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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!

Smear test myths: BUSTED

Time to bust some myths...

There’s a lot of confusion about smear tests, so let’s clear the air.

MYTH 1 – you don’t need to have a cervical smear if you’re not having sex

If you’ve had sex then you should have regular screenings. Even if you’re not currently sexually active, you should still attend your smear test, because the risk of cervical cancer comes through HPV, the Human Papilloma Virus. However, if you’ve never had sex, then the risk is very low, but it’s worth bearing in mind that you could still have a chat with your doctor or practice nurse when you receive the invitation, and talk about your circumstances. Also, because cancer can still happen to anyone, it’s probably best to feel reassured, so make sure you never ignore an invitation to take a smear test, get in touch, and talk to your health care providers.

MYTH 2: You don’t need a smear test if you’re a lesbian

Is HPV a ‘man virus’ thing? Do they pass it on to us? Or should lesbians get themselves checked out and screened too? Well, turns out that HPV is not a ‘man thing’, although the risk is lower, HPV can still be transmitted between women, so, sorry lesbians, you are still at risk. Even if you’ve have never had sex with a man. It’s a low-risk, but a risk nonetheless, so yes, lesbians should get screened.

MYTH 3: there are no signs of cervical cancer

True or false, are there signs to look out for which could help show warnings of cervical cancer? Both – true and false. There are a few things to look out for, for instance, if you are persistently bleeding after sex or experiencing irregular bleeds, like spotting, between your periods, that’s definitely something you should go and see your doctor about. Also, if you experience any unusual discharges, perhaps if they are offensive in smell, or blood-stained, go and get that checked out. Finally, if you’re experiencing discomfort when you have sex, that’s another thing to add to the list. However, because an early cancer doesn’t tend to exhibit symptoms, if you don’t experience any of the above, it’s still always best to get checked out. So when you get your invitation to go for a smear test, pick up that phone and book it in!

Find out more at the NHS cervical screening programme.

Good advice for lesbians and bisexuals here.

What is HPV and how does it cause cervical cancer?

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.

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

Posted on

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?

Posted on

"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