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What happens when it’s an abnormal smear test

So you went for your smear test, got the letter in the post a few weeks later with your results and… there’s a problem. I hope yesterday’s post has show that statistically, things are in your favour. But what happens if you do have an abnormal result? This happened to my friend Jade a few years ago. I asked her to write a post for the blog:

Love this picture of Jade from earlier this year.

“It was just a routine smear test, I didn’t think anything of it at all. I’d never had a problem and felt fine before the test. Then I got the letter. It said that I had ‘abnormal’ cells and asked me to call ‘urgently’. That did make me a bit scared, I rang and the clinic asked me to come in to see them in two days time. I was pleased that they responded so fast but at the same time, felt really anxious — what if it was serious? I mean the NHS aren’t always so quick!

So, when I went in, I saw a specialist who examined me, she told me that I had prominent areas of abnormalities…  I did get a bit upset then, but she sat me down and explained everything to me. My specialist said that she wanted to treat me there and then with a LLETZ. I was encouraged to take some time to read through a leaflet which explained everything about the procedure and then ask questions.

Basically, a LLETZ is a ‘large loop excision of the transformation zone’ which sounds way more complicated than it actually is. The ‘transformation zone’ is the bit of me that had the abnormal cells and the ‘large loop excision’ is a what they were going to use to get rid of them.

I’ve probably got an average pain threshold and it really didn’t hurt. I think the idea of it was a lot worse than the reality. The specialist applied an anaesthetic gel to my cervix and that meant that I didn’t feel any of the injections that I got ‘up there’! Really – it was just a bit uncomfortable. It was all over pretty quickly as well. There was a smell of burning, which they’d warned me about, but was still pretty weird, apparently that was from a procedure that helps stop any bleeding.

One of my main concerns was that I’d heard that the procedure could affect me having children, but I was reassured that it would be OK.  I could walk and sit down afterwards, I was so surprised that it didn’t really hurt – I was more emotional than in pain. I think, as a women, it was an emotional experience to go through, but I talked to friends and my partner, and it helped so much to know what was going on.

That was five years ago.

I have yearly smear tests since – and they’ve all been fine. I’ve never had any problems since. I’d gone from a normal clear smear to three years later discovering that I had what they call ‘CIN2’ moderate cell changes which, if left untreated could leave me at a high risk of cervical cancer. There were no signs at all, maybe just a bit of occasional discomfort with sex but not always, so I didn’t think anything was wrong. That test could have saved my life. I’d say to any women who miss their smear test, you’re crazy not to go.”

Find out more: Get good info, get informed, get tested…   

Smear test recall: what do the results mean?

Just relax if it's a recall.

It’s the day that you’ve been waiting for… statistically, you’re likely to receive the all-clear, with 93.5% of women receiving a clean bill of health. But there’s still no need to be alarmed if you get a recall. I spoke with an NHS spokesperson to get the low-down.

It’s a recall:
You might get a recall as the sample was inadequate. Thanks to better testing nowadays, that’s quite a small percentage, around 2.8% were recalled in 2009-10. All that means is that the your sample did not show up clearly. You will need to call and re-book and repeat your smear test and the result letter will indicate when the next test should be taken.

It says it’s abnormal:
Don’t panic! If you get an abnormal result all that means is that the laboratory has identified that some of your cells may need investigation. You may be asked to go in to repeat your smear test, perhaps in three or six months, because the abnormal cells may return to normal. They’re basically keeping an eye on you to make sure any abnormalities don’t turn into anything to worry about. You may even receive three ‘borderline’ results before you’re referred to the Colposcopy department, which is where you receive a closer examination, (the procedure is called Colposcopy). So don’t worry, just remember this a pre-cancer screening programme, not a test for cancer.

HPV triage testing:
Currently six areas in the UK are using HPV triage testing. This means that samples showing borderline or mild changes are tested for the high risk HPV and those who test positive for HPV are referred to Colposcopy. This has been very well-evaluated, and will be rolled out across the whole UK over the next year. This will speed up the process of those who need to go for further treatment and those who don’t. HPV testing will also include a ‘test of cure’, following treatment for abnormal cells, if the HPV test is negative this allows women to be returned to the normal screening intervals much more quickly.

This is a colposcope

Colposcopy:
This is a further examination. Cervical cancer is rare in the screening programme and only represents 2 in 10,000 women screened. If you get a moderate or severe result in your smear test, you’ll be referred straight to the Colposcopy department. Colposcopy is a procedure that’s similar to a smear test. You still have a speculum put inside you, but your nurse or doctor will use a colposcope to look at your cervix. The colposcope magnifies your cervix so that the nurse or doctor can really see what’s going on. The doctor or nurse will also apply a diluted vinegar solution to your cervix – acetic acid – which helps to show up any abnormalities. At this point, if they believe that you have severely abnormal cells, they make take a biopsy to confirm the diagnosis or they may suggest treatment immediately.  Again, don’t panic! Your healthcare providers will explain everything to you. All the treatments that you may be offered aim to do the same thing, get rid of the abnormal cells so normal ones will grow in their place. You’ll be able to have the treatments under a local anaesthetic and go home straight after treatment.

Find out more:

There’s some great detail and help here if you want to know more about the different kinds of treatment available to get rid of abnormal cells. Also, a reminder on what is HPV and how does it cause cervical cancer?

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!

Does having a smear test hurt?

Just talk to the nurse. (Warning! Nurse may be more friendly in real life...)

I admit it, I’ve had bad smear test experiences in the past. I bled, it was uncomfortable, there was switching-around of speculums. No fun.

But I’m lucky; since that happened, I’ve also had such a good smear test experience, it’s left me utterly fearless about having tests in the future. Basically, I told the nurse what happened the last time and explained that I was really freaking out. We talked, I calmed down, and when she came to take the sample, it was completely painless and over in seconds. Amazing!

I spoke to an NHS spokesperson, who reassured me that I’d been right in talking to the next person who tested me, and confessing my fears. “When you’re having your smear test, if you’re having a bad experience, you will get uptight, and then that experience is not likely to improve. In fact, most women find it a little uncomfortable having the speculum in, but the actual sample-taking is usually painless.

“If you’re anxious about what’s going to happen, it might be worthwhile going to talk to the nurse pre-smear. Just book an appointment to talk and then book a follow-up appointment for the smear test. You could also ask for a longer appointment so that you don’t feel rushed. The key to this is communication; if you make your anxieties clear, then your sample taker will be able to help remove those fears. The golden rule is, if you’ve had a bad experience, then talk about it before your next test. No one wants you to have a repeat of that bad experience, your clinician wants to make it so good that you come back again!”

Be informed: the more you know, the less likely you’ll be worried.

Great advice at the NHS Cervical screening page here.

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.