Hey, lady. I know it’s been all quiet on the Western Front (Cunt?) this week, but I need to ask you something. Ready? OK.
When was the last time you had a cervical smear?
I know. Fuck ME, right? What a drag. You’re probably clicking on the little x in the corner as we speak. IF I DON’T THINK ABOUT IT IT MIGHT GO AWAY. Guess what? It isn’t going away.
It is really REALLY important that you go for a cervical smear, if you haven’t already. And not just because of Jade Goody (RIP).
I went for my first one last week. It was no biggie. You take your pants off, ‘pop yourself’ up on the couch, the nurse fiddles around in your ladybits, and then you pop yourself off the couch again, put your knickers back on, and get on with your day. Easy.
In fact, it was so easy that I completely forgot about it. Or I did, until I got two letters through the door that didn’t look thin enough to simply be saying ‘you’re fine, be gone with you for another three years!’ They looked like cancer letters. OH MY GOD THEY WERE CANCER LETTERS.
They weren’t cancer letters. What they were were letters which explained that my results were ‘abornormal’, that I had something called ‘moderate dyskaryosis’, which would need looking at during something called a ‘colposcopy’. I swear, I understand more Gaelic than I did that letter (Alba gu bràth!) Despite the fact that the letter said ‘it is unlikely you have cancer’, I immediately collapsed in a heap on the floor, weeping that I had been cut down in my prime.
After lying on the floor for about twelve hours, I re-read the letter. It said that if I have any questions about my results, then I should contact my GP or NHS direct. I still wasn’t really sure what ‘moderate dyskaryosis’ was, and had thoroughly shat myself when I googled it and ended up on a cervical cancer forum. Everyone had signatures that said stuff like ‘abnormal smear test result, May 2008/ invasive cervical cancer diagnosed two weeks later’. I decided that I didn’t like the internet. The internet didn’t sugarcoat.
My boyfriend called NHS Direct, because I was ‘too upset to talk’, and explained the situation while I lay face down on my bed. They said that as it wasn’t urgent, that they would call us back in six hours. They never called back. I felt like a loser. Stood up by a public service. THANKS DAVID CAMERON.
The next day I called my GP and asked to speak to the nurse. She came on the phone but only to say ‘I have a train to catch and can’t go through this with you right now’ in a really shitty voice, even though I was sobbing. This made me feel like even more of a loser and even more alone. It was my first ever smear test (I’m 25). It was completely foreign territory.
I’m not one to slag off the NHS. I’m too scared that the ghost of Aneurin Bevan will come and haunt me while I’m sleeping (although, actually, as the first ever NHS representative, I would have appreciated him popping along and telling me that no, you don’t have cancer. No one bloody else was.) I felt very alone. I didn’t really understand what was going on ‘in there’, and there didn’t seem anyone who was able to tell me. I became convinced that I was going to die, that my boyfriend would have to deliver a tearful eulogy while looking delicately handsome in a perfectly cut suit. I started wondering to whom I’d leave my iTunes in my will.
Turns out, feeling like this is totally normal. Most women who get an abnormal smear result freak the fuck out. And, considering that either 1 in 20 or 1 in 12 (the letters differed in this regard) will get an abnormal smear in their lifetime, that’s one hell of a lot of panic attacks going on. So, if you’re worried about going for your smear, or have already had an abnormal smear result, I have some advice for you.
Firstly, it is EXTREMELY unlikely that you have cancer. Cervical screening is not a ‘cancer test’ which you have FAILED, it’s a pre-emptive method for finding abnormal cells which may turn into cancer one day. These cells are called dyskaryosis (mild, moderate, or severe), and even if you have severe, it still doesn’t mean that you have cancer. These cells often take a REALLY LONG time to develop into cancer, which is why it’s so important that you get those fuckers while they’re young.
Secondly, you are not a slut. Abnormal cells on the cervix are often associated with HPV, a sexually transmitted infection. When I first heard this, I wanted to gather all the men I’d slept with together in a room (I won’t tell you how many, but let’s say that it’s in between a gathering and a party) and demand ‘WHICH ONE OF YOU ARSEHOLES GAVE ME HPV?’ in the manner of Shirley Conran’s Lace. But that was before I realised that there is no test for HPV for guys, which is totally unfair but then, as women, we are all used to that. Anyway, once I’d read up on HPV a little more, I realised that most people have it at some point or another. Seriously, that shit is RIFE. There is no point declaring celibacy now, because HPV can linger in your system for years and years, so you might as well enjoy yourself. Good news: most people will fight off the infection in 1 to 2 years. It’s when you have a low immune system and can’t fight it off that HPV starts partying in your cervix and messing things up. Stopping smoking can help stop this happen (I haven’t smoked in one week, MOFOS!)
If you’re freaking out about HPV, I would advise you to watch that episode of Girls called ‘Vagina Panic’ in which Hannah gets it and is totally casual about the whole thing. Maybe if the NHS had some kind of service where a Doctor rang you up and went ‘hey Sugartits, you have an abnormal smear but don’t sweat, it isn’t cancer, yo,’ we would all feel like that. But we don’t and I didn’t, so instead I watched that episode like five times. Remember what Jessa says: ‘all adventurous women have it.’
Thirdly, DON’T GOOGLE. It will just scare you more, and much of the information is designed to cover its own arse in case the worst happens. Instead, read this Scenic Guide to Your Abnormal Pap Smear from The Hairpin. Although written for an American audience, it is absolutely brilliant at putting your mind at rest, and goes into far more medical detail than I do here.
Lastly, and for me this is the most important bit of advice: talk about it. When I got my abnormal smear result, I felt completely and utterly alone. It felt as though I was the only person who had ever had bad shit going down in her cervix after a smear test. And I was too embarrassed to talk about it. Until I started talking about it. To everyone. And encouraged them to talk about it. Here is a list of people who know about my vagina panic: My mum, my boyfriend, my flatmate, my boyfriend’s brother, my boyfriend’s brother’s girlfriend, my boyfriend’s mum, my boyfriend’s sister, my boyfriend’s boss, my fellow Vagenda editor, my mum’s friend, my granddad’s cousin’s wife, my auntie, and my French male cousin. I would have told my Dad, but it was a bank holiday and I didn’t want to piss on his chips by chatting to him about my vagina. I’d already had my bank holiday party ruined when this horrible girl from my school days (HPV personified) turned up at the Notting Hill Carnival when I was trying to have a good time with my friends and not look mental as a result of not being able to smoke a single sodding roll up, so I didn’t want to perpetuate the fun-ruining cycle. (BTW, if you’re reading this Dad, I love you and I’m fine, I think.)
I digress. The worst thing about my abnormal smear result was how I felt inexplicably ashamed and embarrassed about it, as though it was my fault. Why is it that women don’t feel that they can talk about this stuff? As soon as I opened up about it, and my friends and family did the same, it emerged that everyone knew at least ONE person who had an abnormal result. In fact, if 3.7 million women were screened in the year 2010-11, and one in twenty had an abnormal result, that’s a HELL OF A LOT OF WOMEN who have all been through the same thing. As my wise doctor friend told me, the not-talking about it perpetuates ignorance. Oh how I wish I had known about this HPV and colposcopy stuff before I’d got that letter. It would have saved me so much grief and anxiety.
It’s so important that women feel able to talk about this stuff. Before I got my first smear test, no one told me that I shouldn’t have sex the night before, or use lubricants or creams. I didn’t even really know what the test was looking for, and what the possible outcome might be. In my case, it meant that I was referred for colposcopy, which is when you lie spread eagled on a bed while a doctor or nurse looks up your skirt at your cervix through what looks suspiciously like a pair of binoculars. Indeed, the whole process could be said to resemble a Benny Hill sketch. The nurse then paints your cervix with various chemicals which help the abnormal cells to show up. If they do show up, as they did in my case, they’ll often offer you treatment then and there. The most common is LLETZ (Large Loop Excision of the Transformation Zone), which is a snappy way of saying that they use an electrically charged loop to remove all the bad cells. It’s a bit scary because they have to ‘earth you’ and your mum can’t hold your hand in case she gets electrocuted, which would make the day suck even more. I won’t lie, it isn’t the best fun I’ve had all year (especially not the bit where they inject anaesthetic into your cervix) but, having read Caitlin Moran’s vivid description of her traumatic posterior labour the night before, I felt like I wasn’t qualified to moan too much. The nurses were absolutely brilliant, so reassuring, and they kept the radio on during the procedure. Unfortunately the song that was playing was Coldplay’s ‘Fix You’, a song I have always hated because it makes me cry even though I don’t like Coldplay, and which I will now forever associate with having my cervix electronically scraped out. Awesome.
Afterwards, you and your mum get to look at a photograph of your cervix, which is actually quite cool. Some of my friends thought it was weird that my mum got to see it, but then I pointed out that I actually CAME OUT OF HERS, which shut them up. Then the nurse told me I didn’t have cancer but that I couldn’t have sex for six weeks. Not ideal, but I’ll take it, THANKS NHS!!!!!
The moral of this tediously long and detailed story is that silence breeds ignorance, which breeds panic, which breeds you thinking you have cancer when you probably don’t. There is absolutely nothing to be embarrassed about if you get an abnormal smear result, and talking about it REALLY REALLY helps. The more we talk about it, the more in control we feel. Unfortunately an abnormal smear result is something many women will experience in their lifetime, but if the choice is celibacy vs colposopy, I know which one I’d take. One afternoon of cervix rummaging is totally worth ten years of sex (I’m not telling you to go around having unprotected sex willy-nilly, BTW. Wear a condom. It might not stop you getting HPV, but it will stop you getting a whole lot of other stuff you shouldn’t have to deal with) Plus, your boyfriend/girlfriend/loved ones will bring you soup and grapes and flowers, and you won’t have to do any heavy lifting for AGES. Treatment is nearly 100% effective, and the sooner you get it, the less likely it is that it will EVER turn into cervical cancer.
So, if you start feeling guilty about your cervix/HPV, don’t. Remember Girls: all adventurous women do. But being adventurous also means that you need to pay more attention to this stuff, so please do go for that smear test. It could save your life.
Normal Vagenda service will now resume.
In Scotland, ladies are told to get a smear test at 20, but England (and I think Wales) don’t perform them routinely until 25. There needs to be a change to allow women to have the tests earlier. As you mentioned, this was your first test and it returned abnormal results (it’s great that you’ve sorted it all out) but how are you supposed to know this hasn’t been there for the last 2-3 years.
I went for an STD test last week and discovered I had a wart. I wasn’t told anything about it other than that they would freeze it off and if it was still there a week later come back. So I obviously went to Dr Google when I got home and discovered it’s caused by HPV (although not necessarily cancer-causing strains) and I wasn’t offered a smear test as I’m only 22. I’ve got to wait 3 years to discover whether the HPV may have affected my cervial cells.
Allie, they’ve already made the change; it used to be younger (20 as well, I think?) but they put the age up to 25 a few years back. My mum couldn’t believe that I hadn’t been called for one by the time I hit 22 or so, and I had to take to the internet to prove that my letter hadn’t just been lost in the post. I think the consensus was that the abnormalities are so uncommon amongst women in their early 20s that it simply wasn’t worth it, and I guess they have to cut corners somewhere. Luckily, if this post is anything to go by, even abnormal cells discovered at this age are easily fixable, so presumably if she’d had the test 5 years earlier, it wouldn’t have made a difference.
Yes, it would be ideal to have them from an earlier age but sadly there’s only so much the NHS can afford . . .
Having said that, if you’ve got a wart that could be caused by HPV then you should be able to request an early smear test. I’m pretty sure you can do that if you have a history of cervical cancer in your family as well.
From what I’ve been told by my doctor, the reason they don’t offer smears to under 25s is that the cervical cells are still undergoing *natural* changes until that age. So there could very well be changes, but they would be completely harmless. I agree that you should be able to get one at a younger age if you have a history of cervical cancer in the family, though.
Thanks for this post, Vagenda! You reminded me I’m due for a smear test so I booked one for Monday
I’m 20, and had to have a smear a few months ago as I was showing symptoms. While the smear was fine, the fact that the nurse stopped halfway through and sent me straight to a GP (completely unscheduled) led to similar levels of freak out. I think part of the problem is that cancer is built up to be possibly the scariest illness in our society. I knew there were loads of not-cancer things it could be, and that I’m very young for it and have had the HPV jab, but it’s hard to focus on that under stress BECAUSE IT COULD BE CANCER. But I’m really sorry you had such a rough time getting answers out of medical staff, which is utterly inexcusable. And yeah, no one ever told me about the no sex/lube/cream before a smear either. I only found out because I’m a borderline hypochondriac who reads up on everything medical like crazy. They should really tell you when you book the appointment.
Nothing but respect for your choice, but I opted for celibacy (until marriage to my also pre-marriage celibate husband) and reading about getting my ladybits electrically scraped, and having an injection in my cervix(!!) makes me even more super happy with my choice than I already was. Will show this to my little sister so she can consider it (along with lots of other info obviously) as she grows up and makes her own choice.
I’m sorry you felt so much guilt, shame, and fear. You shouldn’t have had to go through that, and it’s especially awful to me that your nurse was so brusque with you when you were obviously upset. I’m glad you’re all better now, and sharing this information with women so they know how important pap smears are! In the U.S. I think they recomend yearly ones if you’re sexually active, or over 21 years old, and if you have three negatives in a row, you can go to every other or every third year.
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I’m sorry your first smear was so awful, and it upsets me that no one at the NHS took the time to explain what was happening. I remember getting the same results when I was 22 and living in Canada, and the nurse took time after her shit to call me personally and explain what the results meant, so I would not freak out. I was eternally grateful for her care.
But you are right! More women should talk about their vaginas! I just wish I could say vagina in front of other women without getting that ” WTF?” look!
Another little info I learned this year: The NHS does not test for SDI’s during your smear. I grew up in Canada where women get their first smear when they become sexually active. Personally I don’t think the smear should be all about the cancer check though it is super important). If you want a STI check, you will have to ask them to do it. It’s a good habit to get into.
In Australia women are recommended to have a pap test every two years from age 18 (or from when becoming sexually active). You can get it done at a clinic (for free) or from your GP.
When a test returned an abnormal result I got a personal call from my GP (who is amazing BTW – props to you Jill Spargo!). She suggested I make an appointment but was equally happy to give me a quick low-down over the phone. I went in and she talked me through what it meant and referred me to the women’s hospital for a coloscopy. I felt apprehensive but supported and informed and the month long wait for an appointment went quickly.
Unfortunately my colposcopy didn’t go so well – efficient nameless doctor told me it didn’t look good so she took a biopsy (i.e. dug out tiny bits of my cervix with a little scooping device) and referred me for laser surgery. I was freaking out during this appointment and afterwards felt sore, scared and uncertain. The next few months went SLOWLY.
The day of my laser surgery rolled around and I went under a general anasthetic for the short procedure (general = optional but efficient nameless doctor suggested it after I sobbed silently while she took the biopsy). I never met the surgeon, just woke up later to my husband by my bed.
Later that night I went home and rested but kept bleeeding. Ended up in A&E at 2am and was sent home about 5am after being told it was probably just an infection and to keep monitoring it. I was in pain, exhausted, still bleeding and didn’t receive any follow up communication.
Luckily I healed up and came good, had to go for a check-up colposcopy a couple of months after the surgery and they took another biopsy but both it and all my smears since (6, 12, 24 & 36 months later) returned normal results.
While I’m fne now, it was a STRESSFUL time and I cannot reiterate enough the advice that you GO FOR A PAP SMEAR! If they’d caught the abnormal cells earlier a simpler procedure could probably have fixed it up and if it hadn’t been caught until later there was a real danger of me developing cervical cancer.
So just hold your head high, drop your pants low and get your ladybits looked at. Could literally save your life
I’ve just had my 1st smear, which took 2 attempts – the 1st time the nurse told me she couldn’t do it as there was blood around my cervix and informed there was some slightly unusual discharge ‘down there’. I, obviously, freaked out and had a panic attack later that day which my poor Dad had to talk me through! The nurse hadn’t attempted to explain any reason for the issues, just sent me on my way. I went back to the doctor a few days later as I still had internal pain – and had no idea whethrr that was normal or not – and she was fantastic, really nice and giving out very laid back vibes, which I definitely needed!
Then I got ‘the letter’ saying I had to go for colposcopy, and toddled off to the hospital. The doctor I had was lovely, but took biopsy of my cervix and did NOT warn me that that bit would be quite painful – my eyes watered quite strongly! The nurses were lovely, told me to go home and put my feet up, but no one mentioned whether there may be side effects, such as changes to my period and some bleeding which can be described best as ‘chunky’ (vom) and I was to teary to ask and just wanted to gtfo of there and go home.
I’m waiting for the results, completely agree with you, being informed would have reduced my anxiety about 300%!