Is there any point - smear

[theskyispurple]

I'm almost 50, married for 10 years, never had abnormal smear results.
I know that the cells only get looked at if the hpv test is positive.
What are the chances of me having hpv now considering that it has never shown up before?
Trying to minimise unnecessary anything in my life - is this something I can cut?

Well it depends if you think there is value in something suspicious being followed up.

I went last week and have been referred to hospital based on something the nurse (and dr) saw. My swab hasn't even been tested yet and I'm already booked into colposcopy clinic.

Hopefully they're being over cautious and it's nothing, I think it's of value to me to be checked out.

Your body your choice but is it really worth not going ? Ten years down the line you might be kicking yourself.

For anyone in doubt that cervical screening has changed to 'HPV primary':

"Once your cervical screening sample is sent to the laboratory, it will first be tested for HPV. If HPV is found, your sample will also be looked at for abnormal cells."

www.england.nhs.uk/south/wp-content/uploads/sites/6/2014/06/hpv-screening-leaflet.pdf

"HPV testing has replaced cervical cytology (looking at the sample of cells under a microscope) as the primary test.

Cytology-based tests will be used if high-risk HPV is found in the sample. A person’s pathway and subsequent follow-up will differ according to the test results."

www.healthscotland.scot/health-topics/screening/cervical-screening

"A trained health care professional will insert a speculum into the vagina to be able to see the cervix. They then use a small soft brush to take a sample of cells from the surface of the cervix. The sample is put into a pot of fluid and sent to the laboratory, where it is tested for the high-risk HPV types. If HPV is found, the cells are then looked at to see if there are any changes."

www.wales.nhs.uk/news/49360

So the main benefits of a smear test over a home HPV swab are:

• Visual examination
• Nurse may do a better job of swabbing

I suspect they will eventually just start sending swabs out to test for HPV at home and you will only come in for an appointment if HPV+. Not only cheaper, but will also encourage more women to check themselves who may otherwise avoid a smear.

@BanjoVio

'I don’t know where you’ve got this ‘information’ from but it’s false. My smears are always HPV negative but the first one came back as showing severe dyskaryosis, so they must’ve looked at it despite being HPV neg. I had to see a colposcopist and have part of my cervix removed to prevent cancer. Go for your smear test.'

www.gov.uk/guidance/cervical-screening-programme-overview#screening-tests

I got it from the government website plus it's on many others.
How long ago was your one that showed dyskariosis? It has definitely changed in my lifetime of having smears.

So I'm
Answer to my first post it seems that quite a few people have posted that hpv can lie dormant for many years and be found later.
So swabbing for hpv is a good idea in my situation.
My decision is whether to pay £48 for a private home test and if it's positive then go and have a smear test.
If negative then no smear required.
The downside is the I won't have a trained eye glancing at my cervix in case there's anything abnormal there?

Or go for my NHS smear and have a potentially unnecessary swab done of my cervix that may be disposed of without being looked at ever.

A smear test is to obtain a sample of cells. There are no other clinical benefits to it. Yes, a nurse may spot something just like they may spot
’something’ if you are in for any other procedure but that is coincidental and not the point of the appointment. With respect, practice nurses are unlikely to have the training or experience to make these ‘spots’ and I say this not to diminish their role but to prevent women erroneously assuming they all clear all round for other conditions just because a practice nurse took a cell sample. This is particularly important if symptoms are being experienced. As for the ‘well, it’s a good opportunity to get women in and talk about other issues like incontinence’, I don’t necessarily disagree that this is the reality but an invasive procedure isn’t some sort of entry ticket to access medical help. Women should be able to access medical attention for
ALL issues when they need it, in an environment they feel comfortable in, without undergoing a test they may experience as intrusive and painful.

It’s definitely quite a recent change @BanjoVio . It was in place last September but not sure how long before that it came in. I think it would be helpful if the guidance stated that it was a new thing, because a lot of women will be scratching their heads saying “I wonder why I didn’t realise this before?”

Loads of reasons.

Prior sexual assault. Trauma. Conditions that make it excruciatingly painful (vaginismus, endometriosis etc.). Cultural factors that make laying on a table with your genitals open to someone to see extremely challenging. Bad prior experiences with rough/insensitive staff. Prior body shaming leaving you feeling as if your genitals are abnormal. Denial because you have symptoms and are terrified but can't face up to it psychologically. Not having the time off a low paid, insecure job to do during surgery hours. Not being able to get an appointment due to the backlog and how stretched the NHS is.

Hope that's answered your question. Brushing off reluctance with 'why wouldn't you, it's a two minute thing' is easy to do, actually thinking for a second takes a bit more effort.

Practice nurses absolutely have the right training and experience for these 'spots'. I've seen hundreds of cervixes and have a pretty good idea of what's 'normal' (although would always get the GP to check if unsure) and referred dozens to colposcopy for anomalies. More than dozens.
It's also amazing how many women for example would never think to report red flags such as post coital, post menopausal or inter menstrual bleeding if not questioned at smear.

You have no idea of my history and it's none of your business.

I am not at risk.

@Elphame I don't care about your history, I was just trying to make it clear that not sleeping with anyone else will not mean you won't get HPV. Which is still the case as unless your history is that you don't have a cervix which if so makes me question why you are even discussing smear tests. Rude.

There needs to be another option then for menopausal woman who find it too painful. There is no way on earth I can go through that again - I will get a HPV test regularly , and then accept the risk of no one looking at my cervix! . I have a far higher risk of breast cancer anyway having had it a few years ago I'm still high risk for that . Life is sadly all about risk - but I definitely cannot tolerate another smear.

I was talking to a friend of mine who is on the other end of the tests, he looks at the samples and tests them. He said that testing for HPV first is being trialed but it only get 70% of cases and that they (the people in the hospital lab) don’t like doing it and it’s cost cutting.

@midairchallenger

Having an invasive internal examination to gather cells that will never be looked at is the definition of unnecessary.

Why do you say they won't be looked at?

This. I know personally half a dozen women over 60, who said they had their last smear at 52/53, then when they were called up at 57/58, they didn't go. Said menopause had affected them badly 'down there' and penetration was impossible, coz they were so tight and dry. The smear at 52-ish was OK, but in the 4 or 5 years since the last one, they had gone REALLY tight and dry. (Sorry TMI!!!)

So as they couldn't even get a little finger in, and nothing would go 'up' further than 2-3 inches, that spatula thingy being shoved up to the uterus was not going to happen!!!

If you have problems with dryness you can talk to your practice nurse who can get a lubricant to use in the week prior to the smear.

It's not just 'dryness' though.

Your right sorry I didn’t use the correct terminology.

it’s an oestrogen based peasant or ring which lubricates and softens the vaginal walls.

menopausesupport.co.uk/?page_id=13707

Pessary not peasant

What?! I never stopped doing them even during lock downs! Official advice from the screening service was to carry on if we could, so we did. Absolutely no excuse to have not restarted, I'd be complaining to the ICB (what was called a CCG last month).

Do you mean the home self swabbing testing for HPV trial? I heard it was being trailed in London. I think it is a good idea for those who would not get a smear otherwise, but still not as good as having a nurse do it as we go further up (plus you get an actual visual examination).

He was saying that they test the sample for HPV and if it doesn’t have it then they don’t examine the sample.
He was also saying that the uptake for smears is really low at the moment. Lots of younger women are not coming as they have had the HPV jab. However what most people don’t realise is that the jab only protect you against some of the variants, the ones most common in Europe, and not all variants.

I realise I didn’t completely answer your question, these are the samples from the smear he was talking about.

I can’t imagine anyone with an ounce of sense can think it’s anything other than a cost cutting measure - which will probably come back to bite them on the bum!!

Thankfully I no longer get ‘invited’ for them as I opted out more than 10 years ago. On the other hand, have just received the first mammogram invite (and that will go back to them too!)

Because they only go on to look at the smear cells if you test positive for HPV. If negative the sample is disposed of and you’re left to wait for your next smear test in 3/5 years depending on your age.