“Oh my god. You’re that nurse…”: Smear test post part 2

// 19 September 2011

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A photograph of a pink placard, which reads, In yesterday’s post, I talked about many women’s experiences of smear tests, and what can go wrong as well as what can go right.

So what needs to happen for all smear test experiences to be positive ones? Firstly, there are steps we can take that can help to ensure a more positive test. Some women have taken an unusual approach and had a much more successful experience as a result. @MsEmmaB “once engaged in an in-depth discussion re my ‘hood piercing, whilst she was ‘down there’ looking at it.made me giggle.”, while @elmyra‘s “friend handed out business cards for her pole dancing school during hers.”.

Others’ advice centred around similar themes: @Sevenhelz advises, “take a friend? try to be somewhere the staff make you feel safe and comfortable, even the receptionists”, and @SirenOfBrixton offers “Advice to women who are nervous: imagine it’s your ear they’re looking in. It’s your body, try NEVER to be embarrassed by it. Easier said than done, I know, but sometimes you can fake it til you make it. Love your bits!”

While some people’s smear experiences were inappropriate and awkward, others were downright unprofessional, and thanks to information supplied by @other_red, I can tell you that if you want to raise concerns about how a smear was carried out, you can contact the PALS team – there’s one in every PCT. You can find your PALS team on the NHS Choices website. The Scottish equivalent for making a complaint is Health Rights Information Scotland, and Bwrrd Cymru provides information for people in Wales.

Other good advice is to seek out someone experienced to carry out your smear test. When I was younger this meant the University Health Service nurses, as they did an awful lot of them, but these days that might be less true, as under-25s are not called for smear tests any more. Doctors and nurses at GU Clinics and Sexual Health Clinics are very specialist in internal examinations, and could be a good choice, although not all offer smear tests, so check before you go. See which nurse your friends recommend, or who made you feel comfortable when she was giving you an innoculation. Feeling relaxed with someone makes a big difference to how your experience will be.

I started having smear tests when I became sexually active, which was the advice at the time, and I’ve had some really bad experiences. I put off my last one until it was 6 years overdue, then finally had the test a few months ago. I chose who I saw carefully, a doctor I felt comfortable with, and who does a lot of them, and am pleased to report that it was uneventful, not painful, and it left me wondering what I’d been worried about. But I know very well what I’d been worrying about, and we need to work for smear tests that are made as easy as possible for us by the professionals who carry them out.

Trans men are advised that smear tests are still essential as long as they have a cervix. FTM Guide suggest going to a GP rather than a “women’s clinic”, and West London Centre for Sexual Health have started a sexual health clinic for the Trans community, including offering smear tests.

According to the RCN Good Practice Guidelines,

  • All women attending for screening should be offered the option of having a chaperone present during any consultation, examination, treatment or care.
  • The healthcare professional should be alert and sensitive to what the woman may wish to discuss.
  • All healthcare professionals involved in caring for women should be aware that domestic violence is not uncommon.
  • It is highly unlikely that a woman who has experienced female genital mutilation will come forward for cervical screening. However, all health care professionals should be aware of this practice and be prepared to care for a woman who has undergone this.
  • You should again offer the woman the opportunity to decline the examination, ensuring you re-affirm her right to withdraw consent at any time and request the procedure be stopped.
  • The examination should take place in a closed room that cannot be entered while the examination is in progress.
  • You should explain every phase of the test before you proceed.
  • You should offer to demonstrate the speculum.

It then summarises that good practice should encompass the following:

  • ensuring informed consent is obtained from the woman
  • offering appropriate help and advice at all stages of the process
  • understanding of, and sensitivity to, cultural issues in relation to the procedure
  • enabling vulnerable women to access the service – for example women with learning disabilities

(These are selected from the full document for relevance, as are the notes above).

There is no mention of caring for trans men, and virtually nothing about the thing that so many of us have found difficult about them, which is the professional making insensitive and inappropriate comments.

While details of how to reassure and inform patients about specific issues, such as STIs, the limits of smear tests, and having a chaperone, are included in the guidance, there is no mention of reassurance for sexual assault and rape survivors, and the particular issues that can bring.

The guidance that exists is good, but a long way from complete, in my opinion. It is also clear that having good practice guidance, and having all staff follow good practice guidance, are two different things. But as we have access to the guidance (pdf), it could be useful in making any necessary complaints – we can refer to it as evidence of why what happened to us was wrong. However if you are a trans man, or if the guidance does not otherwise cover your situation, it will be less useful.

The image is a photograph of a pink placard, which reads, “Don’t take away my cancer screenings”. Tall buildings are visible behind the placard, and a person’s hand and hair in front of it. It was taken by Pretty Kate Machine and is used under a Creative Commons Licence.

Special thanks goes to all who contributed to the initial discussion, and to @CynicalRhubarb for some fact-checking help.

Comments From You

sprysi // Posted 19 September 2011 at 8:37 pm

I wish I’d been prepared for my first (and only) smear this summer, regarding the pain. My (female) GP, who knows I have vaginismus and referred me for surgery down there, was totally unsympathetic and actually laughed at me. My vision went white – I couldn’t breathe and I struggled. It was awful. The embarrassment isn’t an issue for me, but the pain was so extreme that I’m considering not having another smear.

I was not offered a chaperone, I wasn’t asked for consent and I wasn’t shown the speculum.

Perhaps if someone had said to me, “look, this is going to be awful, but we can get through it together”, it would have been bearable. But so much of the information out there just prepares you for ‘mild discomfort’. I’d recommend any women with vaginismus to bring someone with them, if only to make sure the GP follows the guidelines above.

Philippa Willitts // Posted 19 September 2011 at 8:44 pm

I agree that ‘mild discomfort’ can be misleading. I guess that’s the ideal, and maybe even the majority case, but I’ve had some that were agonising. Although others that were mild discomfort, too.

For women with pain conditions like vulvodynia, or spasms and pain like vaginismus, I think there should be additional guidelines and steps to follow. It is just not good enough that people who are already known to have excessive pain with penetration are being laughed at and dismissed during examinations and tests.

Emma // Posted 19 September 2011 at 9:10 pm

Great posts, Philippa!

@sprysi: I’m so sorry to hear about your experience. Have you thought about making a complaint? The attitude of your GP was completely unacceptable. If it’s any consolation, you’re not alone – I too had to go through an extremely painful smear test carried out by a completely unconcerned gynaecologist!

For women experiencing vulval pain, vaginusmus and other conditions that can make smear tests extremely painful, there is a very helpful guide called ‘Smears Without Tears’ published by the Vulval Pain Society: http://vulvalpainsociety.org/index.php?page=smears-without-tears

Emma x

sprysi // Posted 21 September 2011 at 10:56 am

Emma, that’s really helpful – thank you

Charlotte // Posted 23 September 2011 at 10:09 pm

I asked (and was permitted) to insert the speculum myself the second time I encountered one. It made the experience a lot better!

violet // Posted 15 October 2011 at 1:33 am

“@elmyra’s friend handed out business cards for her pole dancing school during hers.”.

Not sure if from this if Elymra’s friend was the nurse, or the patient (and if she was the patient who was she handing them out to, apart from the nurse?) but if you’re concerned about “there is no mention of reassurance for sexual assault and rape survivors, and the particular issues that can bring.” then I’m not sure handing round cards for an exercise related to sex-work is the best way to help. Sex-workers deserve to be screened in a polite, professional, confidential and sensitive way; so do those who have been assaulted (whether in sex work or not), and those who would be offended by pole-dancing etc, whether for personal or religious reasons. One person’s “funny sex-positive” anecdote is someone else’s trigger.

And yes, the service seems poorly set up to deal with women who have had traumatic sexual experiences – Germaine Greer’s “sheep through a sheepdip” comment seems apt as there seems to have been a basic assumption built into the screening programme that every woman is the same, despite the immense variety in physical/emotional/mental and sexual feelings, abilities and experiences across 30 million women in the UK (never mind the physical and emotional changes that take place between someone being screened when they’re 25 all the way to being screened at 65).

All this aside, it’s very good that F-Word are prepared to put a critical eye to the screening programme – too often I’ve seen women’s criticism’s of their experiences brushed off with “but you can’t criticise the service! You’ll put other women off!!!” which simply means that the same issues re: informed consent/treatment keep reappearing and disappearing without being fed back into actually IMPROVING the service.

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