Cervical screening (smear test) and HPV: what to expect

Cervical screening is a test of the cervix, the opening to the womb from the vagina. The NHS says it used to be called a smear test, and that it is not a test for cancer: it is a test to help prevent cancer. This guide brings together what the NHS and the WHO say on the subject. Ages and gaps between tests depend on national guidelines, so it gives no local rules. It is general information, not medical advice, and it cannot speak to your own situation. For that, a doctor, a nurse or a sexual health service is the right place to ask.

What cervical screening looks for

During the appointment, a small sample of cells is taken from the cervix. According to the NHS, it is checked for certain types of human papillomavirus (HPV) that can change the cells of the cervix, called high risk types. If they are not found, no further tests are needed. If they are found, the sample is checked for changes in the cells, which can be treated to help prevent cervical cancer.

Everyone with a cervix should go for screening, the NHS says, including trans men and non binary people who have one.

Speculum

A smooth, tube shaped tool placed in the vagina so that the cervix can be seen

Colposcopy

A simple procedure to look at the cervix, done in hospital

Who is invited, from what age and how often, is for each national programme to decide, and programmes differ. As a global reference, the WHO advises women to be screened with a high performance test every 5 to 10 years starting at age 30, and women living with HIV every 3 to 5 years starting at age 25. It also says that self collection of a sample for HPV testing has been shown to be as reliable as a sample collected by a health professional. A doctor or a nurse can say what applies where you live.

HPV in plain words

HPV affects the skin and places such as the inside of the mouth, throat, vagina and anus, according to the NHS. It is very common: most people will get some type in their life, and it is nothing to feel ashamed or embarrassed about. The WHO adds that almost all sexually active people will be infected at some point.

Many types are easy to catch, and penetrative sex is not needed. The NHS lists these ways it can pass:

• Any skin to skin contact of the genital area.
• Vaginal, oral or anal sex.
• Sharing sex toys. Sex toy safety covers how to reduce this.

HPV does not usually cause symptoms, so a person may not know she has it. Sometimes it causes painless growths or lumps around the vagina, penis or anus, called genital warts. It can be caught the first time you have sex, and it can stay for many years without any problem, even with no sexual activity, or no new partner, for a long time.

The body usually clears the virus within 2 years, though it can stay longer, the NHS says. There is no treatment for the infection itself, but the problems it causes, such as genital warts or changes to the cells of the cervix, can be treated. The WHO says a persistent infection with certain types can cause abnormal cells that may develop into cancer. That usually takes 15 to 20 years, or 5 to 10 years with a weakened immune system, such as untreated HIV.

There is no blood test for HPV: testing is part of cervical screening. HPV is one of the viral infections covered in the guide to STI testing.

Who is at risk, and why screening still matters

Anyone with a cervix who has had any kind of sexual contact, with a man or a woman, could get cervical cancer, the NHS says, because nearly all cervical cancers are caused by infection with high risk types of HPV. The risk remains in these situations:

• You have had the HPV vaccine, which does not protect against all types of HPV.
• You have had only one sexual partner, since HPV can be caught the first time.
• You have had the same partner, or no sex, for a long time, since HPV can go unnoticed for years.
• You are a lesbian or bisexual, because the risk applies after any sexual contact.
• You are a trans man with a cervix.
• You have had a partial hysterectomy that did not remove all of the cervix.

The WHO adds that precancers rarely cause symptoms, which is why regular screening matters even after vaccination. The NHS says screening is no longer needed after a total hysterectomy that removed the womb and the cervix. For someone who has never had sexual contact it says the risk is low, but cervical cancer is possible without HPV, so it still advises going when invited.

What happens at the appointment

The NHS describes the test in these steps. You are in control, and you can ask to stop at any time.

1. 1

   Undress from the waist down

   You do this behind a screen, and you are given a sheet to put over you.

2. 2

   Lie back on a bed

   Usually with your legs bent, feet together and knees apart. Sometimes you may need to change position during the test.

3. 3

   The speculum goes in

   The nurse or doctor gently puts a speculum into your vagina. A small amount of lubricant may be used. They open it so that they can see your cervix.

4. 4

   A sample is taken

   With a soft brush, they take a small sample of cells from your cervix.

5. 5

   The test is over

   They close and remove the speculum and leave you to get dressed.

The test itself should take less than 5 minutes, and the whole appointment about 10 minutes, the NHS says. It does not usually hurt, but some people find it uncomfortable or painful. Light bleeding or spotting may follow, and it should stop within a few hours.

Making the appointment easier

The NHS lists things you can ask for or try if the test worries you:

Ideas from the NHS

• A woman to do the test. Most nurses and doctors who take these samples are female.
• Another person in the room, a chaperone: someone you know, another nurse or a trained member of staff.
• A longer appointment, a smaller speculum, or the chance to put the speculum in yourself.
• Another position, such as lying on your side with your knees pulled up to your chest.
• Breathing exercises, which the nurse or doctor can explain.
• Clothes you can leave on during the test, such as a skirt, someone to come with you, and something to listen to or read.

You can stop at any time, and telling the nurse or doctor how you feel helps them understand what support you might need. After the menopause, the doctor can prescribe a vaginal treatment to use before the test if it feels harder. After sexual violence, screening can feel very difficult, and the NHS points to an organisation that runs screening clinics for people in that situation. A doctor or a nurse can say what exists where you live.

On timing, the NHS suggests booking when you do not have your period and, if you have unusual vaginal discharge or a pelvic infection, after treatment has finished. Normal discharge has its own guide. It advises avoiding vaginal medicines, lubricants and creams in the 2 days before, because they can affect the results. Screening is safe during pregnancy: for a routine test, the doctor or nurse may ask you to wait until about 3 months after the baby is due.

What the results mean

The result says whether HPV was found, what that means and what happens next. Most people have a normal result, according to the NHS, and a longer wait than expected does not mean anything is wrong.

Result	What happens next
HPV not found (HPV negative)	No more tests for cell changes
Unclear result	The test is repeated, sometimes after 3 months
HPV found, no cell changes	The test is repeated after a time
HPV found, with cell changes	A colposcopy

HPV not found. The risk of cervical cancer is then very low, and no further tests are needed to check for abnormal cell changes, even if there were changes in the past.

An unclear result. It is sometimes called inadequate. It does not mean anything is wrong: the results were unclear, so you may be asked to repeat the test, sometimes after 3 months.

HPV found, with no cell changes. In the NHS programme, for example, screening is offered again after 1 year, and again 1 year later if HPV is still found. If HPV is still there after 2 years, a colposcopy is asked for. Other programmes set their own gaps.

HPV found, with cell changes. A colposcopy is asked for. It is similar to cervical screening but done in hospital, and the NHS says changes to the cells will not get worse while you wait for the appointment.

A positive HPV result does not mean a partner has had sex with someone else while you have been together, the NHS says.

Treatment of cell changes

The WHO describes the treatment of precancers as a simple and effective way to prevent cervical cancer. It is usually quick, with limited discomfort compared with other medical procedures. The WHO lists four options:

Treatment	How it works
Thermal ablation	A heated probe destroys abnormal cells
Cryotherapy	A cold probe destroys abnormal cells
Large loop excision (LEEP or LEETZ)	An electric heated loop removes abnormal tissue
Cone biopsy	A cone shaped piece of tissue is removed for assessment

The HPV vaccine and other ways to lower the risk

The WHO says HPV vaccination for girls aged 9 to 14 is highly effective at preventing infection, cervical cancer and other HPV related cancers, and that it is a priority before they become sexually active. The licensed vaccines all protect against the high risk types 16 and 18, which cause around 76% of cervical cancers. Depending on the national schedule, it may be given as one or two injections. The NHS says the vaccine does not protect against all types of HPV, which is why screening still matters.

The WHO also lists not smoking, or stopping smoking, and using condoms. The NHS says condoms can help protect against HPV, but they do not cover all the skin around the genitals, so protection is not complete. Safer sex basics explains how condoms and dental dams are used.

When to get help

The WHO says cervical cancer can be cured if it is found early and treated promptly. It lists these reasons to consult a health professional:

• Unusual bleeding between periods, after the menopause or after sex.
• Increased or foul smelling vaginal discharge.
• Persistent pain in the back, legs or pelvis, or swelling in the legs.
• Weight loss, fatigue, loss of appetite or vaginal discomfort.

Bleeding or unusual discharge should not wait for the next screening appointment, the NHS says. It also points to a doctor or a nurse in these situations:

• Heavy bleeding after the test, or spotting that does not stop after a few hours.
• A wait for results that is longer than expected.
• A missed or unbooked appointment. You can still book, even if the invitation came weeks or months ago.
• Doubts about screening, or difficulty with the test. You are in control, and support exists. Painful sex covers vaginismus.

Questions about cervical screening and HPV

Is a smear test the same as cervical screening?

Yes. The NHS says cervical screening used to be called a smear test. It is not a test for cancer, but a test to help prevent it.

Does cervical screening hurt?

It does not usually hurt, but some people find it uncomfortable or painful. You can ask to stop at any time.

Can I have cervical screening during my period?

The NHS suggests booking for a time when you do not have your period. If your period starts on the day, it says to contact the doctor’s practice to rearrange.

Can I have cervical screening when pregnant?

The NHS says it is safe during pregnancy. For routine screening, the doctor or nurse may ask you to wait until about 3 months after the baby is due, and a repeat test after an abnormal result can still be done.

Do I still need screening if I have had the HPV vaccine or only one partner?

According to the NHS, yes. The vaccine does not protect against all types of HPV, and HPV can be caught the first time you have sex. The risk also remains with the same partner for a long time, and for lesbian and bisexual women.

Does a positive HPV result mean my partner has been unfaithful?

No. The NHS says a positive result does not mean a partner has had sex with someone else while you have been together. HPV can stay in the body for many years without any problem.