Many people find being invited for and having cervical screening (a smear test) uncomfortable and distressing. But if you have experienced sexual violence, you may find it particularly traumatic or distressing. If you feel this way, you are not alone. We know that many survivors do not attend cervical screening because of their experience of sexual violence.
Cervical screening can feel both intrusive and intimate because of the physical position the test is done in and the medical equipment used. This means it can trigger flashbacks of the things you have been through, or evoke physical and psychological responses, like a panic attack, dissociation, or freezing. Many survivors are anxious about having to disclose their experience to a healthcare professional.
Remember that these are all normal, reasonable responses and there is support available, including our Emotional Support Line and Emotional Support Email.
Getting the letter inviting you to cervical screening can be upsetting and make you feel very anxious. If you feel able, talking about your feelings with someone you trust could be a first step to dealing with any issues or concerns the letter might be bringing up.
You might want to talk to your partner, a friend, relative, doctor or nurse. If you are currently getting mental health support to deal with your experiences of sexual violence, you might prefer to speak to one of our Emotional Support Line team or one of our Counsellors, if you have one, one of our Independent Sexual Violence Advisors (ISVA), or another support professional.
If thinking about cervical screening is too much, you can ask your doctor to take your name off the cervical screening automatic invitation list until you feel stronger. Please be aware that you may be asked why you want your name removed.
Above all, try to remember that the violence you experienced was not your fault, and that you are deserving of care, safety, and dignity. It is also important to remember it is your choice whether to go for cervical screening and, if you do go, you are in control of the test.
Feeling that you are not in control of your cervical screening appointment may remind you of past violent or abusive incidents. You can begin to take back that sense of control by making some decisions about how you want the appointment to go:
- Ask for an appointment with a nurse (sample taker) of your preferred gender.
- Ask to be seen by a trusted doctor or nurse who you already have a good relationship with. While they may not already be fully aware of your situation, knowing that you chose them can help to make the appointment feel more comfortable. Be aware that they might not be qualified to do the test, but can be with you or talk to colleagues on your behalf.
- Book an appointment just to talk about cervical screening and find out more about what happens. You do not have to have the test at this appointment.
- If you are anxious about being alone with your nurse, or just want extra emotional support, take someone you trust to the appointment.
- Ask for a longer or double appointment. This allows you a little extra breathing space before and after the test, so you can take the appointment at a pace that is more comfortable for you.
- Plan what you are going to do after the appointment. You may not be able to carry on as normal immediately and need more time to ground yourself.
Disclosing sexual violence
You may find disclosing your experience of sexual violence very difficult or you may have never disclosed. You may also deny it when asked. All of these feelings and reactions are normal. There is absolutely no pressure to disclose anything during your appointment. But it might be helpful to let the nurse know that you are feeling uneasy. If they are aware, it may help them better understand how to help you through the appointment.
You may find it helpful to:
- Ask them to talk you through the test beforehand and show you the speculum and brush.
- Tell them what words or phrases you prefer or are comfortable with, to help them avoid any language that may be distressing.
- Tell them how heavy or light their touch should be, or not to touch certain areas if possible.
- Ask whether you can insert the speculum yourself, if that would feel more comfortable.
If you would prefer your nurse to know about your history, try practising this conversation beforehand with someone you trust. Alternatively, you can take a trusted person with you, who can be your voice if you lose yours. Or it might be easier to write it in a note that you can pass to your smear taker.
If you are worried about stress responses kicking in, coping with these, or what your nurse might think, it may be a good idea to let your nurse know before the test. For example, you can tell them “I might cry” or “I might not be able to answer your questions”. You do not have to explain why you might react this way.
If you feel able, you and your nurse can agree a plan of action. It may include a word or signal that lets them know you need to stop the test immediately.
If your distress or anxiety starts rising, some self-care techniques may help:
- Try breathing deeply from your diaphragm (the part between your chest and stomach) for counts of 5 breaths in and 5 breaths out.
- Mindfulness or visualisation exercises may help prevent panic attacks.
- Distract your mind by listening to music or speaking with the nurse. You could ask them to keep calmly and gently reassuring you.
- Take a particular object, photograph, or scent with you to help keep you grounded in the present moment.
Taking control – You can stop at anytime
Remember that if you feel unsafe, uncomfortable or distressed, it is your right to stop or pause the test at any time – whether you simply want a short time to collect yourself, or you would prefer to leave altogether.
It is absolutely fine if you don’t go through with your cervical screening on the first attempt. You can always try again on another day or with another nurse. Be patient and gentle with yourself, and remember that your nurse’s main concern is your health and wellbeing. They are not there to judge, and should be respectful of your emotional need to move forwards at your own pace.
Likewise, once you have had your cervical screening, give yourself the time and compassion you need to deal with any difficult feelings it may have brought up.
Waiting for your results can be an anxious time. Try to remember that most of us will have a clear result.
If you do have cell changes (abnormal cells) on your cervix or high-risk human papillomavirus (HPV), it may bring up lots of feeling or memories about what you have been through. Going for further tests or treatment may feel impossible or too upsetting.
You don’t have to cope with these feelings alone. If you feel able, speak with your doctor or nurse about your results and ask for more emotional support if you need it. They can refer you to an NHS counsellor or you can find a private counsellor who suits you. Remember that private counselling does cost money.
Jo’s Trust, the UK’s leading cervical cancer charity, has lots of information about cervical screening that you may find helpful, including a blog with useful tips. They also have support services, including:
You are not alone
We are here to help you and, no matter how hard it may seem, we will get there together.
The training sessions were engaging, very informative and eye opening. The information on the statistics and range of services was very useful to know as they helped understand the scale and difficulties with sexual violence etc.
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My time here has been so helpful to me. Having time to step back and look at some of the difficult things that have happened in my life and recognise I have strength has been so precious to me. I am so thankful for being able to access such an amazing safe haven! You have given me the opportunity to step back and breathe again. I feel like a stronger person, able to face the world and live again. I am empowered!
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