Went for smear test - AIBU to be upset?

[hellsBells246]

I've just turned fifty. Went for a smear test today. The nurse mentioned four times beforehand that it might be uncomfortable and was I sure I wanted to continue? I said yes, it's fine.

So she shoves the speculum in hard, and I jumped. She said to relax 🙄

So she tried again. It was uncomfortable - more than other smear tests I've had.

So she opened the speculum and collected the cells, then said to me, 'are you sure you're not taking HRT?' (She had asked me this before). I said no, why do you ask? She said, oh, no reason. 🙄

Then I said 'ouch' when she withdrew the speculum, and she said, 'ah, it's more uncomfortable this time than it has been because you're menopausal and dry.'

Now, this might be factual but she made me feel about 104. I was really quite upset.

AIBU to be upset?!

I winced reading that. It's an awful experience all round.

@hellsBells246 the last time i went for a smear I came out bleeding! never went again

Same here. The technology hasn't changed in 70 years. Self-testing wasn't even mentioned as a possible alternative to what amounted almost to sexual assault. I can't understand why the NHS doesn't enquire about why so many women give up having smears after decades of attending with no problem. Oh. It's because it's women. Older women.

I read somewhere they are trialling a wee test to replace smears. X

I'm supposed to have gone in December but I've been a bit of a coward and put it off. I'm 62 so this will be my last one. It's quite important for me to go because after 65 you don't get invited anymore. It gets more uncomfortable as you get older in my experience.

I’m so sad reading this thread. I’m a nurse practitioner, specialise in women’s health and it’s so important to me that I, and any nurses and GPs I train, are doing the very best we can for women attending for smears.

Yes menopausal women can find it more uncomfortable due to vaginal dryness, atrophy and cervical stenosis. Yes some cervices can be harder to find, and harder to get a good sample from. Yes some women find it much more uncomfortable than others regardless of age. However it is our job to make the whole process as “pleasant” as it can be.

I am always very clear we take our time, always tell women what we are about to do (no surprises!) and that it’s their bodies and they’re in charge. Some insert the speculum themselves, some lie on their side, some bring someone for moral support, some listen to music or play on their phone. Some aren’t fazed at all. Anything goes.

We are discouraged from using lube as it can clog the machine that processes the samples, but of course use it if needed. Hormonal contraception and HRT can make the cervix look different. Metal speculums haven’t been used for about 15 years (except in hospitals or as part of a coil insertion set). The process is a lot better than it used to be now we have liquid based cytology and cervex brushes rather than glass slides and wooden spatulas.

@hellsBells246 i do hope the surgery respond sympathetically. I would be upset to receive feedback like that but then would never talk to a woman like that or shove anything! Feedback should always be appreciated and used as an opportunity for reflective practice.

@Product3257
join in with the patronising why don't you. If you haven't had a horrible nurse and/or horrible experience YET, remember your response when you do

I didn't think I had vaginal sodding atrophy. No symptoms. Sex is fine (no discomfort). Nothing feels dry or atrophied 🙄

@Gooseysgirl

Was it at your GP? You can ask for someone else to do it, but don't cut your nose off to spite your face!

Sorry OP but you are being a bit oversensitive. Of course it looks different if you're on HRT As the hormone levels in the body affect the mucous membranes of the vagina and vulva. Doesn't mean you need to go on it, but from a biological perspective she can probably see a difference

??

She asked if I was sure I wasn't taking HRT, suggesting that my vagina looks sufficiently moist, surely??

Well I wasn't suggesting it looked either way - just that it would make a visual difference so it's not a weird or offensive comment to make while in the middle of the procedure.

When I had my LLETZ ( to treat pre cancerous cells following a smear) the nurse said to me ‘ oh apparently there’s a new blood text to test for prostate cancer cos men are put off by the finger test’

id Be interested to know how much funding has been put into alternative testing for prostate cancer v smear tests

I am in my fifties and last time I had a smear the young nurse said my cervix didn't look right at all and googled advanced cervical cancer and showed me her screen and said did I have any of these symptoms. I was clinically depressed until the results came through completely negative. Some of these nurses are completely incompetent.

Unbelievable. Fucking idiot x

The problem with that is those of us who are HPV negative. If we do a self swab all we get is a “you are negative for HPV so we haven’t bothered to look at your cells” message. At least with a traditional smear test there is a visual check of the cervix for abnormalities. I know I’m HPV negative so smear tests are now entirely pointless apart from the visual check.

Op and others who've suffered - I've had the same, told the procedure hurt because of my body rather than because of their techniques. I stopped the last one and refused to go back. Recently when I was seeing a nurse for a Jab she mentioned that my smear was over due and I told her that it's incredibly painful and I'm told to just breath and relax and that's not OK. She volunteered to speak to my gp to see if i could have a referral to have it done under sedation. Gp said i would have to speak with her in person face to face to discuss this. That felt like it was meant to be off putting in the current climate of how hard it is to get an in person gp appt, but i rang up to book that discussion. To my delight my gp had no bookable appointments so i was asked if i was willing to see a gp who i think was in training, and a man. I said sure, it's just a discussion. The poor guy was about half my age. He asked why i struggled and i explained. He asked if I'd tried their specialist nurses and I said i have. He asked what i wanted and i said the referral to have it done under sedation. This was a few weeks ago, my appt is at the end of March. I'm glad i stuck to what i know is fair. It's not my fault where my cervix is located or that I'm in my 50s. I'm not the only one. They have to do better than tell me to just breath and relax.

What a shame

I had one and the nurse was brilliant, not uncomfortable

You can opt out, either email your drs surgery or if you are in the surgery for some reason, just ask to be removed from the list.
It lasts 5 years and then you can ask again if you want.

Since they only look for the hpv now and only look at the scraped off cells IF you have hpv show up, it seems a huge waste of time and resources.

I had a terrible smear years ago, I will never put myself through that again for the miniscule chance I have a cancer.

I've opted out of breast cancer screening until they can tell me categorically men of any gender identity wont be in there with me. They wont guarantee it, I wont attend.

I have a tilted cervix and the nurse told me to put my hands under my bottom while laying down.
Never had no problems. Just slightly uncomfortable.
Don’t get me wrong I know it can be awful for some women.
YANBU. The nurse was unprofessional. Maybe inexperienced.
it’s bad enough laying down in an undignified position !!!

To answer some questions
Info about HPV and risk
High risk HPV and abnormalities seen on cytology
Self sampling is in trial for NHS screening and HPValidate

Use of lubricant when taking cervical samples. Some types are ok to use, as they don’t cause as much as problem as @Sidge mentioned. The issue is carbomers present in some lubricants fool the filter which the cells attach to when preparing a sample, so the machine thinks it’s got enough cells and instead it’s mostly lubricant. An example here and image here

Does the cervix appearance change with age?
Sidge would be able to explain better than me, but the appearance and volume of the cervix changes with hormones. So it increases in size at puberty, and everts into the vagina, some of the endocervical canal is pushed outwards. In response to the change in environment, metaplasia is triggered (the cervical skin or epithelium transforms into protective squamous cells). This area is the squamo-columnar junction (SCJ) and where the cells change type is called the transformation zone or TZ. Depending on hormonal status, the SCJ location can be further out onto the cervix, close to the endocervical canal or back up in the endocervical canal. The latter is TZ type 3, is mostly seen post-menopause. The epithelium is also thinner making it more difficult to sample and more likely to bleed.

Diagram comparing the three types

Colposcopy images comparing TZ type 1 with type 3 (SCJ in canal often atrophic, post-menopausal)

I actually didn’t think it made a difference for me and I didn’t have any hrt

Sad to see so many on this thread blaming women for being affected by a bad experience.

So from this thread I have learned:

• self testing IS available (but not being offered)
• smear compatible lube IS available (but not being used)
• different positions, a smaller speculum, an ounce of compassion CAN help (but some HCPs aren't availing themselves of these)

I would like an awareness campaign for practice nurses for them to reflect that they potentially put lives at risk when their poor practice and thoughtless speech puts women off seeking health care.

Unfair? Well so is blaming women for their natural human response to a negative experience.