First Person delivers candid personal narratives illustrating intimate experiences and larger conversations about health
by Annabel Sowemimo Follow @sosowemimo
Over a fifth of black women have never had a routine cervical smear, as compared to less than ten percent of white women. This means that when black and minority women present with cervical cancer it has often progressed further, it can be more difficult to treat, and the results are often fatal.
During my fourth year of medical school we held a session on cervical smears. We were split into small groups so that female volunteers could discuss smear practice and talk us through the procedure. Throughout the process they provided feedback on our technique and how to make it more comfortable and bearable for women. These women were incredibly patient, some of them having experienced cervical cancer themselves or knowing loved ones who were affected. They let their barriers down, enabling us to subsequently provide a better experience for hundreds of women.
Not every medical student is fortunate enough to receive this vital training: it only became part of my medical training following efforts made by some dedicated teachers within the medical faculty. It represents a push back against patriarchal medicine, and a holistic approach to patient centred healthcare. For several male medical students these were the only smears they were able to practice prior to graduation, and an important opportunity to speak with anxious female patients.
A year ago I turned twenty-five, and that fateful smear reminder slid through my letterbox. I knew that I should attend, which in turn meant that I’d have to endure my first ever speculum examination. I took a deep breath and made the necessary arrangements with my GP. Despite having carried out several genital examinations myself in the sexual health clinic, and knowing exactly what to expect, I still felt a horrible nausea at the thought of it all. When I examine a man or a woman, I notice pubic hair, a rash, or a piercing, but only for its medical significance. People are often shocked that I can examine genitalia with such neutrality, but it’s precisely because I feel that sexual health is like any other aspect of our health that I wish to be a sexual health specialist. If we view genitalia as taboo then how will we continue to engage people with their sexual health? With all this in mind I still couldn’t help but contemplate what my female, middle-aged GP would make of my foliage…
My fears regarding the procedure were unwarranted. Within ten minutes I was up on the couch, the speculum in, my cervix found and the smear sample bottled away. Yaaass, I thought, that’s my first smear done and my cervix can hide away, never to be thought of for another five years. I had not really considered the possibility of my smear being ‘abnormal’. So when that second letter arrived stating that I had to attend colposcopy clinic, I was completely blown away.
High risk HPV types 16 and 18 are known to cause cervical cancer as well as vaginal, penile and throat cancers. Most HPV infections are cleared by the body but some go on to cause abnormal cell growth, which can develop into cancer. At times it seems that too much information can be more frightening than not having any information at all.
I was forced to wait another few weeks before my colposcopy appointment, which involved both a specialist nurse and a gynaecologist performing a camera test, and taking a biopsy of my cervix. It is a similar process to the smear, except that the gynaecologist can visualise your cervix on a screen, apply dye to identify any abnormal areas, and biopsy these if needs be. Imagine my utter confusion when I received a third letter asking me to attend for another colposcopy test in a few months as my sample had been inadequate. I couldn’t help but think that anything that became this complicated was bound to have an unhappy ending. I tried to push it to the back of my mind but I couldn’t help falling in to the trap of Googling treatments amongst other random things, as many patients inevitably do. The mind can be strange that way. Despite all of this, my repeat colposcopy was absolutely fine, with the exception of the moment that the specialist nurse informed me that she knew my father – not exactly what you want to hear while two people are looking at your cervix.
As unlucky as all of this may sound, it was actually a relief to know that my cervix had been checked so thoroughly, and is doing just fine. For me, the fear of not knowing would have been far greater. Even if something had turned out to be wrong, or if it does in the future, I know that going for a cervical smear ensures that I can receive treatment early.
I know that deciding to attend cervical smear screening is far more complicated for some than it has been for me. Some have experienced gender based violence and avoid screening as they are fearful of having a stranger examining them. Many women who have undergone FGM avoid cervical smearing due to fear of judgement by health providers, and because of pain associated with the procedure. A trans male friend told me that they completely dissociated with their female genitalia, and the thought of a doctor examining this region would be deeply problematic.
Several factors ultimately influence whether a woman attends for cervical screening, and it’s our duty to ensure that we do our best to ensure every women feels comfortable enough to attend. Providers are now much better at recognising the diverse fears women have related to cervical screening. One hospital in East London has developed a clinic to provide counselling support as part of the smear process.
Since the new HPV vaccination was rolled out for all thirteen-year-old girls in the UK in 2008 (and was recently made available for purchase by men), there is hope that fewer women will have to experience the anxiety of an abnormal smear. It also protects against HPV 6 and 11 which cause genital warts. The cervical smear has saved thousands of women’s lives but cervical cancer continues to disproportionately affect women of colour. Try not to focus on the possible discomfort but consider the long term consequences of your decision – the freedom one gets from better knowing their sexual health status.
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Annabel is a junior doctor studying for her MSc in Sexual and Reproductive Health Research. Twitter: @sosowemimo
2 thoughts on “First Person: Smear Fear”
As a junior doctor you must have known that an HPV infection is necessary for cervical cancer to develop, so when you got the recalls to colposcopy, were you not curious to find out if you were HPV+? If you had tested negative you would have known that you could not get cervical cancer, and needn’t have worried or might have decided not to attend the colposcopy at all.
I also agree with Valid Consent above that the medical profession has very little consideration for just how deeply traumatic and painful many women find this test. HPV self-tests should be available to everyone, and those who are negative could safely decline the invasive exam.
To clarify; the My Body Back Project runs a cervical smear and infection testing clinic in London. It is not run by the hospital. The project is a ‘volunteer lead’ organisation but it is not a Charity at this time, and has no basic governance, such as a complaints procedure or service level agreement, The governance between the hospital and the organisation is not clear either. This leaves potential patients vulnerable.
It is just a wish that services are getting better- trauma informed and trauma focused sexual health clinics for all genders and sexualities should be provided for by mainstream sexual health clinics/ contraceptive clinics. The failure of services to provide this support, given the extent of sexual violence in society, shows clearly that there is not a great deal of understanding or skills in the medical profession. The people who are the weakest at understanding this are the medics, who do the most invasive procedures. Improvements there maybe- but such a long way to go.
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