Seven years ago, I collected stories on Twitter about surprising things that people had had said to them during a smear test and published them. From one woman who was recognised from being on TV to others being complimented on their cervix, it is clear that inappropriate comments are far from unusual.
Others experienced colleagues of the doctor or nurse, including students, attending without permission or even entering the room during the course of the examination and, although many people in the discussion were keen to point out that smear tests are usually painless and quick, it was clear that they are not painless enough, or quick enough, for many.
Anyone who has suffered the indignity of a gynaecological examination knows the score. At best, it’s a bit awkward but essentially fine; at worst, it’s humiliating, painful, damaging and triggering. It can cause physical injury, it can lead to misgendering and it can cause psychological trauma. At least one person I know have even had her GP tell her to skip smear tests in the future because the potential benefit of detecting cervical cancer does not weigh up against the trauma to her mental health that she experiences whenever a speculum is involved in her care.
So I was interested when, this week, research from the charity Jo’s Trust looked into why one in four women (it looks like Jo’s Trust did not study trans men or non-binary people) do not attend their smear test when they are called to.
The results of their research demonstrated that:
- 35% of women are embarrassed to attend their smear test appointment because of their body shape
- 34% of women are embarrassed because of the appearance of their vulva
- 38% of women are worried that their genitals do not smell “normal”.
These results made me sad. Roughly 1/3 of women are embarrassed about their general appearance or the appearance or smell of their genitals, and this puts them off attending their smear tests – which are, after all, potentially life-saving procedures that spot signs of cervical cancer at an early stage.
A patriarchal society that makes women so self-conscious that they are willing to risk their health due to embarrassment is one that needs to be challenged, and body positive and fat positive feminists are doing some great work in this respect. Fat phobia is a well-known reason fat people avoid health professionals, and even women who are not fat are affected by the culture that says that anything other than mainstream beauties have no right to exist.
Robert Music, Chief Executive Jo’s Cervical Cancer Trust, said: “Smear tests prevent 75% of cervical cancers so it is a big worry that so many young women, those who are most at risk of the disease, are unaware of the importance of attending. It is of further concern that body worries are contributing to non attendance. Please don’t let unhappiness or uncertainty about your body stop you from attending what could be a life-saving test. Nurses are professionals who carry out millions of tests every year, they can play a big part in ensuring women are comfortable.”
However, the agenda behind the research seems to have been to demonstrate the impact body positivity (or a lack of it, more specifically), could affect smear test attendance, and while it is important, it misses some of the key reasons people avoid their smear tests; reasons that are arguably more significant than self-consciousness.
Transphobia
Trans men and non-binary people are supposed to have smear tests if they still have a cervix. However, difficulties over being misgendered and not being welcome at “women’s health” or “well women” clinics abound.
Not knowing how a nurse will react when presented with a man to carry out the test on can be offputting and proper provision for trans people must be provided if this group of adults is to be expected to attend smear tests regularly.
Trauma survivors
A weekly clinic has opened in London and another is due to open in Glasgow that are specifically geared towards providing sexual health services for survivors of rape and sexual abuse. The project behind it, My Body Back, also runs a maternity clinic in London.
Although a lot of their website specifies that they provide services for women, they do also mention trans men in the information about their cervical screening programme. The way the clinic helps survivors is as follows:
“The SVHA will discuss your needs with you, and how to ensure you are comfortable throughout the smear test. For example, if there are certain body positions you don’t like, places you don’t want to be touched, or phrases you would prefer are not used during the test – then these will not be used. The SVHA will also discuss grounding techniques to make the test easier for you, breathing exercises, and optional aromatherapy services as some women have reported this helps them feel calmer during testing. You don’t have to have the smear taken in one go, and can use a series of sessions to work up to the actual smear. For example, you or the nurse can insert the speculum at the entrance of the vagina in the first session, then a quarter of the way in during the second session, half way in during the third session, until you are ready to have it inserted the whole way and have the smear taken. You are welcome to insert the speculum yourself if this makes you feel more comfortable.
“Before and after the test, we’ll offer you tea and cake, to ensure you feel calm and in a good frame of mind.”
These procedures should go without saying but, in many cases, with undertrained nurses providing smear tests on a day-to-day basis, survivors may find that they do not receive the care they would ideally like to receive. Instead, they are faced with procedures that can trigger memories of their trauma and exacerbate physical damage that they suffered during assault.
If we are to really tackle the reasons people avoid their tests, this is really the place to start.
Disabled people
In some of the disability-related Facebook groups I belong to, a common question is, “I’ve been called for my smear but I can’t get onto examination tables. What should I do?”.
This is clearly a widespread problem that is not addressed, and recommendations are usually to ask for a referral to a gynaecologist, mentioning your access needs, so that they can be met at a hospital rather than a GP clinic.
But these literal barriers are overwhelming to many. A smear test is bad enough, do you really want to turn it into a day out to a big hospital just so you can get onto the bed? Accessible treatment at local health clinics should not be a faraway dream, and many disabled people would be far likelier to attend preventative health treatments, such as smear tests, if they felt a degree of confidence that they would be able to get through it with some dignity intact.
Photo: Pan American Health Organization/Creative Commons