AIBU to complain about smear test experience?

[Ktmc94]

On Monday I contacted my GP surgery to get a new prescription for my pill. I spoke to the nurse who sorted that out but then proceeded to ambush me into a smear test appointment. I have looked into the screening for myself and was not convinced that I wanted to participate (I'm 26). I got flustered and agreed to the appointment thinking that at the very least I could have a discussion with her about it.

Then yesterday I arrived for my appointment. Blood pressure taken for pill and then I was weighed (didn't see the weight on the scale but I'm about a size 14/16). What came next was effectively a lecture about my weight which sent me reeling because I was already feeling nervous and uncomfortable about what was to come.

I was then ordered to strip behind the curtain without further ado, I tried to intimate that I was feeling apprehensive and was basically told to get on with it "it's only 20 seconds it's fine". No reassurance, no chat about the procedure or pros and cons of screening.

She then presented which, to me, looked like a rather large speculum and I voiced my concerns about it and was told that due to my weight a larger size was needed (I have never given birth). I was shell-shocked by this pronouncement and the bloody thing hurt before it was even opened but was once again told to relax and get on with it.

I left the appointment absolutely devastated at being lectured about my weight while feeling too vulnerable to assert myself. Fine, I need to do something about it but to launch immediately into a diabetes and heart disease lecture and then telling me that because I'm a bit chunky it means I must have a fat vag and offering no further explanation on the matter was just too much in my view.

I couldn't sleep last night tossing between wondering if I'm overreacting and feeling very upset about what happened. I phoned the practice manager this morning to discuss what had happened and was not encouraged. She skipped over the part about me trying to make an informed choice before deciding to screen and said "but you're 26 you should have had one by now" and "the nurse has been doing these on a daily basis for 30 odd years" and then rounded off by saying "not in any way to diminish your feelings about what happened" while having no comment on the fact that a weight lecture took up more of the appointment than some much needed reassurance about an invasive test.

I can't find anyone of any size who has been refused even a try with a smaller speculum and if I'm being honest I'm not massively fat, just pandemic misery has got me seeking dopamine in the biscuit tin but she could not have cared less about the state of my mental health. I'm still spotting and cramping which I had to find out for myself were side effects.

What an absolute vulgar woman. Please read about doctor Margaret McCartney and her research on smear tests.

You are a patient, you have a right to privacy and dignity and I'm sorry that this was not how you were treated.

Weight does not determine the size or shape of your vagina or vulva.

You were brave and stood up for your body autonomy by reporting her disgusting behaviour to the manager.

26 is not a surprising age to not have a smear test, they used to start at aged 25 up until recently.

She does sound like she needs retraining. Smear tests are to be pain free and to be done slowly.

You can say no, you can stop half way through, you can change your mind and you can come back another time.

Your body, your choice. No matter how big or small.

You’ll be thanking that ‘pushy’ nurse if your smear comes back abnormal!

Ktm, I once had a bad smear experience clumsy nurse did it rather painfully that might have put me off if I hadn't had plenty of good ones before. So I sympathise. But please don't be put off having your regular smear test. It really is not worth risking cervical cancer.

Like other PPs, I remember Jade Goody.

I had a smear test yesterday and apparently I have a high cervix. I did ask if I needed a badge or anything. I think sometimes they just make comments.

YANBU OP. A positive consent experience for your first smear is very important and often dictates uptake of later smears. Some HCPs seem to not understand adequate consent saves time, lives and worry overall. I had my first smear at 20 (standard at the time) and the nurse was absolutely lovely. I've never hesitated to book smears because of that nurse.

I find speculums fucking massive even when they use the small one

How dare she say you needed a large one for your fat vagina that is not even a thing

Complain about her
With thirty years work experience you would have thought the woman would have more compassion

Pandemic or no pandemic there is zero excuse for her making a decision on the size of your vagina based on your weight

Sounds brutish and unfair.

Yabu on your comments about smears but not having a fat vagina

Is it true that you need a big one for fat peopel? I didn't know this

They use one for children on me as I am so small and it really hurts

I would always have a smear and I have paid to have them done privately too when I've been worried

I am 28

@RichardMarxisinnocent

You are 26, you should've have a smear before now. Just wanted to point out that if someone has never been sexually active they don't have to have a smear, no matter their age. They can choose to have one, but it's thought that as the risk of cervical cancer for them is so low it isn't essential.

I thought the programme only starts at 25 in England?

Some really nasty comments on here.

And nobody has been diagnosed with cancer because smear tests were delayed during the first lockdown (unless they were already years late) - they may have abnormal cells to get rid of which isn't the same.

OP when I had my first smear test (I was about 23 because you started earlier then) it was horrible, but the nurse who did it was nice. I am due one now and the last two times it wasn't pleasant, so I'm not rushing to get it done although I will.

Bit surprised the nurse was bothered about BP and weight etc, whenever I've gone they've done the smear and that's it.

@CoolCovidCat

I had CIN-3 when I was 26, and had bad cells from my cervix removed. I have 3 friends who have also had the lletz treatment. It's not uncommon.

I feel very lucky and grateful to have had this done.

Nobody likes smear tests. They're there to save your life.

I don't get what you mean about doing your own research and not knowing if you wanted to participate.

I echo this. Similar experience also, I had CIN 2 and lletz treatment when I was 24 (I got the test earlier because they sent the letter through 6 months before and I booked it straight away). They’re not fun and nobody enjoys them but they’re important OP. Far better that than invasive cancer treatment.

It doesn’t sound like she was particularly kind about your weight though. I’m a size 16 as well and to be honest I cba with the lecture when I go to a GP because I’m not daft nor blind so it doesn’t really make me aware of anything that I wasn’t beforehand - does make you feel like shit though . But not enough to put down the cake .

Obesity comes with many health risks. If your weight came up in discussion around contraception then I think a high bmi means you can’t take combination pills.

I’m confused why the nurse said “you’re 26 so you should have had a smear test by now.” I’m under 25 so I can’t have a smear test yet. It’s not like you have had years of opportunities to have a test.

I’m thin so I’m not worried about the weight comments (not sure if you’re overly sensitive or if the nurse has bad bedside manner). However, I’m terrified about having a smear test! It sounds horrific.

All that about a larger speculum is a bit weird. I'm size 18 to 20 and they have to use the virgin size one for me and they can't even get that open more often than not. Can't see a size 16 needing a superspeculum. She doesn't sound very professional no matter how long she's been doing it. Maybe complain in writing? They tend to take you more seriously if you do.

Having a smear test, especially for the first time, can have us feeling very vulnerable. It does sound as though her bedside manner could have been a bit better!

But this comment puzzles me:

No reassurance, no chat about the procedure or pros and cons of screening

Why on earth would she discuss the "pros and cons of screening" when you had already booked yourself in to be screened?!

I'm a health professional and feel that you're not being completely unreasonable.

When being trained to do smears, explaining the procedure and ensuring your patient is actually ok is pretty key. She should have initiated at least a brief discussion about the procedure and any concerns, before asking you to undress. Especially if it's a first smear.

With regards to weight- I am a similar dress size to you and am very sensitive about my weight. I would not have taken it well, but as others have said it is her job to inform you of the health risks.

Personally I would make some written feedback to the surgery and ask for it to be fed back to the nurse. Sure she was just busy and stressed but I would argue she's, from the sounds of things, forgotten some bedside manner.

She should not have dismissed your concerns @Ktmc94 and absolutely you should leave a review.

Fortunately not all medical practitioners are so unempathic. Next time your smear test is due I would look for your nearest Well Woman clinic.

That sounds a lot like my smear 21 years ago, 6 weeks post partum. Except that I wasn't there for a smear, I was just told I was having it when I went for the 6 week check. I had stopped bleeding from the birth and subsequent infection about 3 days before, and bled for another 6 days after.

In between asking and explaining (I had also been stitched too tight from 2nd degree tear) I screamed all 3 times she shoved it up whilst telling me how stupid I was and how a smaller one wouldn't work. Eventually, I am sure only because of the screaming, she huffed off and came back with a smaller one which appeared to work just fine.

It was horrific and has very much affected my attendance at smears since.

You absolutely would NBU to complain. If you have the ability to complain please please do. It will support those of us who just did not have the inner strength to do so at the time. Hopefully it will also both make you feel better and bring about some change in your GP practice.

Regarding informed consent, both that GP and my current one have a very obvious intentional policy of preventing the "informed" part of consent. There may be several reasons for this but I have no doubt that one of them is that ambushing people results in ticking more completions with less effort in the short term. Never mind the mental health of the human being ambushed and without a thought to their willingness to comply participate in future.
tl;dr YANBU

It doesn't sound great and I hope that your next will be better.

The nurse at mine got me to add up every glass of wine I drink in a week and then showed me a chart saying that I drink more than 96% of women in the UK I took this with grace, as I do drink a fair bit.

Sorry to double post but the first speculum was at least 10cm across and the second maybe as big as 5cm. The difference was stark and I felt there should be an inbetween size. Both clear plastic and did not seem to have any moving parts, though obviously I was several feet away and distressed so can't be sure.

Also:

A bit shocked by some of these threads who think you aren't entitled to discuss the screening before going ahead. A small thing called 'informed consent', anyone?

Some screening tests are not an absolute 'duh! Of course it could save your life, go for it'. For example, the PSA test for prostate cancer leads to a notable number of men who do not have cancer having invasive testing, and long term issues following this, due to the non specific nature of the test. Although cervical screening is less like this, OP is well within rights to talk to a professional before under going screening.

Perhaps in hindsight you could have asked to have a phone call with the nurse before booking the actual physical appointment, but appreciate that you might not have known that was an option.

@Ktmc94
I a reasonably tall, and was a size 10 and the nurse said ''I can't reach, I'll have to use a slightly larger one''...It seemed to mean ''Longer'' , not that we have a fanny like a bucket.

I hate smears [No one in their right minds likes them] but one has to grin and bear it.

A skilled operator makes it much better.

A wonderful Nurse did my last one... and it was done in under 20 seconds..No putting an arm up trying to get a sample, or sweeping the chimney with a coarse brush.

But...I tend to joke about these things. :)

I get this often with anything I go for, my friend too. We joke we'd get a diagnosis of fat for tonsillitis.

However, I am quite assertive now and ask them the following:

Would you say the same thing is a thin person presented with the same concerns what would you say?

If a thin person presented with these symptoms what treatment options would be available?

You can take such comments and make them fit into whatever issue you are having with your GP but people being rude towards people who are overweight is a huge issue in the NHS.

@TableFlowerss

You’ll be thanking that ‘pushy’ nurse if your smear comes back abnormal!

She won't be thanking that 'pushy' nurse if she feels to anxious to go for future smear tests and misses early abnormal cells

I always thought there are just two types of speculum- one for adults and one for children/ teens.

I don't think yabu at all. Every smear I've been to the nurse has gone through the procedure first and asked if I have any queries/ concerns. The last time I went she was amazing - she even drew a little diagram and when I bled afterwards she explained why (cervical entrophy or something like that). She was also very caring and lovely about a recent miscarriage I had that came up on my notes. I've even had to have a colposcopy in the past and the nurse held my hand as it hurt! I think it really does make a difference having someone show a bit of care/sympathy. It's not a pleasant experience at all without someone being dismissive/horrid. And fwiw I'm a size 14 now and my weight wasn't mentioned at all at my last appointment. If it did impact the speculum she used then she certainly didn't mention it.

All of the nurses that work in my surgery are severely overweight, and yet it is their job to tell others to lose weight! It is just as well most of the patients are polite and are not into fat shaming in the name of medicine.