Cervical Smear Tests
Most commonly you will be referred to a nurse for a smear test, occasionally the appointment may be with a doctor. If you so wish, you can ask for a female to do the smear test (if available). You can even request to have it done by specialists at the colposcopy clinic if you have had problems with smears.
Why are smears tests painful for some women?
Pain during a smear test can be due to an infection in the vagina, such as thrush or Bacterial Vaginosis (BV). Though thrush often causes soreness and itching, BV may not cause any symptoms, other than a slight fishy smell.
Having a smear test can also be uncomfortable if the nurse (or doctor) does not use sufficient lubrication on the speculum, which is the instrument used to allow the neck of the womb to be seen.
In women past the menopause the vagina can be dry and slightly inflamed due to low levels of oestrogen, and the first sign of this is often discomfort either during sex or during a pelvic examination. This type of problem can be corrected using oestrogen cream inside the vagina.
Being anxious about having a smear test, and tensing the pelvic muscles can also make it uncomfortable. This is usually the most common cause for painful smear tests.
What can I do to help myself?
If smears have been a painful exercise for you, it is important that you discuss this with the doctor/nurse first about this.
Usually you are advised to take a friend in with you who can sit by your side to hold your hand, take notes and speak on your behalf.
Most clinics usually provide a chaperone but occasionally you may have to ask for one. Your friend could act as a chaperone.
Students attend consultations as part of their training. You may refuse to allow them at yours, but anything they learn from you may help other students and patients.
What does the smear test involve?
Before you undress, be sure you know what to expect. The door or screen should be secured for your privacy. If you feel cold, or exposed, ask for a blanket or your clothes to cover you.
You can ask to look at any instruments the doctor or nurse will use. If you know you need a smaller speculum, please do not hesitate to say so.
Ask the doctor/nurse to tell you step by step what they are going to do and to proceed at a pace you are comfortable with. You can ask to stop the procedure at any time.
You can ask your doctor to use lubricant as this will help the speculum glide in more easily.
It is important that if anyone does anything which causes you pain or distress please let them know, this will undoubtably be unintentional and they are likely to be completely unaware.
Ask the doctor/nurse to slide the speculum fully in, then open it slowly, just as far as you can bear. Then it won’t over stretch the vaginal entrance.
For some women, it helps if the speculum is opened sideways, not up and down.
What position do I need to be in?
Placing you legs in stirrups may help- they tilt your hips and make the cervix easier to see.
Or you can do this (you may need to practice this at home first)
Lie on your back with pillows under your head to make eye contact with the doctor easier.
Place a pillow under your hips to tilt the pelvis to a better angle.
Place your feet shoulder–width apart to make it easier to relax.
Slide your heels up close to your hips, then let you knees open.
How to relax prior to the smear test?
- Make sure you have something interesting to read or an IPod/MP3 player with you while you are waiting for the smear test. This will help to reduce the anxiety
- Learn proper abdominal breathing, which is amazingly effective for relaxing women prior to a pelvic exam and practice breathing twice a day for two weeks prior to your visit.
- Find a calm place to think about while practicing your breathing, such as the beach or the mountains. You need to feel peaceful and relaxed in this place. As you focus on your calm place, come up with a cue word that you can repeat to yourself, such as "calm," or "peace."
- Have a strategy during your exam. For example, my own doctor is very talkative and friendly, and she always asks me about my children or my last holiday. My strategy is to tell her about my children’s antics or my holiday experience. By the time I have finished with my talking, the smear has been taken.
- If talking does not sound appealing to you, pick a focal point to stare at, breathe, and repeat your cue word to yourself. The key is to practice relaxation on a daily basis before relying on it to keep you calm in a situation such as a smear test.