It’s OK to struggle with getting your smear

Getting a smear, particularly for the first time, is often a case of putting your big girl’s pants on and being brave for a few minutes.  For most women, it’s also a case of realising the reality wasn’t as painful as you thought it would be.  However, some of us find that for many (and very valid) reasons, no matter how big their big girl’s pants are, they still struggle with a painful smear.  This can feel really disheartening and you can feel like you’re the only one who is finding it painful or that you’re being a bit dramatic.  This isn’t the case.

There are lots of reasons why a smear test might be painful, such as:

• Clenching and feeling unable to relax – this can be due to anxiety or a previous bad smear experience.  It’s also a very intimate area for a stranger to be given access to.
• History of sexual abuse or violence
• Traumatic labour and/or birthing injuries
• Vaginismus – a condition where the vagina involuntarily tightens as you try to insert something into it
• Vaginal dryness – which could be related to the menopause
• Female genital mutilation (FGM) – which is when the genital area has been deliberately cut and changed
• Cervical erosion
• Endometriosis and other gynaecological conditions

It can feel scary to book yourself in for a smear knowing that it is going to be hard for any of the reasons I have listed above.  However, it is still so important to go.

All women and people with a cervix aged 25 to 64 should get a letter to invite them for a smear. If you’ve not been invited and think you’re eligible, please contact your GP surgery. How often you need screening depends on how old you are.

If you’re:

• under 25, you’ll be invited up to 6 months before you turn 25
• 25 to 49, you’ll be invited every 3 years
• 50 to 64, you’ll be invited every 5 years
• 65 or older, you’ll only be invited if 1 of your last 3 tests was abnormal. You can request one.

Cervical cancer is the 14th most common cancer in females in the UK, with around 3200 new diagnoses every year.

Since the NHS Cervical Screening Programme (NHSCSP) was introduced, the number of women dying from cervical cancer has halved.

The cervical screening process helps you get early treatment for any cell changes well before them developing into cancer.  It also now includes a check to see if you have the HPV virus, which can go on to cause cervical cancer. Early detection can prevent approximately 70% of cervical cancers from developing. Even if you do not have any symptoms, it is very important to have a smear test done.

The most important thing is that you feel in control of the situation and that you are helped as much as possible to get through the test.  It can feel like a really vulnerable moment, but hopefully using some of the tips below can help you feel more in control.

Tell the nurse if you think it is going to be hard for you, particularly if you for any of the reasons listed above.  Not only will they bear this in mind as they carry out the test but they may know of other NHS services that may be able to help you, such as psychosexual therapies.

Take your time.  Ask for more time or a double appointment if you need it.  If it’s not working, book another appointment.  If the nurse isn’t understanding, go and see another one.

Ask the nurse any questions you might have.  If it is your first smear the nurse should sit down with you beforehand and show you all the instruments she will use and talk you through the process.

Ask the nurse to use a smaller speculum, even if they say you ‘should’ be using a larger one.  They should be using whatever speculum makes you feel comfortable and able to do the smear.  They come in lots of different sizes and can be very small.

Ask for more lubrication or vaginal oestrogen cream, or a pessary.  The nurse will talk you through the options.  This can make inserting the speculum easier and hopefully lessen any pain.

Put the speculum in yourself, if you feel that this would help.  The nurse will still need to take the swab, but putting the speculum in yourself means you can go at your own pace and feel more in control.

Lie in a different position.  Traditionally, women lie on their backs for a smear, but if this position doesn’t work for you, you can try lying on your side or putting your hands or a cushion underneath your bottom.  This can really help if you have a tilted womb, for example.

Bring a friend if it will make you feel more comfortable.  Book the morning or afternoon off work so you won’t be in a rush to get anywhere afterwards and you can give yourself a little treat.  You’ll deserve it!

Last updated 8 January 2025.