The new smear tests

[NicoleWatterson]

So I duly went for my smear this morning. I do firmly believe in their importance, so despite them being unpleasant I've always gone.

I was encouraged by seeing the new implement on this morning, a little soft brush that takes the cells. Is that what they used on me, is it fuck it's a point jabby thing with a cutting device that cuts a circle out your cervix.
It was bloody awful! What happened to the soft tickly brush?!?

There's a high chance I'm going to get a recall as I had to ask her to stop. Is there a way I can ask for the old one? Or even that lovely brush I saw on this morning.

I've had many many smears over the years. Apparently my cervix is tucked away and a bit harder to reach than for most people. There have been occasions when I have bled, occasions when the test has had to be redone, occasions when it has hurt and one occasion when the nurse didn't stop when I asked her to.

For years and years I paid for it to be done privately, and never any problems when the gynaecologist did it.

Recently, we moved house to a lovely new GP. The new GP asked why it was overdue and why I felt I had to have it done privately. She made me an appointment with her to do it on Monday.

It does concern me a bit that the mantra is always that nurses will do it better because they do more of them. In my experience they don't do it better and would not allow a nurse to do my smear.

The thing I particularly hate about a smear test is that they always want to weigh me and take my blood pressure beforehand. And it's high. No, shit sherlock. (24 hr monitoring is fine). Can I refuse this? Will the nurse be extra pokey with the smear if I do?

As a smear test is optional, it cannot be "overdue". If you decide to have a test, you do not need to be weighed or have your blood pressure taken. If you are concerned that the nurse may be extra pokey if you refuse, I would ask for another nurse. I expect the nurse has been told to weigh you and take your blood pressure to update your record. This information is not needed for a smear test. More QOF points!

Having recently had a failed attempt to remove my mirena (the strings broke - great) followed by the gp numbing my cervix with injections and poking about with special forceps, all to no avail, I'm delighted to hear upthread that the hysteroscopy I now have to have to drag it out will be unrelieved agony .

Even a basic smear test is incredibly painful for me, and no gp or nurse can seem to explain why.

Im feeling a lot better today, thank you . A good snooze seemed to do the trick, bit of spotting (to be expected) although I'm still a bit tender when i go to the loo.

Ungulater
Funnily enough the nurse said its silly doing the blood pressure then as well!! Id have thought you can refuse to have any aspect done, or maybe suggest after?

I think MNHQ were right not to delete this thread, i hope with the other stories it shows my experience wasn't normal. I just panicked that i might put people off this really important procedure, lets face it we are really lucky to have this screening to hopefully pick things up earlier so that although the treatment is not nice its a lot better then the treatment (or worse outcome) if found later.
I had a look at the instruments on that link whatevva it wasn't any of those, they look pretty harsh, to the ladies who have had to go through those. I did have a google of what the brush looks like and it does look like thats what it was. I don't think it helped she explained the new devices 'trick' just before the smear, so i was already tense (which never makes for an easy smear at the best of times). But I'm really not sure why it was quite so bad. I don't remember being sore when going to the loo after either. If i do get a recall i guess I'm going to have to have a chat with the nurse about the best way forward, as something can't have been right with it.

The HPV test sounds interesting, but it would concern me that its not the ONLY cause of cervical cancer, although the most common. But the test sounds preferable!!!

Coconutty- honestly mine was absolutely fine. Was actually playing a timed game on my phone and from start to finish I think it was 34 seconds. I bled after but I'm a bleeder with everything
It felt scratchy but wasn't even uncomfortable and I have an awkward cervix. I did ask for the smallest speculum before she started which they always happily do

The brush has been in use for years. I have always paid for private smears as I like them more often than the NHS allows, so I have gone every 2-3 years for ages- at least 10 years- and the brushes have been used on me for all of that time. Maybe some NHS places have cut corners financially and stuck with spatulas for longer?

It doesn't cut you- any nurse who says that is bonkers and ought to think about what she says. It removes some cells.

It clearly goes into the cervical opening a little to gain more cells, but it's not as unpleasant as some posters here say. The whole thing lasts about 2 minutes so even if it's a bit 'ouch' which it can be, then it's all over pretty fast.

Agree that smear tests differ enormously depending on who is doing them - some nurses seem to have a knack of making it pretty pain-free. Uterine biopsies, though, hurt like a complete bastard.

Hassled - you are spot on - uterine biopsies can be really painful for a lot of women. I was offered one due to heavy bleeding and the doctor said it was "painless, like a smear". I'm a HCP and I have worked in gynae. I knew he was lying and told him so. He said that if he told the truth he wouldn't be able to convince women to go ahead without a GA.

I declined his offer.

When my GP made the biopsy referral, she said that it would be "a bit ouchy". I translated that as "will hurt a fair bit" so was at least vaguely prepared, but not prepared enough. I can see why they lie, but for many people it's much better to actually know what you're up against.

I think it's really important on threads like this to include the proviso- 'hurt like hell for me' rather than terrify other women witless!

Toads I have had 2 uterine biopsies- one on its own which was completely painless and another as part of a hysteroscopy without either a GA or a local ( and which took my lovely consultant 30 minutes due to my cervix not being cooperative that day) and which I can say was also painless. I chose to have it done that way on the condition that if it got painful they could give me a local and if that didn't work or I chose not to have it, then it would be rescheduled for a GA.

I felt only the tiniest nip and certainly no worse than having your teeth cleaned at the dentist - in fact far less discomfort.

Meols a hysteroscopy was always performed under GA until about 5 years (?) ago when they started allowing senior nurses to do them with no anesthetist or just by applying a local (basically a gel). That's roughly the time when GP's started saying they didn't hurt

I need one every year because of my increased risk of endo cancer (genetic). I have to go private just to get pain relief. The lack of adequate anasthesia for female NHSpatients undergoing painful procedures is a feminist issue imo. I hope I haven't put you off, but it was unrelenting agony (for me) and I wish someone had told me in advance, so I could have demanded anaesthesia. Your experience may be completely different/painless - I sincerely hope so.

Young could you re-phrase all of that and say it applies to you' :)

I'm sorry you found it painful but I didn't.

It's really not helpful to describe procedures as 'agony' when it's a personal experience.

I don't think you are correct about the guidelines for using a GA. I had mine done roughly 4 years ago- coming up to 5 I think- and the leaflet from the hospital / consultant gave all 3 options: nothing, local or GA.

I chose to have nothing and ok, this is only my personal experience too, I grant that, but it's important that women hear both sides of experiences.
I was post-meno when I had the procedure and in theory should have found it uncomfortable as the cervix gets tighter post meno. It did take time - 30 minutes- but my consultant is brilliant and one of the best.

I don't see really how nurses can carry out hysteroscopies- this has to be done by consultant gynaes who look at the screen once they have accessed the uterus.

Do you mean a nurse takes a biopsy? I'd still not be happy with that.

I said "it was unrelenting agony for me". Might not be a bad idea to read things properly if you are going to (patronisingly, I might add) ask people to rephrase.

In case that still isn't clear because you have been lobotomised My personal experience was that hysteroscopy without GA was like being stabbed repeatedly in the fanjo with a rusty blade. I screamed non-stop the whole time and shook uncontrollably afterwards for several hours. I am guessing I was not alone in that experience because one nurse seemed to be employed solely to hold patients' hands and whisper platitudes. Why the fuck they didn't use her salary to offer GA instead I have no idea, but then again I am do not have the infinite wisdom of a hospital manager.

To repeat, for the hard of thinking: my hysteroscopy was carried out by a nurse without GA. I was not given a choice. I am very happy for you that you were given options 3 years ago, but I wonder whether it would've the same now. Possibly different areas deal with it differently. I can assure you that if I had been given those choices, I would not be paying 3 grand a pop to get it done privately just so as not to be experience the same excruciating medieval torturous pain again. Incidentally, my private gynae told me there was no way in hell he would have the procedure without a GA, but if you can tolerate it, well done.

You don't like anyone picking you up on things do you??? Talk about being rude to someone!!! and sarcasm to boot- what's your problem? So you are allowed to give a dramatic account of what it was like for you- but if i say it was okay then you respond with heavy sarcasm.Lovely.

I can read perfectly well, thanks. I just thought you should have made it a bit more clear that this was your personal reaction and considered that it might not be the same for everyone. Mentioning that would have helped.

I'm not being patronising. I'm pointing out that it's always good to acknowledge there can be different experiences.

I still think you are talking about biopsies. Nurses do not carry out hysteroscopies- where they view the uterus on a screen and decide if there are malignancies or anything else that needs treating.

I would be given the choice again because it was private.

Clearer than saying "this is how is was FOR ME" - are there many 5 year olds reading? Otherwise I think I made it perfectly clear.

Please read my post. I have Lynch syndrome ie an 85% chance of getting endometrial cancer. This unfortunately means I have encyclopedic knowledge of this brutal procedure and others. I am not just talking about a one-off painful procedure. I have these done ANNUALLY. I can assure you the procedure in question was a hysteroscopy and I can also assure you that this procedure was carried out by a nurse on the NHS. Not privately, I hasten to add - privately it is done by a consultant gynae under GA (as it should be imo and as I would always insist on it being in future for the simple reason that (FOR ME) it hurts like an absolute evil bastard and the thought of the pain still gives me nightmares after several years).

This is precisely the reason why GA should be available on demand for all patients - because we experience things differently.

Carry on like this and your posts will be reported for personal attacks, and probably deleted.

I am afraid I cannot begin to understand that a nurse can carry out a hysteroscopy. This is a camera inserted into the uterus. The uterus is then filled with gas or saline(you will of course know this, but others reading, including any 5 year olds, won't)

The image is on a screen and the consultant views it to look for thickening, polyps or anything else that may suggest cancer.

This is specialist knowledge and can only be done by consultants. Nurses cannot make judgements about cancer.

At the same time they may decide to take a biopsy by threading a small instrument through the same scope when it's in place.

I discussed all 3 options with my consultant beforehand and asked to have the procedure done with nothing. I had already, a year previously, had a biopsy taken in his surgery with a pipelle, which was completely painless.

It was fine and my advice to women is keep an open mind as we are all different.

You are insinuating that I am lying - and I am not. So yea, it's irritating. Sorry that you feel I am being rude, but asking me to "rephrase" and then suggesting that I am somehow wrong about what procedure was carried out by whom is more than a little inappropriate imo. Especially when I have explained (twice) why it is I have so much experience of this procedure and why I have had it so often. As I have said, I had to go private to avoid it - hardly the actions of someone who had a choice in the matter!

For the third time, it was a hysteroscopy. Carried out by a nurse. Involving a biopsy to check for malignancy. You are right to be shocked because I agree it is totally inappropriate. Since you had your own procedure carried out privately, you may not be aware that this is pretty standard in the NHS (or at least it is where I live). That is why I said it is a feminist issue - not all women cope with pain, but not all women get the choice of having a GA.

You seem keen to suppress and denigrate my own experience which is equally valid as yours. I wish to God someone had told me it could hurt as much as it did before I agreed to do it without anaesthesia. I will not make that mistake again and my view was completely vindicated by my private gynae.

Sorry if that doesn't reflect your sanitized version of reality.

All you had to do was say politely that your experience was different. There is absolutely no need for your outbursts of rudeness - ie lobotomy- just because someone says something with which you disagree.
Maybe instead of taking this so personally and ranting, you could engage in a reasonable discussion?

There is also no need to patronise me or use sarcasm. As someone who is post menopause, and possibly even twice your age, I've spoken to and known many women who have had this procedure- both NHS and privately. I am not ignorant as you suggest of the NHS system.

I'd be very interested to see a link to the hospital in your area- not because I don't believe you but out of interest.

I cannot understand how nurses are allowed to make judgements on what they find. Maybe if you explained what they were looking for, the judgements they made, and the dialogue between you, then it would help.

I could just about accept they might carry out a biopsy, but as my consultant needed another 2 pairs of hands ( 2 nurses) to carry out a simple biopsy in his surgery, I still struggle with the idea.

He also needed a nurse on hand for the hysteroscopy, to hand him the equipment needed.

You have received very poor care. I know women from other forums- menopause forums- where this procedure is carried out very often for post meno bleeding. They have had the procedure terminated due to discomfort or more often a cervix which won't dilate. If your team of nurses of whoever continued despite you writhing in agony then that is disgraceful. The procedure should have been abandoned.

I insisted on a GA for my LLETZ and hysteroscopy. My consultant agreed because he could see how uncomfortable my colposcopy was, tbh I wouldn't have left the room without the GA being signed off.

And, yes, I think there a feminist issue here. It's women being expected to suck up discomfort and pain yet a-bloody-gain.

Just to give some balance, and I know that it's only my experience.

I had a hysteroscopy performed a few weeks ago by a nurse consultant without GA. I am a complete wuss and was absolutely terrified of the procedure. She was assisted by another nurse who held my hand. I was talked through every stage of the procedure. I was told that some women find taking the endometrial biopsy a little uncomfortable, but that it should hurt less than mirena insertion. She told me that she would stop at any point that I asked, she was gentle, reassuring and professional.

I can honestly say that I was barely aware of when she inserted the camera (very slight feeling of pressure) and neither did I feel her taking the biopsy. The whole procedure took less than 5 minutes for her to photograph my womb and get the samples needed. I was still waiting for the pain when she told me that she had finished. I think that having the procedure done in a hospital gynae setting with the special chair helped.

After the test she showed me the photos - I could have looked at the screen during the procedure but was too scared. I was kind of interesting to see my insides, Fallopian tubes etc. My hysteroscopy did not include any biopsies of my cervix, so I can't comment on these. But please anyone reading this, do not assume that every hysteroscopy is going to be agony for everyone. I can't promise that it will be as easy as mine, but it might be. I have had two vaginal births, so not sure if this is relevant. After the procedure I had some period pain cramps and some bleeding for a few days. Many people take ibuprofen half an hour before to reduce discomfort. I can't take ibuprofen and managed fine.

We seem to have moved on from the original point of smear tests! :)

I assume that the nurses then send the images to a consultant for examination? I apologise for being sceptical about nurses carrying this out and I still think it's a case of dumbing down treatment because ultimately a consultant does have to view the images.

It's worth bearing in mind that TVS (transvaginal scans) now give very high definition images. Many consultants are happy to request/ carry out a scan as a precursor/alternative to a hysteroscopy. I have annual scans - for other reasons- and if no abnormalities are seen on a scan then there is no need for a hysteroscopy - or a biopsy can be an option. GPs have to refer women for investigations for various symptoms but the hysteroscopy- whilst considered the gold standard for certain symptoms- can be replaced with a TVS or a biopsy in some instances. It's therefore worth asking about less invasive procedures instead of always assuming there is only one option.

I had a smear booked last week and want desperately to have it done for personal reasons.

It's not the embarrassment factor, shyness or anything like that but...the nurse just couldn't physically carry it out. Anyone any suggestions as I really, really want it done!