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?!

Self sampling has not yet been approved for the screening programme, I believe the results of the study are being written up for publication.
NIHR / HTA are commencing an assessment on implementation https://www.nihr.ac.uk/documents/23106-the-use-of-hpv-self-sampling-within-cervical-screening-programme/33704

Questioning if you are on hrt then saying it hurts cos you are dry? What is it then? Sorry for your horrid experience you aren't a piece of meat.

I have a rear tilting cervix and have terrible difficulties at every smear test. There used to be a lovely doctor at our surgery with tiny hands who was a dab hand at it. I have so much sympathy for you OP. It's horrible when you have that type of interaction.

AQuantityofNaughtyCats
I am a GP doing loads women’s health.
Cervical abnormalities are always linked HPV…I felt the same as you when I heard new test 5 or so years ago… but actually it is better for screening (screening means looking at asymptomatic women for a disease which potentially can have severe consequences) .
If you have concerning symptoms ( bleeding between periods or after sex or increase bleeding or pain) then it is no longer screening and you will be offered conventional test along with other appropriate tests.
The HPV test is a better test at picking up abnormalities… proven in lots clinical trials. I was sceptical too… but now totally convinced. It will also mean that more women will present for screening as less invasive.

A few years ago I had an IUD changed and the woman who did (and who I've seen previously) and I had a chat about perimenopause, menopause and HRT. She said she could tell because of how my cervix looked. I didn't take this at anything other than face value because I was perimenopausal and considering taking HRT. In fact, because of this appointment (and the pain, something I had never had previously during an IUD insertion/removal or smears), I realised I was suffering with vaginal atrophy. I mentioned this to my doctor and was easily resolved with Vagifem. (Note - Vagifem is separate to HRT and vagina specific).

Recently, I had to have a smear. I mentioned to the nurse that I had issues in the past with vaginal atrophy and she had no idea what I was talking about, and confused it with vaginismus. She really rammed the speculum in despite me telling her she was angled at totally the wrong angle. She got very stroppy with me and said she knew what she was doing. I replied that might be the case butI knew my body better than she did, and if she angled the other way, it would go in properly and she could see my cervix. And guess what? Once she listened to me, she could and she did. Regrettably, this made her even stroppier. I was so concerned with her lack of knowledge about atrophy and inability to listen that I wrote to the practice manager.

The last time I went, she said she didn't have a large enough speculum (after spending a good ten mins fiddling around in my nethers)

Made me feel like a I had a large cavern rather than a vagina!!

Definitely some nhs staff are better at this than others.

Speaking from experience...

If you are post menopausal you may need to use vaginal estrogen in order for a sample to be obtained.

Even if you don't 'feel dry' there may be a problem taking enough cells from your cervix to get a result.

Even if you use vaginal estrogen twice a week, (already) this may not be enough to facilitate a good enough sample.

If that's the case and you are recalled because of sample issues , the smear will be done again after 3 months.

you should use vaginal estrogen for 14 days leading up to a smear. You need to stop the estrogen 4 days before your smear.

So 18 days ahead of a smear, start the countdown.

That's interesting, thanks.

Right! I clearly know very little about my cervix.

But if the nurse had seen anything concerning, she should have mentioned it to me at the time, shouldn't she?

@hellsBells246 You can always opt out the NHS system for smears and have yours done privately. It's not hugely expensive, especially once every 3 years.
You may not want to of course, but it's there as an option.

Because it was twelve years ago when they tested every sample, not just the ones from women who have HPV. I was negative for HPV. Have had the same partner since 1999, so it would be rather suspicious if I did to say the least.

@shearwater2 I thought that HPV testing only came in in 2019 as routine?
Before then smears didn't include an HPV test. And they are 2 separate tests.

@JinglingSpringbells the timeline was
2001 liquid based cytology (LBC) and HPV testing trials (the HPV test done after the cytology was looked at).
LBC was implemented across England 2005-2008. HPV test of cure and triage was implemented across England in 2012.
Primary HPV testing was implemented across England in 2019-2020. The areas doing trials carried on from 2001, with additional areas implementing Primary HPV earlier, from around 2018, to help deal with backlogs of work and staffing problems. The reason for staffing problems was the imminent nationwide change to primary HPV which closed down all but a handful of labs.

primary HPV is where the sample is tested for high risk HPV types first, then a cytology slide is examined if hrHPV is found. Previously the sample was only tested for hrHPV if the cytology was borderline, low grade or the patient was on follow up for treatment. Both tests are done from the same sample, as the primary HPV only needs a small amount of fluid.

So why do we need to keep being retested if we are negative for HPV in two smears and remaining with the same partner?

I guess it's in case our partner is unfaithful, or they don't trust us to tell the truth that we only shag one person.
I've often wondered why I kept going even though I knew I wouldn't have HPV because of only one faithful partner and at least 10 negatives for HPV. I'm never going again!

Someone I know has regular smears all ok. Then after her h had an affair they had clinic tests and all were okay but at the next smear she tested positive for HPV. After a while they split, she slept with someone else and the next smear was HPV negative. I tried to explain what happened but didn't really understand. I was confused.

pantsalot. For the same reason conventional smears are needed…. HPV can lay dormant, there are many strains of HPV and that the biggest risk group for cervical cancer are unscreened older woman.

Everyone! A nurse asked me if I wanted to put the speculum in myself - transformative!

Tell them you can put it in yourself. It should be offered every time to everyone.

I had an impossible smear test, they couldn't even get the speculum in. I then had a different nurse who, when she realised how painful it was, put me on Vagifem. Readers, it was a revelation. The subsequent test was the easiest test I've had in nearly 40 years.

@hellsBells246 ignore anyone who isn't menopausal or postmenopausal, they don't (with the utmost respect) have a clue.

They tested me for HPV. It was in my notes and also a HCP told me about it. It was when I had further treatment, not when I had the smear test.The vaccination programme for HPV started in 2008 in the UK so it was certainly known about in 2010.

If you check on sites like Jo's Trust, and other medical sites, they all say that cervical dysplasia cannot occur without HPV infection.

In some women HPV doesn't clear completely but remains at low, undetectable levels. You can have HPV at undetectable levels, not picked up by the threshold of sampling, hence a negative smear. Then the HPV levels can increase so becomes detectable at which point a risk of CIN increases.

The more negative samples you have the less likely the risk of HPV but it's low risk, not no risk, hence the offer of screening.

I have just received my call up papers for a smear.
I'm menopausal
Dry as a bone . Using vagifem which doesn't help.
My vagina is sore and feels like sand paper
Can't have hrt due to other meds I'm on
I can't even have sex so how the hell they will do the smear I don't know
For the first time ever I feel like putting it off.

Which meds are you on that mean you can't use HRT?

The only ones I'm aware of are ones women use after breast cancer or some other female cancers.

You could increase your Vagifem and go back to the original 14 days in a row. Or try a vaginal estrogen ring, or Ovestin.

If you're being treated by a specialist, you should ask for a referral to a gynae who may be able to help with other treatments. For example, I've heard and read some menopause specialists mentioning DHEA as a treatment for vaginal atrophy (in women who can't use topical estrogen.)

Are you currently under a specialist for your meds?