I felt my knees creeping together! But once I said I needed the longer speculum, I was in and out in less than 5 minutes.  After such a positive experience, I’ve had no more anxieties. So here’s my no-fail relaxation tips to see you through your smear test with a smile…**

1. About a week before your test, lie down somewhere quiet and run through the whole smear test experience in your mind. Go through the whole thing, from leaving home or work, then waiting in the waiting room, going in, chatting with the nurse, straight through to the actual test lasting less than a few minutes and then walking away, feeling happy and positive. Run through this in your mind a few times before you go. By the time the test actually happens, it will feel familiar and you’ll be relaxed.

2. Go to your ‘happy place’! Think back to somewhere you felt completely relaxed and happy. It may have been on a beach on holiday, it could even be somewhere in your imagination, just close your eyes and focus your mind on exploring that place. Think about the sounds, the feeling of the breeze or the sunshine on your skin. Imagine feeling completely happy and relaxed there. Practice this before you go and then start thinking about it in the waiting room. Your body may be on the couch, but your mind can take you far away, to somewhere you feel more relaxed.

3. If you lie on the couch and feel tense, don’t be afraid to ask the nurse or doctor to wait for a moment until you feel calm. If you do tense up, focus on your breathing. Take a slow deep breath in, hold it for a few seconds and then breathe out slowly. Repeat a few times and then imagine your body relaxing into the couch and going limp. The more relaxed you are, the easier it will be.

Plan to do something fun afterwards!

4. Arrange something fantastic to do afterwards… whether it’s having a facial, lunch with a mate, or just a small treat like a new lipstick, a magazine or even a bar of your favourite chocolate, focus on the good times ahead and remember – the test takes almost no time at all and it’s usually completely painless. 

5 . Be prepared. If you know what lies ahead, there’s nothing to fear. And whatever happens, it almost certainly won’t be as embarrassing as my mates’ stories which I’ll share in another post!

** OK – maybe not a smile – but at least not a grimace!

Find Out More:
The NHS cervical screening website.