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Need to know: cervix facts

So, it's a bit like a bagel...

OK, I admit it. I was pretty clueless about my cervix before I started researching all this. I mean, it’s essentially a bit of a design fault, how are you meant to know much about what you can’t see? Typically, now I’ve read up on this and talked to a few experts, I can’t stop myself sharing the odd fascinating fact over lunch with a girlfriend… in fact you could say I am now horribly guilty of over-sharing. “T.M.I.” howled my friend Alex over brunch as I excitedly waved my hands around saying, “So, imagine your cervix is like a doughnut, no, a, bagel without a hole…

But I’m allowed to over-share here. And TOO MUCH INFO is precisely what this is all about… so pretend you’re at brunch with me, grab a latte, and no howling…

1. Cervixes don’t all look the same. Some are long, some are short, some big, some small. We’re all different and our insides are just as different as our outsides. So if your nurse or doctor thinks that your cervix looks unusual and refers you to a specialist, it’s most likely because hey, sometimes cervixes DO look a bit different and they’re just sending you to someone who’s an expert in this area. Don’t worry!

2. So what’s a cervix like? Imagine a kind of fleshy doughnut with a dimple rather than hole in the middle. That’s your cervix. The dimple is called an os and it’s the small hole through which menstrual blood flows, and, as it’s the opening of your cervix, it can dilate to allow for the birth of your baby. Going in the other direction, unless you use condoms or a cap, it’s the opening where sperm passes through when you have sex.

3. You can feel your cervix. If you put a finger inside yourself, you’ll feel something firm, smooth and moist; a bit like the inside of your cheek that you can feel with your tongue.

4. OK, so turns out that a tilted cervix, or a ‘shy’ cervix are basically the same thing. Your uterus sits within your pelvis and the neck of the womb pokes down into the vagina, sometimes a cervix faces one way, sometimes the other — both are perfectly normal. The correct term is a ‘retroverted’ cervix. The reason that it’s ‘shy’ is because it’s a little more tricky to see – which is why a longer speculum is needed for the smear test.

5. Through your menstrual cycle, your cervix changes. It softens, hardens, moves up and down and also experiences changes in levels of vaginal fluids. There is probably no better or more comprehensive record of the changes in a cervix than at the Beautiful Cervix Project, an amazing project that a 25-year old blogged, with photos of her own cervix, taken every day throughout a typical menstrual cycle. Graphic, frank and brilliant!

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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.

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.

So, why should I have a smear test?

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The more I research into stats about cervical cancer the more I realise, that when it comes to cervical cancer, that the old saying ‘ignorance kills’ is painfully true. Cervical cancer is really treatable — if it’s caught early enough — and regular smear tests every three years should hopefully see to that.

Now, I know that Jade Goody’s untimely death bought cervical cancer into the limelight but so much more needs to be done to de-mystify the smear test process and banish any remaining taboos on the subject. Maybe we’re squeamish about discussing cervical cancer because, it’s, you know, *cough* down there?  Maybe it’s just the word ‘smear’ which really doesn’t help? Or maybe we should just get over ourselves and stop being embarrassed about our bodies and start taking care of our health!

I’ve included a few of the most helpful links I found, but just to get you started, here’s the top three things that you need to know about cervical cancer and why you should get a smear test.

1. Having regular smear tests can help detect abnormal pre-cancerous cells. Around 1000 women die of cervical cancer each year in the UK and you have to wonder what percentage of those women could have been saved. Even if it’s just one woman, it’s worth it. Want to find out if you might develop cervical cancer? Have a smear test.

2. In a staggering 99.7% of cervical cancer cases, a virus called human papillomavirus (HPV), has been shown to be present, which is a very common type of virus. Fortunately, the type of HPV which can lead to cervical cancer is rare. So, if cervical cancer isn’t hereditary, and there’s no way of guessing if you might or might not be prone to developing it, you need to have a smear test to find out.

Seriously, it takes more time to boil a kettle than it does to have a smear test!

Seriously, it takes more time to boil a kettle than it does to have a smear test!

3. OK, go and put the kettle on – just fill it enough for one cuppa. Make it and then come back…  You done? Good – that is longer than it takes to get a smear test.

Seriously. Having a smear test is quick, and easy, and thanks to the NHS, it’s also free for you at your doctor, the local family planning clinic or GUM (Genito-urinary medicine) clinic.

Want to 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.

 Cervical Screening in Wales.

Cervical screening in N. Ireland.

HPV Testing.