Smear tests, pap smears, pelvic exam, cervical screening. Whatever the term, if you have a cervix you’ll have heard of them, and if you’re over 24 you’ve hopefully been for one. In the UK, the NHS will invite you to start having cervical screening as soon as you turn 25, and if all is normal, they will continue to screen you every 3 years or so. The process is quick, if a bit uncomfortable, and it could prevent you from developing full blown cervical cancer.
My first cervical screening was three years late. I know how important tests like this are. I’ve always been great at getting checked for STDs. I visit the nurse once a year or each time a relationship ends (whichever comes first) for a full STD screening. Yet I had some kind of block when it came to going for my smear. It didn’t help that shortly after being invited for my first cervical screening my GP deleted me from their system. I called up to make the appointment to find out I’d been removed. It was because I had been registered as student and my undergraduate degree had ended two years previously. The surgery was attached to the university. They systematically removed students even though I had continued to be a student for another 5 years, through a master’s degree then a PhD. Even more bizarrely I’d been to see them only a few months before they deleted me.
They said I’d have to come in with proof of address to register with them again. This felt like a massive hassle at the time, partnered with the stress of a postgraduate degree, I just didn’t get around to it. Fast forward through the end of my PhD, a couple of stressful academic jobs, moving across the country and registering with an over subscribed surgery. I just never got around to it, even though I know it’s important, even though I would always encourage other people to have it.
I lost my job, moved back to my hometown, and registered with a new GP surgery. My health at this point in time was so bad my family was begging me to visit a doctor. One of the first questions my GP asked me was when my last smear was. I guiltily admitted I had yet to have one.
My First Smear
I booked my smear, my first smear, at the age of 28. A week later I was sitting in the doctor’s office waiting for the nurse to call my name. The nurse’s name was Sister Theresa Murphy. I was picturing an irish nun, in full habit looking like she’d jumped straight out of call the midwife. What I was met with was a middle aged woman in a normal nurse’s uniform. Part of me was disappointed.
She began by telling me all about what a cervical screening was. I found out that it doesn’t detect cancer, just abnormal cells. I found out it is preventative, if abnormalities are detected the bad cells can be removed before their mutation grows into full blown cancer. I found out that the majority of smear tests come back normal. It was nothing to worry about.
She asked me when my last period was, and when my next period was due. This was a problem; I have such irregular and wide spread periods that I had no idea. Being unemployed had also warped my sense of time, the days meant nothing and I was struggling to keep track of anything. Sister Theresa Murphy did not know what to do with this information. She had to put something on her form, and I wasn’t being helpful. Eventually she moved passed it.
She asked me about my contraceptive method, if I’d every had a miscarriage, if I ever bleed after sex or between my periods. I tried to explain again, that I wouldn’t know if I was bleeding between my periods. Sometimes a period seems very close to the last period, and it doesn’t last long and there is very little blood. Does that count? Sister Theresa wasn’t sure. I got the feeling my periods were starting to cause her annoyance. I got the feeling Sister Theresa thought I was being difficult on purpose.
We moved on to the exam. I was asked to strip from the waist down and lie on an exam bed. The bed was covered in paper, and I could use a big square of paper on top of me to cover myself. This struck me as weird; hiding my body from myself while the nurse will be looking deep inside. I did it anyway in an elaborate display of false modesty.
Sister Theresa Murphy asked me to spread my knees apart while she angled a light at my vulva. She got out a small plastic speculum and lubed it up with some jelly type lubricant using her sterile gloved hands. She started to insert the speculum into my vagina. She told me to relax. She commented that my pelvic floor muscles must be really strong. It was an odd complement to get while a medical professional was struggling to insert a plastic instrument into my vagina. I didn’t reply, thinking that my vagina was just scared shut.
Once the speculum was in place, Sister Theresa began to crank it open. My vagina did not like that at all. It wasn’t painful exactly, it just felt uncomfortable. Sister Theresa peered into my vagina, and commented that she thought my period will start soon. I had no idea you could tell something like that just by glancing at a cervix. She then inserted a small brush on a stick, and swept it against my cervix. This too wasn’t exactly painful, but it didn’t feel nice either. She quickly put the brush into a test tube of solution and shook it around a bit.
Then she tried to removed the speculum. It had got stuck. Yep, that vagina that didn’t want it in there in the first place was now gripping on to it for dear life. Sister Theresa had to effortfully pull on it until it audibly popped out. She gave me some tissue to wipe myself off and said I could get dressed again.
She told me that she had made me start bleeding. She said there was a small amount of blood in my sample, and that might mean it is useless to the lab. If it is useless I would have to come back again. She told me I should get the results in 2 to 3 weeks.
I bled for about a week and a half afterwards. A pretty normal period for me. I don’t know if I had happened to go for my smear on the first day of my period or if poking at my cervix made it come on quicker. To be honest it doesn’t really matter either way, I’ve had a penis bring on my period before. My flatmate refers to it as “bashing it out of you like a ketchup from a glass bottle”. It’s nothing new.
My First Smear Results
Four weeks later and I still hadn’t had my results. I called up my doctors surgery to enquire. The receptionist told me the nurse shouldn’t have told me I’d get my result so quickly, that it usually takes at least 6 weeks. She said she would have a word with the nurse, because I wasn’t the first person to call up asking about my smear results. I didn’t worry too much about it, thinking it’s statistically likely my results will be normal anyway. I could wait another few weeks for the letter.
The letter finally arrived about 6 weeks after my smear test. I opened it up right away, cheerfully expecting an all clear result. The first line thanked me for going for a cervical screening test. The second line informed me the laboratory had found abnormal cells, which are sometimes caused by the human papilomavirus (HPV). The next line told me I also have HPV. The letter ended by saying I would be referred for a colposcopy at the hospital. It said the hospital would be in touch to arrange it.
To be honest, I freaked the fuck out. I worried about cancer. I worried about my fertility. I felt guilt, thinking about all the times I’d been loose with condoms. My husband and I want to try and conceive soon. I was terrified that measures would have to be taken that would make conception more difficult. That I would have miscarriages. That I would have to have such an extensive amount of tissue removed from my cervix that it wouldn’t hold a fetus in.
I knew I was being irrational, but my anxiety had kicked in and I was headed straight for the worse case scenario. I couldn’t help myself. I felt like if I voiced all that was going on in my head I would seem crazy. I started going further down this destructive path. Every twinge in my abdomen was evidence of a cancer growing deep inside me. Every back ache evidence the cancer had spread, that it would be untreatable. I started worrying about my husband and how he would cope with my death. I worried about him being alone. I worried about him getting deported, because without me he had no legal rights to renew his visa. All this anxiety over one little abnormal result. One little letter.
I think part of the problem was all the NHS literature tells you that a normal result is far more likely than an abnormal one. That knowledge made me over react. Luckily some very kind people on twitter came to my aid and answered all my dumb questions. They had been through this before, they could relate, and they made me realise the whole thing was a lot less scary that my brain had blown it up to be.
The thing I had to keep reminding myself is that the whole point of this service is to prevent cervical cancer. So that the abnormal cells had been spotted is a good thing. We can get them out of me before they become cancerous. I still felt guilty about the HPV.
My guilt about the HPV comes from two sources. One, is my flatmate. She is a bit of a germaphobe. I came home one day to find her disinfecting the outside of two bottles of wine. She had said the cashier at the local shop had a cold sore on her face. My flatmate was terrified about getting HPV through the cashier touching her own face then touching the wine bottles. I tried to explain it didn’t work like that, that you would actually need skin to skin contact to pass on the virus, but she wasn’t having it. She continued to disinfect whilst telling me stories of similar situations where she’d had to be vigilant about HPV. It was obvious this was a really scary prospect to her. Needless to say, I haven’t discussed my results with her for fear of being treated like a dangerous infectious object. She makes me feel like one.
The second source was a thread I read a while ago on the Lovehoney forum. I can’t remember the start of the thread, but it devolved into outraged users saying that people with HPV must disclose it to any potential sexual partners. Despite a few reasonable users pointing out that most people with HPV have no idea they have it (indeed, I had no idea), and that NHS sexual screening does not even test for it, and that there is currently no male test for HPV, and that about 80% of the population have had HPV and most strains are completely harmless. The consensus was still overwhelmingly that people who do not disclose are irresponsible assholes. Sure, I can see why disclosing HPV to new partners is a good thing. But the way it was being discussed and the way users with the view that disclosure isn’t necessary were being treated, it really pushed the idea into my mind that HPV was something to be ashamed of.
I was wondering how long I have had it, and who I got it from. Have I passed it on to anyone else? It made me worry about having sex with anyone else. I became nervous about going down on my husband incase I got HPV in my throat and ended up with throat cancer. I love giving him blow jobs and this stupid virus was ruining it for me.
An interim GP appointment
A week later I got a letter saying that my hospital appointment would be in 3 weeks time. Meanwhile, I had another appointment with my GP. She was investigating me for polycystic ovaries. She did an internal exam, then popped a speculum inside me to have a look inside. She said I had erosion of the cervix, and immediately asked me about my smear result. She seemed concerned but was reassured to know I was going to have a colposcopy in three weeks. She didn’t explain what cervical erosion is, or why it concerned her. She was pushed for time, as many GPs are with only 10 minute appointments. She said she’d ordered an ultra sound and blood test for me to check my ovaries and off I went.
At home, I googled erosion of the cervix. I found out it’s a totally normal thing that can happen when the cells from inside the womb end up on the lower part of the cervix. You can have it without having any symptoms, although some people bleed after sex. It’s not a problem and usually causes no issues. Oh, I thought, I wonder why she was so freaked out about it. Then, I came across a page that said that although erosion of the cervix is a normal and harmless thing, that in appearance it is indistinguishable from the early stages of cervical cancer.
That’s why she had asked about my smear. That’s why she was so concerned about me having my colposcopy. My cancer anxiety started to grow again. I tried to put it from my mind, focusing on the practicalities of what will happen at my colposcopy visit. I read up, finding out all the different options of what could possibly happen at this visit. If anything I was over prepared. Information makes me feel safer. Having all the facts allows me to rationalise and calm myself.
My First Colposcopy
The day of my colposcopy arrives and I’ve gone so far the other way its unreal. I’m now convinced that the abnormalities will be so minor that they won’t need to do anything, and that I’ve been worrying for nothing.
My name is called by a student nurse who brings me through to a small windowless office. She asks me if I mind her observing. I don’t. What’s one more pair of strangers eyes looking at my vulva anyway? The gynecologist arrives, introduces herself and shakes my hand. She explains to me what the results of my letter mean, stressing that any abnormalities are likely to be pre cancerous, not cancer.
She asks me when my last period was. This time I’m prepared; I’d marked on my phone’s calendar the dates of my last period. She is concerned that it was a while ago, and I explain about my far spaced, irregular periods, and that I am being investigated for polycystic ovaries. Then she said something strange. She said I didn’t look like I have PCOS. She said she can often tell by looking but I don’t look like I have it, and do I have have any other symptoms other than the spacing of my periods? I figured out she must be referring to my current lack of facial hair, which is a ridiculous thing to say seeing as I had waxed it all off 3 days ago. I told her I had a lot of body hair. She seemed satisfied by that answer. She asked if I had been given any medication for PCOS, I said no, as I was waiting for the results of my ultra sound. Then she continued with questions about contraception and other medications. She struck me to be, like many doctors, very matter of fact and straight-forward.
She explained what would happen today. She reassured me that 80% of people have HPV and because I am in the younger age group it is likely my body will fight it off and it will go away on its own. She also seemed pretty confident that she wouldn’t find any abnormalities today, and that I would be referred back to my GP and go back to have cervical screenings every three years. I was asked if I had any questions before being lead through to the colposcopy room.
A nurse showed me to a small curtained off corner where I could strip from the waist down and come out covered in a white sheet. I’d worn a loose dress for the occasion, so I just took off my shoes and my underwear. I was glad I had down this, both because it was quick to undress and because I could walk across the room fully dressed. I scooched up onto a tissue covered hospital bed, lifting my legs up into the stirrups. My dress was hitched up around my waist and a sheet was covering my lower half. There were two nurses in addition to the student and the gynecologist in the room. I thought again about the weirdness of this sheet that effectively hid my vulva from myself but left it fully on display to these four women.
The nurses were all cheerfully trying to engage me in small talk about transport and holidays. They were trying their hardest to make the situation seem less weird, as if we had all gathered around me in bed to have a chat not look inside my vagina. The colposcopy machine was wheeled up next to me and the bed was raised up so my vulva was eye level with the seated gynecologist. She moved the sheet downs so she could talk to me from between my legs, killing all the forced small talk and explaining what would happen.
The speculum was inserted and cranked open, a sensation that I will never get used to. Then my cervix appeared on a screen. The gynecologist moved the screen around so I could see what was going on. It looked unreal to me. Or rather, it looked like a cervix, but not anything that I could identify as a part of myself. It was too big and too round and didn’t look at all familiar. The gynecologist pointed out my erosion and told me what it meant, reassuring me that it wasn’t a problem. She then sprayed a clear liquid onto my cervix, telling me it would stain any abnormal cells. It felt cool and a little weird.
Almost immediately she said it looked like there wasn’t any problems. She said we just had to wait a few minutes for it to develop but that it looked all clear. She shouldn’t have spoken so soon. I began to see a significant patch on the left side of my cervix begin to turn whiter and whiter. As it developed it became more clear that this area was being stained. She added a statistical colour map on top of the image of my cervix, it showed a scale from pale blue to red to bright white. White was the strongest indicator on the colour scale and a whole patch was reading that. She added some iodine using a swab. It felt odd to feel it sweep across my cervix. She said the iodine would make it clearer if there were any abnormalities and how large the abnormal patch was. The stats map didn’t change much after the iodine, and she zoomed in on the white section.
She said she wanted to biopsy the area. The screen was immediately turned away from me so that I couldn’t see what was going on. New instruments were brought out and opened from sterile packets. The gynecologist said I might feel a small pinch. She said she was taking a piece of tissue only about the size of a grain of rice. This didn’t comfort me, I was thinking about how big rice is compared to how small my cervix is. She told me she was going to count to three, and on three she wanted me to put my hand over my mouth and cough hard. I was not expecting that. My response was “huh?” and she had to say it again. She counted to three and I gave a couple of coughs. I had expected to feel pain, but I only felt a strange unsettled feeling. I felt sick, but I know it was the idea of being damaged that was causing it. I felt very little pain.
The gyenacologist used sticks with silver nitrate on them to stop the bleeding. They didn’t work, so she added monsol’s solution to seal over the bleeding area. She said that it will scab over and I should expect some gritty discharge which is the monsol’s solution coming away. She asked me if I was okay frequently through this whole ordeal. She told me not to have sex or baths or go in swimming pools or spas for two weeks to reduce my risk of infection. She asked me several times if I was going on holiday anytime soon, in case I needed to come back for another visit.
The quickness of the change in the gynacologist and how quickly everything happened from the biopsy onwards overwhelmed me a bit. It felt like her laid back attitude suddenly flipped. She was suddenly moving very quickly and with a regimented professionalism. It could just be that we were running out of time and they had to get the next patient in, but it was odd to see the atmosphere flip from everyone chilling out watching my cervix turn white, to a well oiled assembly line of medical precision.
The speculum was removed, the gynecologist said she would write to me with the results of the biopsy within 4 weeks. She asked again about my holidays and told me again not to have sex or go to a spa. She said if I have any heavy bleeding I should go to a doctor right away. Then she left. The nurses pointed me in the direction of the changing area, which had tissues and sanitary pads for me to use. They said its a good idea to use a pad because the iodine will come right out. I had brought a couple with me from home but I was glad to see they had provided them here too.
One of the nurses led me to a “post treatment area”. She gave me an information sheet which told me all the things I can’t do, and what I should look out for in case I have an infection. She asked if I wanted a hot drink, there was a free coffee machine there. I said I was good. She left me there for 10 minutes or so then said I could go. I’m not sure why I had to hang out there, perhaps it was just in case I had a delayed reaction or if I started bleeding out. Whatever the case, I was fine, and I walked off to catch a bus home.
The next two days I had some pain, but no worse than bad period pain. I started bleeding on the second day so put a pad on. It’s really weird for me to start using pads again, I’ve not used them since I was 16 or so. Thankfully it was only a light bit of blood and my period didn’t start while I was unable to insert anything into my vagina.
About 3 weeks after my colposcopy I received my biopsy results in the post. During these three weeks I have been yo-yoing between believing with absolute conviction that my abnormalities will be so low grade that I won’t have to do anything about it, to googling early and late stage symptoms of cervical cancer, convincing myself that I have all the symptoms of the advanced stage.
When the letter did finally arrive I’d almost become bored of the whole subject. The letter told that the biopsy had shown I have CIN 3 grade pre cancerous changes. I of course looked up the CIN grades, and 3 is the highest level you can have without having cancer. It basically means the cells have a high risk of becoming cancerous in the future.
The letter gave me a date and time to come back to the clinic to have a LLETZ Diathermy to remove the abnormal cells from my cervix. I might update this post or do a new post about the LLETZ after I’ve had it done. This post is too long already.
I’m still a little nervous, but mostly I’m grateful that I live in a place that will screen me and treat me for free. I feel grateful that there’s a strong likelihood that after this treatment I won’t develop cervical cancer. I still feel some guilt. You can be sure I won’t ever be late for a smear again.
I wrote this post because I wanted to know exactly what having a smear test is like. After I got my result I wanted to know what it is like to have a colposcopy and what will happen at a colposcopy. I wanted to know how long I would need to wait for results. I wanted to know what having my cervix biopsy would feel like. I googled all of these questions, which lead me to medical sites and cervical cancer forums, but no blow by accounts of personal experience. I found the forums jumped around and often offered conflicting advice or information. For example, I’m worried I will be on my period when I go for my LLETZ, and I have found info saying I have to cancel it if I am on my period, and info saying they will do the procedure anyway even if I am on my period. If it does occur I will call up my clinic for the answer. The information booklet they posted to me doesn’t say. So I wrote this for all the other nervous googlers, in the hope this will be helpful to them. I also wanted to express my anxiety surrounding all of this. Sometimes it makes me feel better just to know that someone else had all the same thoughts that I did.