30% of us still aren’t getting smear tests, and that’s putting us at risk of potentially life-limiting illnesses. So, what’s the problem?
You’re going about your day, minding your own business when suddenly, you receive a text or letter: “You’re now due for your cervical screening.” Do you book the appointment right away? Or do you avoid it at all costs, ghosting the NHS?
If you’re in the latter camp, you’re not alone. In fact, more than 30% of people between the ages of 25 and 49 eligible for cervical screening in England didn’t attend their appointments in the screening year 2020/2021, according to the most recent UK government data. On TikTok, users are also avoiding their gynaecological appointments and tests. The hashtag #smeartest has more than 37 million views, and there you’ll find, in the comment section of almost every video, users stating that they’ll never get a smear test. “It’s not even the pain I worry about, it’s the embarrassment,” one user writes. “My pap will never be smeared, I’d rather die,” someone else comments.
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That seems at best dramatic, and at worst, downright dangerous. A cervical screening – also known as a smear or pap smear – is the most effective way to prevent cervical cancer. The test is able to detect high-risk types of HPV viruses that can result in cervical cancer. According to Public Health England research, about 83% of cervical cancer cases could be prevented with regular cervical screenings. That’s why in England, women and people with a cervix aged 25-49 are invited to be tested every three years, with those aged 50-64 getting the call every five years.
Even though a smear test is important for our overall health, however, many simply aren’t turning up to have them done – and that’s because they’re too invasive.
Smears can be uncomfortable for survivors of sexual abuse
For sexual assault survivors like artist Caroline Angénieux, internal examinations can be triggering. As a French-British citizen, she’s lived in both countries and had her first smear test in France when she was 17 years old.
“I was on the pill and ‘sexually active’ as the doctor called it, so the doctor wanted me to have a smear test,” she tells Stylist. “I was terrified and the nurse didn’t try to calm me down or explain the test. I had to lie down with my legs open, and she inserted the tools and would command me to relax. I was crying because the pain was intense.”
That lack of respect on behalf of the practitioner only made the situation worse. “I told the nurse that I was in pain, and she said it was because I wasn’t relaxed enough.She told me to stop exaggerating because the test wasn’t that painful. Once it was over, she said that if I was having sex, then I was grown up enough to handle the test.”
Bad first experiences can make future smears more uncomfortable
Therapist Tasha Bailey, who specializes in trauma and identity, explains that our bodies hold memories of past trauma and the sensory information of a smear test or other gynaecological appointments can definitely trigger past trauma, like sexual trauma, domestic violence and childbirth violence. “Being on a hospital bed to be examined can be really vulnerable, especially because it’s a situation where you’re being asked to let go of control,” she explains.
According to Bailey, if your first appointment is an uncomfortable one, it can make future tests harder. “Sensory information can trigger our trauma. If you’ve had a difficult smear test before, being in that situation again can trigger you and lead you to panic.”
That’s why gynaecological appointments can be psychologically invasive. “A lot of the time, medical professionals look at the body, but not at the person and so there’s this real disconnect,” Bailey says.
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That’s not to say that doctors and nurses can’t make smears less worrying. “Medical professionals can take a little bit of extra time to explore people’s emotions and feelings about their smear tests,” says Dr Brooke Vandermolen, an OBGYN-registered doctor. “That can drastically improve our uptake of important tests, as well as helping to diagnose other conditions like STIs.”
Now living in the UK,Angénieux has had a positive experience at an appointment with a medical professional who understood her sexual trauma. “I had an appointment where I didn’t have to complete the examination. The nurse was very kind, she showed me the tools and explained the test. I was so terrified that I didn’t even take off my coat for the whole appointment,” she says.
Angénieuxwasn’t forced to do anything she wasn’t comfortable with. “She said I could book as many appointments as I wanted and that if I only came and looked at the tools, that was OK,” Angénieuxsays. The practitioner explained that the examination could be done gradually. “For instance: the first time, I can sit; the next time, maybe laying down clothed; the next session, I could lay without clothes. That gave me a lot of reassurance. I think I would need to hear that again to overcome the trauma,” she adds.
How to advocate for better smear tests
Dr Vandermolen explains that if people don’t feel respected during a gynaecological appointment, the first step would be to find an alternative provider and share with them any concerns and previous experiences. “And if the previous provider was disrespectful, insulting or racist, it would be important to lodge a formal complaint to prevent them taking similar prejudices to other patients.”
It’s also important to have enough information to advocate for your rights during a gynaecological appointment – the patient can ask the practitioner to stop at any time. Dr Vandermolen believes that the lack of information surrounding gynaecological appointments is one of the reasons why young people find appointments invasive and are avoiding tests.
That’s why she started sharing information and resources on her Instagram account. “When we show that the clinic rooms aren’t so imposing, it can feel more comfortable when you arrive,” Vandermolen says.
That’s also what motivated Leanna Alaiwat, an OBGYN physician assistant, to share information on her TikTok account. “When it comes to sexual and reproductive health, many of the topics discussed are rather taboo. I know this because I was raised in a very traditional Muslim Arab American family. When I first started working in OBGYN, I was faced with the harsh reality that the majority of the patients were unaware of not only their anatomy but also their rights,” she tells Stylist.
“I found that many patients were anxious and fearful of the unknown, but when educated, they felt more empowered than when they first walked in. Ultimately, I realised that I was not only focused on diagnosing and treating patients daily, but also on educating them so that they could properly advocate for themselves and understand the medical options they have regarding reproductive care,” Alaiwat adds.
For more comfort, women can bring their favourite items into the surgery with them. According to therapist Bailey, sensory information can trigger trauma but it can also help the patient go through a difficult situation, such as a gynaecological appointment. “We can also be soothed by sensory information, so if you have a favourite blanket, teddy bear or even a vanilla-scented hand cream that makes you feel soothed, then you can bring those things with you,” she says.
Trans people also struggle to receive the proper care
Gynaecological appointments can also be challenging and invasive to disabled people, people of colour, non-binary people and transgender men. Blogger Quinn Rhodes, 24, still hasn’t had his first smear test (you tend to get your first invite at 25), but gynaecological appointments can be difficult for him. He deals with vaginismus and appointments can be very painful. But that’s not his only barrier: “As a transgender man, I’m not just worried about the pain, but of going through a process that’s misgendering and dysphoria-inducing,” he says.
“Even the fact I’m going to be invited for a smear test means I’m registered in the system as ‘female’. My deadname is still on all my medical files. The letter for the appointment may be from Women’s Health Services. And that’s all before I get in the room, to get naked and trust that whoever is administering my smear test understands that not only women have vaginas.
“It’s not uncommon for me to be the first trans person a medical professional has had and that shows in how they interact with me. I don’t want to have to educate the person whom I’m vulnerable and exposed in front of about how they should be treating me.”
Clearly, there are a number of barriers to getting tested for those that need to be tested. But it’s important to stress that smear tests really do save lives and that if you possibly can, it’s worthwhile pushing through. That’s not the same as suffering in silence or allowing your issues to be trampled over.
Remember, you have the right to ask for a different nurse or doctor, to ask for the test to stop or to ask for a double appointment to give you the time to talk and prepare.
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