Cervical Smear Test Information and advice

www.mariestopes.org.uk

Many women feel a little nervous about having a smear test (cervical screening). Yet, regular screening has saved thousands of lives. Smear tests can discover potential problems before they become serious. So please don’t be nervous – be confident that you are taking control of your health. This leaflet explains more about cervical screening and your appointment with Marie Stopes UK.

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A cervical smear test is a way to check up on the health of your cervix – the entrance to your womb (uterus) which is located at the top of your vagina.

Why cervical smear tests are important The test looks for changes in the cells of your cervix. This isn’t a test for cancer, but can detect abnormal cells that could lead to serious problems like cervical cancer. Around 3,000 women are diagnosed with cancer of the cervix every year1. Symptoms may not be experienced beforehand, until the condition is at an advanced stage. Abnormal cells are not usually cancerous2, especially if you have regular screenings. But, if abnormal cells are noticed at screening they can be closely observed and/or treated to prevent cancer from developing. Regular screening has been proved to reduce the risk of advanced cancer by 90% on average for women aged 35-643.

1 NHS, 2015. Cervical Cancer. [online] Available at: , [Accessed 2nd September 2016] 2 Cancer Research UK, 2016. Cervical Cancer Screening. [online] Available at: http:// www.cancerresearchuk.org/about-cancer/type/cervical-cancer/about/cervical-cancerscreening, [Accessed 15th September 2016] 3 Sasieni, P, et al., 2009. Effectiveness of cervical screening with age: population based case-control study of prospectively recorded data. BMJ 2009; 339: b2968

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Cervical Smear Test Frequently asked questions How often should I be screened? The cervical screening programme ran by the NHS in England starts at the age of 25. Women are invited for a cervical screening every 3 years until the age of 49, and then every 5 years until the age of 64. At Marie Stopes UK you can ask for a screening any time from the age of 16. It’s also offered as part of our Well Woman Comprehensive health check.

Will I have to undress for the screening? You will be asked to undress from the waist down. If you are wearing a full skirt or a dress with a full skirt you can lift the skirt up rather than take it off. We will provide something for you to cover yourself with while we perform the test, if you like.

Does it hurt? Some women find it momentarily uncomfortable, but it is a very quick procedure. The apprehension, along with embarrassment, puts some women off having a smear test. Try not to worry. Many women will tell you that they found it fine and that it’s worth a little discomfort for peace of mind. It is best to relax as much as possible by breathing slowly and deeply to ease any tension.

Can I have sex before the screening? Some chemicals found in spermicide, lubricant, or barrier methods of contraception such as condoms, cervical caps and diaphragms could affect the test. Please refrain from having sex using these methods of birth control for 24 hours before the test. Sex with any other contraceptive method before the test will be fine.

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How do I book an appointment? Cervical screening is available at selected Marie Stopes Centres in London. To book an appointment you can call our advice line on 0345 300 0652 (24 hours). You can’t be screened while you are on your period, so the best time to make your appointment is roughly 2 weeks after the first day of your period (between days 10 and 16 of your monthly cycle).

We have both female and male practitioners. If you don’t feel comfortable seeing a male practitioner then please let an advisor know when booking your appointment.

Arranging payment for your smear test You’ll be asked to pay a deposit when booking your cervical screening appointment. You can pay the remaining fees on the day of your appointment. If you’re paying for your smear test yourself we offer a number of ways that you can pay. This includes cash, Visa, Mastercard, Switch, Delta, Solo, and Electron. However, we can’t accept cheques. All card payments will be made in pound sterling. If someone else is paying on your behalf by credit or debit cards, the cardholder must accompany you to the centre at the time the payment is made. For our full list of fees for cervical screening fees please visit our website: www.mariestopes.org.uk/gynae-fees

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Cervical Smear Test What to expect at your appointment The practitioner (either a Contraception and Sexual Health (CaSH) Nurse Specialist or a doctor) will ask you to lie on a couch. They will gently insert an instrument called a speculum into your vagina in order to view your cervix. A small brush is used to take a sample. This picks up cells from inside the opening of the cervix. The test only takes a couple of minutes. You can choose whether you would like to see our CaSH Nurse Specialist or a doctor when you book your appointment. If you have any health concerns further to your smear which you would like to talk about, you may want your appointment to be with a doctor to ask your questions.

Testing the sample The laboratory will examine your sample for any cells which appear to be irregular. We use a liquid cytology method for sample analysis, this allows for a clear view of the cells by filtering out any mucous. The sample will be examined under a microscope.

Receiving your Results We will send your smear test results to your home by post or by email, usually within 2 weeks. We can also send a copy to your GP if you wish. The results you receive will be described as either: • Normal / negative • Unclear / insufficient / inadequate – meaning that the cells could not be viewed and we will need to take another sample in 3 months’ time • Abnormal / irregular – meaning that changes have been observed, either mild, moderate or severe We understand that receiving test results can be worrying or confusing. Please do contact us at any time if you have questions or concerns: 0345 300 0652 (24 hours).

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If your results are irregular or abnormal Please don’t be frightened. Any change in the cells of the cervix usually happens very slowly, and may be cleared by the body’s immune system. Slight abnormalities are very common in women under 25. Abnormal cells are not cancerous, but could be an early warning sign which we need to keep an eye on. We’ll send a full explanation of what the test results show and advise you on what to do next. If your results show cell changes we may recommend that you have another smear test after a period of time, or suggest that you make an appointment for further investigation. Further investigation, such as a colposcopy, depends on the type of abnormality seen.

What is a colposcopy? This is an examination which looks closely at the cervix to identify where the abnormal cells are so they can be treated if necessary. A specialist will carry out this screening process using a colposcope, which is a bit like a microscope to give a magnified view. If necessary a tiny sample of tissue will be taken and tested in more detail. Marie Stopes UK does not carry out the colposcopy procedure, but we can make a referral for you if needed. Alternatively, you can visit your GP who will make the referral.

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Additional Screening Human Papilloma Virus (HPV) If your smear test results are described as abnormal or irregular, the sample taken during your smear will be used to test for HPV. HPV is a very common infection and most men and women who are sexually active are exposed to it at some time in their life. There are many types of HPV, most of which are harmless and clear up without treatment. What makes HPV an important factor in cervical screening is that infection with some ‘high risk’ types of HPV can cause abnormal cells. If left untreated, these cells may develop into cervical cancer.4 Having HPV does not necessarily mean that you will develop cancer. It does mean that women at risk of cervical cancer can be identified much earlier and watched closely. A HPV test can be done using the same sample of cells taken in your smear test. The cells are analysed for current HPV infection. You can book a HPV Screening at any time if you want to, even if your smear results are described as normal. Ask us if you would like a HPV test, which can be booked with an additional fee. You can view our HPV Screening fees on our website: www.mariestopes.org.uk/gynae-fees

HPV vaccine A vaccine has been developed for young people aged 12 up to 26 to protect against high risk types of HPV, and also protects against genital warts. We can provide this at Marie Stopes UK. Please ask us for more information.

4 Public Health England, 2015. A description of the NHS cervical screening programme, including evidence on screening for cancer and HPV for women over 25. [online] Available at: , [Accessed 15th September 2016]

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We hope this leaflet has helped answer your questions so far about cervical smear tests. If there is anything that you are unsure about, or if anything is worrying you, please get in touch.

Booking a smear test appointment: 0345 300 0652 (24 hours) Marie Stopes UK Aftercare Nurses: 0345 122 1441 (24 hours) www.mariestopes.org.uk

Health Check packages are also available: A Well Woman check at Marie Stopes UK is available in two options: Well Woman Essential and Well Woman Comprehensive Well Woman Essential includes: Physical examination, medical history discussion, blood pressure, pulse rate, height, weight, BMI, wait to height measurement, urine analysis, cholesterol blood test, lipid profile blood test, Q risk score (risk of heart attack in next 10 years), lifestyle advice and personalised action plan

Well Woman Comprehensive includes: Physical examination, medical history discussion, blood pressure, pulse rate, height, weight, BMI, wait to height measurement, urine analysis, cholesterol blood test, lipid profile blood test, , Q risk score (risk of heart attack in next 10 years), lifestyle advice and personalised action plan, breast exam and awareness advice, smear test, diabetes blood test and risk score.

Call us anytime to arrange a health check: 0345 300 0460 (24 hours) 9

About Marie Stopes UK Marie Stopes United Kingdom is part of Marie Stopes International, a specialist reproductive healthcare organisation and a registered charity working in both the UK and overseas. Our main UK centres help over 100,000 women and men each year with abortion, sterilisation, contraception and health checks…but the good work does not stop here. Any financial surplus generated in the UK helps us provide reproductive healthcare services to women and their families in some of the poorest communities in the world. The organisation campaigns for better awareness of sexual health issues and open access for everyone. Our aim is to provide high quality services, tailored to individual need. Whichever service you require, we offer convenient appointments, expert professional care and all the support you need.

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Marie Stopes United Kingdom 1 Conway Street Fitzroy Square London W1T 6LP United Kingdom Information and appointments 24 hours +44 (0)345 300 8090 Telephone +44 (0)20 7636 6200 Fax +44 (0)20 7034 2369 Email [email protected] Website www.mariestopes.org.uk Registered charity no. 265543 Company no. 1102208 Marie Stopes United Kingdom, September 2016. Code: 201.1023.06.09/16. The information included in this publication was correct at time of going to press. We plan to review this publication within three years.

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