To ask why you’ve missed/delayed/declined cervical screening?

[chickentikkawhatswrong]

I see a lot of the campaigns on Facebook about women not going to smears or putting them off for too long.

However it’s generally stats and doesn’t seem to delve too far into the actual reasons?

If you are reluctant what holds you back from attending?

@SpaghettiArmsMurderer

Not sure what you mean *@MarchCrocus*. I read the thread, I agreed that it is painful and upsetting for many women. Smears still save the lives of women who are low risk. If the risk is 1 in a million, there is a woman who is that 1 and if she didn't get a smear then that would be very unfortunate.

You're still failing to read it now.

Multiple women have already told you that your approach is unhelpful. Your surprise at women who have had different experiences to you assessing the issue differently has already taken up far too much space in this discussion.

Because I have a cervix that's tucked away (retroverted I think). They used to be fine when the Dr did them. Since it was transferred to nurses I've had an experience where the nurse complained it was only uncomfortable because of my cervix and another who made me bleed whilst wanting to discuss my sex life. I don't find the nurses particularly well skilled clinically and neither do I fund them respectful.

The last one was done my GP who commented at a routine apt it was overdue and needed to be done. Only because I said I'd pay privately rather than go to one if her nurses again. She was kind, professional, gentle and treated me with dignity. I don't understand why practice nurses can't behave similarly.

I don’t go anymore as am practically incontinent now. I would 100% pee getting it done. I explained this to the nurse recently and she had nothing to say - no suggestions about how people with this issue usually get a smear done, or that I shouldn’t be embarrassed and we would work around it, or any other advice.

I’m now seeing a urologist so hopefully will be able to get smears done in the future but for now it’s a big nope.

Trauma. I feel incredibly violated during the process and it leads to freezing and awful flashbacks. I wish there was self screening options.

I also can't get my head around the fact that doctors consider general anaesthetic better than the HPV vaginal swab test. I would be very interested to see the risk assessment weighing up the risks of general anaesthesia against the risks of doing the HPV swab rather than a smear.

A history of sexual abuse and a strange fold in my vagina caused by an internal tear during childbirth means that I don't have smear tests. It's a personal decision and I wish they would speed up the self testing which was suggested years ago. It reminds me of when my grandmother talked about having hourly anal examinations during a long labour as the GP said a vaginal examination was undignified.
I don't think men would be subjected to similar examinations for most of their lives.

@RedToothBrush just so worried that I will be one of the unlucky ones who develops cervical cancer and could have prevented it.
Only slept with 2 people in my 45 years (been with husband since early 20’s) and he’s also only slept with me and one other.
Had clear smears every time I’ve been.
So hoping risk is low.
Just wish to goodness that there was a less invasive way. Been hoping that for the past 20 years but nothing has changed.
Why has nothing changed?

I do go regularly (more often than whatever the schedule is because I have gynae problems) but I find it horrendously painful. I dose myself up with painkillers before I go then grab on to the bed and do breathing exercises and try not to tense up too much. I don't find the speculum as painful, although it's embarrassing because it always makes me bleed and every single time the nurse comments on it even though I warn her in advance, but I find the actual swab excrutiating, the scraping of the cervix just makes me want to scream in pain.

I have a friends who can't go because their GP surgery only offers daytime appointments, and they can't get time off work (if you work in central London and your GP is in outer London and doesn't offer smear appointments before 10.30am, that's effectively a half day off). Or others have young children, whom you're not allowed to bring to the appointment with you (surgery rules), so unless you have other childcare options, you can't go.

Its also not just a sacrificing 10mins etc etc etc

For some its SO invansive, uncomfortable, triggering. I get why those dont want it. Ive done smears on ladies who have come who have been sexually abused. I just take longer with them and am totally led by them. Sometimes we get it done, sometimes not. Its no big deal if not. Ill rebook them there and then if they want so they dont have to fight to get through to reception and book.

This is why a self admin test would be fantastic.

Can a GP confirm that cervical screening is currently about HPV screening and doesn't check for pre cancerous or cancerous changes in the cervix unless HPV is confirmed?

Can't believe there would be so much bad science.

Yes, men have uncomfortable and embarrassing checks for prostate problems. But it is initially done manually with a gloved hand. Not quite the same as (often cold) steel being inserted inside you and expanded while another object is put up for the "scrape".

Uncomfortable for some women. Downright painful for others. Impossible for those whose muscles clench tight when a foreign object is introduced.

Why is more research not being done on refusal rates, reasons, and ways to either obviate the process or improve it?

I had my first post menopausal smear test three years ago. It was an ex
Midwife st my local rather decrepit inner lindon surgery. It was agony and totally humiliating. She made me get into a stupidly undignified position to get the speculum in abs made me feel like a piece of meat. Don’t want to face her again.

@Rummikub

Isn’t it true that incidence of cervical cancer in nuns is low/nil?

Yeah it would be likely as it’s caused by a sexually transmitted virus.

I put my first one off due to embarassment, didn't have it until I was 29. Then I realised that they do it day in day out, it really isn't that embarassing and thought how I would feel if I got cervical cancer and didn't know until it was really bad. So I went and it was absolutely fine, and now I make sure I book an appointment as soon as I get the letter. Thankfully all mine have been HPV negative up until now.

[quote Silverswirl]@RedToothBrush just so worried that I will be one of the unlucky ones who develops cervical cancer and could have prevented it.
Only slept with 2 people in my 45 years (been with husband since early 20’s) and he’s also only slept with me and one other.
Had clear smears every time I’ve been.
So hoping risk is low.
Just wish to goodness that there was a less invasive way. Been hoping that for the past 20 years but nothing has changed.
Why has nothing changed?[/quote]
Do you worry about other health or lifestyle issues in the same way? Do you know if these are more or less likely?

I put it to you that the whole 'screening guilt campaign' is part of the problem.

Read the Patient Paradox by Margaret McCartney.

The pain it causes you is a legitimate reason not to have. That doesn't mean you should not take action if you have symptoms.

Seriously the culture of the 'worried well' does help anyone.

Not all cervical cancer is caused by HPV.

Which is why a screening just for HPV is a bit shit.

Why is more research not being done on refusal rates, reasons, and ways to either obviate the process or improve it?

Because it’s much cheaper for them to just tell us we are being silly girls and we need to just get over it.

No i dont want one. Improve medicine.

Is a valid and legitimate reason to this.

I am now up to date with mine but I delayed it for a few months last year because I genuinely couldn't fit it in. I got the invite just before the summer holidays. I'm a single parent and I didn't want to have to take my children with me and I don't have a lot of child free time during the week when I'm not working. Then my period was a couple of weeks late so I couldn't really book it until it arrived etc etc

Can a GP confirm that cervical screening is currently about HPV screening and doesn't check for pre cancerous or cancerous changes in the cervix unless HPV is confirmed?

Correct

@Letsallscreamatthesistene

Not all cervical cancer is caused by HPV.

Which is why a screening just for HPV is a bit shit.

The vast majority of cervical cancer is caused by hpv. Screening programmes are there to prevent the greatest number of deaths across an entire populations. Looking for hpv achieves that. You’re right that it doesn’t help those with non hpv related issues.

I’m sure the invasive screening will be replaced by hpv tests in the next few years.

@EmmaH2022

Bowel cancer screening is hardly intrusive. You dip a stick into your faeces, put it in a container and post it off for testing. At a time of your own choosing and in your own home.

You only get to colonoscopy if you are already reporting symptoms which is a red alert to your GP.

@Letsallscreamatthesistene

Not all cervical cancer is caused by HPV.

Which is why a screening just for HPV is a bit shit.

Yeah that is shit. I would guess you can otherwise get cancer there just like other parts of the body. Does the triage for CC stop if you don’t have HPV then? You don’t get any regular interval examination?

@Igloo79

Why is more research not being done on refusal rates, reasons, and ways to either obviate the process or improve it?

Because it’s much cheaper for them to just tell us we are being silly girls and we need to just get over it.

I actually had a doctor say that, mid appt, told me I was a silly woman and that my husband would leave me if I didn’t learn to lie quietly and put up with things . He was a gynaecologist mid examination . I’ve had fourteen apologies from the NHS for the way they treated me, but it doesn’t take any of it away .

You can order a DIY at home HPV test from Superdrug for £48.

onlinedoctor.superdrug.com/hpv-test.html

I find them really painful, but went along dutifully when they called.

No issues for years then got the dreaded abnormal. Went for another, was then called in for a really painful colonoscopy treatment where the guy burned the side of my vagina which still bothers me years later. He called a couple of weeks later and cheerfully announced (over the phone when I was in the back of a taxi with my boss en route to a meeting) they were really surprised to find a tiny cancerous cell. Then followed 3 years of 6 monthly follow ups and treatment until I saw another gynaecologist who couldn’t understand why I’d had so much treatment and put me back on the annual testing schedule which I can only have done at gynae because it has left the whole thing such a mess the test is really difficult to get. It also kicked off a pretty serious health anxiety.

I’ve since read a fair bit of research that the number of women treated unnecessarily v the number of women saved is a pretty high ratio and that only a tiny number of abnormal test results actually go on to develop cancer.

I don’t know if I had known all this sooner if I would have done anything differently, but I’m glad with the HPV vaccine we’ve found a better way for our future daughters to avoid going through unnecessary screening and treatment.