Women failing to attend smear tests

[guardianfree]

Women generally but young women in particular - 1 in 3 not attending.

www.independent.co.uk/news/uk/home-news/jos-cervical-cancer-trust-charity-smear-tests-terminal-illness-health-wellbeing-hospitals-a8171011.html

I know they're unpleasant (and often feel humiliating) but what can we do to reassure women that they can be life savers?

The online campaign is #smearforsmear today. In which we have photos of pretty young women smearing bright lipstick on their faces to highlight the topic.

"Like someone earlier in the thread said, if you were told you can have a simple test for detecting one of the most common types of cancer in women, allowing treatment and potentially saving your life. What's to think about?"

All of the issues raised by different women on this thread,

HTH.

You seem incapable of thinking about this in any depth. Your opinion is simply that many young women are simply stupid or uneducated.

The issue is with "simple test". For many women it isn't simple.

What's to think about

Health anxiety epidemic with the worried well.

The risk of unnecessary treatment which could leave you unable to carry a baby.

The actual size if the risk versus the risk of unnecessary treatment.

Its not as simple as its stated in campaigns like this which regularly dont discuss these because they want women to conform and behave in a certain way rather than make an informed decision.

Which rather boils my piss in terms of ethical practice and the principle of consent.

I haven't been for mine because I hate it. It hurts so bad it makes me feel sick and I also have a real hang up about people looking at me there. Even when giving birth I was trying to cover up. I know that's a stupid reason.

Also the last two times I went it hurt so bad I was sick and the nurse spoke to me like I was a dog/toddler with all her high pitched "that's a good girl" and "well done/clever girl" rubbish. If I wasn't so shy I probably would have said something.

" What's to think about? "

the fact that as women we are infantilised and told what is 'best' for us, when it is probably a test that was invented by male doctors to humiliate and demean women. a bit like the craze for whipping out uteruses (uteri?) that my mother's generation had to suffer.

oh plus all the other very good points raised on this thread.

www.telegraph.co.uk/news/2018/01/22/third-young-women-do-not-attend-smear-tests-due-embarrassment/amp/?utm_campaign=Echobox&utm_medium=Social&utm_source=Twitter&__twitter_impression=true

Heres another article which doesn't once mention the risk of screening and instead criticises for not increasing uptake.

RatInTheHat it's not a stupid reason.

Our society is very squeamish about women's genitals / reproductive stuff, and there's a lot of subtle and not so subtle stuff around how women "ought" to look and so forth. Plus in general it's a very private area, culturally. Probably the most private area.

It's a perfectly valid way to feel - although not very helpful in this situation - but hardly your fault.

It's annoying the way society throws all this stuff at women, and then in the next breath expects us to whip our knickers off and spread our legs. Very few women feel entirely relaxed and comfortable about this, like it's just showing them your arm or something.

HCPs need to believe women if they say that find the procedure painful.

I'm 40 and have always gone for my smear test, albeit sometimes after a second letter prompting me, and have always found them painful. Not embarrassing, actually painful. I'd been referred to hospital in my 20s for pain while attempting penetrative intercourse and inserting tampons (which was never resolved), and later had investigations because of infertility (TTC despite the pain) so was no stranger to being examined.

I've not had the same person do one twice for me, have had them done by nurses, GPs, at surgery, at a young persons sexual health clinic and each time I've not been believed, and they seem surprised when I'm crying quietly, bleeding or instinctively trying to climb off the bed away from them. More than once they simply couldn't get a sample. I'm not normally an anxious person or prone to hysterics. On some occasions I've bled at the time, and/or later and found sitting down uncomfortable for days afterwards.

Finally got it sorted a year or so ago, following a referral from my GP who was unable to get a sample despite several attempts with the smallest plastic speculum in the survey. Had a smear done while under general anaesthetic for surgery for Fenton's procedure. When I came round the consultant said they didn't actually do the Fenton's, and instead removed bits of hymen. Once healed it's made a huge difference and I can finally have pain free sex, and I anticipate that my next smear test shouldn't be anything like as difficult and distressing as all the rest were.

I realise that my experience isn't likely to be representative, and my difficulties turned out to be because of an underlying problem. I don't want to put anyone off of going for their smear, but I'm annoyed that this took the best part of 20 years to resolve, almost taking my marriage and hopes of motherhood with it. It took so much courage for me to seek help for this the first time, as a young newly wed, and to be met with such scorn, indifference and disbelief put me off pursuing it again for years. You only have to read threads on here and elsewhere about difficult births to see that women are routinely ignored when trying to advocate for their own health.

I suspect that there is an element of backlash happening due to this old fashioned approach to promoting smears to be honest.

When it comes to painful smears and embarrassment, rude nurses etc. the NHS could just let you choose your HCP.

My first and second smears were agony because they were done by a GP, who in hindsight when I compare to my ob now, must have been nervous, didn't use lubricant and may have used the wrong size speculum that was too cold into the bargain. The table also made my hips hurt.

Fast forward 15 years, ob, who I have known since my pregnancy early last year, was literally 2 seconds and had finished before I'd realised he'd started. With a pleasant attitude that really makes you forget what he's looking at. Breast exam after was the same.

I say let patients choose who treats them and they'll find someone they feel comfortable with.

I go because I now have the confidence to say (for example)
"Please can you use the smallest speculum?"
"My cervix is quite difficult to find"
"Am I ok to put my fists under my bum?"
"Do you mind if I insert the speculum?"

It makes it more comfortable, not painful and quicker. But when I was younger I wouldn't have know what to ask or had the confidence to say it

Yy red.

I wasn't allowed to do my own insertion. It's not 'appropriate protocol'. I was being 'a bit silly' to even ask.

I asked for the smallest. Nurse refused and then wasted several before emitting a tinkly laugh and saying 'gosh, you really are little aren't you?'

Well yes. The first clue was when I asked. The second clue was when I had to use the step to get on the couch.

Prior to this I had a number of smears with other nurses that were fine. My first ever was in the metal days. I kept laughing and pushing the speculum out, then the nurse began laughing so we both had to sit in the waiting area for a bit to try and simmer down. If she was still practicing I'd have a smear monthly without any problems.

And this - points upthread - is why so many women don't attend their appointments.

Some years ago I cancelled and failed to re book a mammogram (insanely busy at work) . I got a threatening letter from Health England which (after a lot of patronising bollocks) actually threatened to remove me from my GP's list.
I went ballistic - wrote a formal complaint, alleged discrimination against older women, sent FOIs asking for the numbers of letters that had been sent, the numbers of patients that Health England had removed from their GPs lists etc. I subsequently received a very apologetic phone call from the fool man who signed the letter assuring me that it had been withdrawn etc. But the preparedness of them to bully and threaten women into having mammograms was typical of what RedToothbrush is talking about.

I have childcare one afternoon a week, which makes it quite tricky to schedule an appointment, for one thing. For another, I'm particularly dreading my next one as I tore giving birth, and I don't know how gentle (or otherwise) the nurse is going to be. I'll go, because the thought of dying and leaving ds behind is even worse, but if it wasn't for that I might well not bother. I should be able to feel confident that I'll be listened to and not hurt by an HCP, but that's just not my experience.

At least it won't be the GP who insisted on an internal examination when I went to her about period pain (which I was not expecting at all) and who snapped, 'You have had sex, haven't you?' when the speculum was too painful, I suppose. I've moved practice!

I am finding myself becoming increasingly annoyed the way women are pressured into having smears-
HPV can be tested without doing a smear, I think the screening is inadequate in this sense and procedure needs changing.
I think the pressure to have a smear is too much, e.g. NHS posters saying "my mum missed her smear test, now I miss my mum"- I find this emotional blackmail unacceptable.
Hpv normally clears itself if left, so do cell abnormalities- 95% of moderate changes will never progress to cancer- yet thousands of women are subjected to unnecessary procedures such as lletz, cone biopsy etc and the worry of being told they are "precancerous". I find a lot of women don't fully understand what it actually means. They say they had their lives saved by the smear, when in fact in most cases this isn't true.
I'm not saying that smears aren't useful or people shouldn't go- but women are made to feel irresponsible if they dont have one, almost a victim blamey- well if you get cancer it's then your own fault.
Further more I've had recent experience where I had cin 2, i didn't want to have the lletz and opted to "watch and wait" when nurse gave me option. Then I was told after an MDT meeting that I needed the lletz. I got pregnant in the mean time and had to be monitored throughout. The doctor kept telling me I must have the lletz after baby- but I had already said I just wanted to monitor, knowing that in most cases it clears by itself but I wasn't listened to and felt under a lot of pressure.
Anyway fast forward to after having the baby and low and behold the abnormality is completely gone of its own accord.
The smear test isn't that effective, it frequently causes unnecessary intervention, procedures for a cancer which is quite rare and then sometimes misses cancer. I don't like the way treatment is almost insisted on when in most cases the cin regresses by itself.
Further more when I read stories in news about young women having died from cervical cancer and calls to lower the screening age- it's usually the doctors that didn't investigate actual symtoms when they presented such as unexpected bleeding, if they had the outcome may have been different.

I'd like more transparency with the statistics so women can make an informed choice- without the emotional blackmail.

Missy God, yes, to all that you say.

As well as the traumatic and patronising treatment I previously mentioned, given my family history, lack of symptoms, lifestyle choices and the careful monitoring I recieve for a chronic condition, my risk is vanishingly small.

I recently read an article about prostate cancer screening- and it said it's not for everyone, some
men might wish to opt out.
Yet women aren't told this- no were responsible for leaving our children motherless due to our being irresponsible and not just "sucking it up" like we're spose to.

I never went for a smear through pure laziness, comments made during birth of 1st (asked if I’d had procedures on my cervix as it looked abnormal) plus my docs receptionist pushing me into. (She rang every time there was a smear clinic on ) pushed me into getting mine. I had it aged 29 so only a little late, CIN3 and lletz procedure done.
So very thankful for being pushed into it and glad my ignorance didn’t put my life at risk.
Repeat smear last year (so painful due to scar tissue) but thankfully all clear and no HPV.
I’ll push anyone to get a smear any day, recently two friends have been diagnosed with cervical cancer... so ladies just get one!

Some HCP's don't do enough to ensure women's dignity (e.g. the practice nurse who inserted an old fashioned, metal speculum in me and then left me lying there, completely exposed and feeling like my insides were being dragged out while she faffed about collecting the other equipment she needed and then proceeded to literally scrub my cervix with the swab for what felt like forever leaving me cramping and bleeding for a week) so some retraining is definitely needed.

Since then I've always gone to my local family planning clinic, they do so many it's like shelling peas to them I think, over in seconds , painless and as 'pleasant' as it possibly can be. Except now they've closed the FPC and the new sexual health clinic (they've merged GUM and contraception) don't do smears (???) So I have my first smear with the practice nurse at my new surgery on Friday and I feel sick with nerves already.

I would like a specific service for smears, something like the mobile breast screening units where the HCP's do nothing else. I think that gives women the best chance of as comfortable an experience as is possible because it means HCP's become 'specialised' rather than doing a wide variety of treatments and procedures. Direct booking flexible enough to take account of periods in addition to the usual work/childcare issues would be good too.

I suspect that there is an element of backlash happening due to this old fashioned approach to promoting smears to be honest

Too true.

Also the system that makes changes is long winded. Primary HPV screening was finally ok'd in 2015, but will not be available to everyone until 2020. Women who have been vaccinated will continue to be called up because they don't know how this will pan out and they need the data. They will continue to do a full smear, but only test for HPV for the vast majority of women and only do the cytology if that is positive. They could find a quicker, cheaper way but that will take time and they will have to change the system again.

Things are changing rapidly in cervical screening.

The old fashioned approach worked well for MIL - as the post-war generation, they took an 'all girls together' approach so that those who needed it would not be embarrassed at being screened, and did not think to much about whether they needed it themselves......

I not go to smear tests or mammograms either because, having researched it, your chances of dying of breast cancer of cervical cancer are the same wether you do have tests or not.
As there is also a non négligeable false positive results (so people who are treated with chemo etc.. when they didn’t actually have cancer), I’ve decided not to do it.

Having said all that, if you want more women to do those tests, you might want to check why women don’t do them.
Being at the bottom of the pile is certainly one of them (I’ll do it when I have time syndrome)
As well as being hard to go there, not feeling at ease with the nurse doing the smear tests an Times available making it hard for women to attend.