Cervical Screening: What Every Woman Should Know

Cervical screening (commonly known as a smear test) is one of the most effective tools we have for preventing cervical cancer. Yet uptake in England has been declining, with nearly 1 in 3 eligible women not attending their screening. Understanding what screening involves, why it matters, and what the current guidelines say can help you make an informed decision.

What does cervical screening actually test for?

The primary purpose of cervical screening in the UK is now to test for high-risk strains of the human papillomavirus (HPV), which is the cause of virtually all cervical cancers. If HPV is detected, the sample is then examined for abnormal cell changes (cytology).

This “HPV-first” approach, introduced in 2019, is more sensitive than traditional cytology alone and means that HPV-negative women can be reassured that their risk is very low.

Understanding HPV and what a positive result means

Human papillomavirus is extraordinarily common — most sexually active people will be exposed to it at some point. What I tell my patients is that a positive HPV result does not mean you have cervical cancer, or even that you will develop it. The vast majority of HPV infections are cleared by the immune system within one to two years without causing any harm at all.

The strains we are most concerned about are the high-risk types, particularly HPV 16 and HPV 18, which together account for roughly 70% of cervical cancers. When your screening sample tests positive for high-risk HPV, the laboratory will then examine the cells under a microscope (cytology) to check for any abnormal changes. If the cells look normal, you will simply be recalled for screening in 12 months to see whether the virus has cleared.

What happens during the test: step by step

In my clinic, I walk every patient through each step before we begin. You will lie on your back with your knees bent and apart. I gently insert a speculum — a smooth, plastic instrument that holds the vaginal walls open so I can see the cervix. This is the part that most women find unfamiliar, but it should not be painful. Once the cervix is visible, I use a small soft brush to sweep cells from its surface. The whole process takes less than two minutes. The sample goes into a liquid container and is sent to the laboratory, where it is tested for HPV first. If HPV is detected, the same sample is then examined for cell changes — no second appointment needed.

What happens after an abnormal result

If your screening shows HPV-positive with abnormal cells, you will be referred for a colposcopy. I know the word sounds alarming, but a colposcopy is simply a more detailed look at the cervix using a magnifying instrument — a bit like a powerful pair of binoculars on a stand. A dilute solution of acetic acid (vinegar) is applied to the cervix, which highlights any abnormal areas. The procedure is done as an outpatient and takes around 15–20 minutes.

If abnormal cells are confirmed, the most common treatment in the UK is LLETZ (large loop excision of the transformation zone). This is performed under local anaesthetic, often at the same appointment as the colposcopy. A thin heated wire loop removes the affected area of tissue. Most women describe it as mildly uncomfortable rather than painful, and recovery takes a few weeks with some light bleeding or discharge. The success rate is excellent — over 95% of cases are treated with a single procedure.

Self-collection: a new option

I often see women who have been avoiding screening for years because they find the speculum examination distressing. If this sounds familiar, you should know that self-collection for HPV testing is now becoming available in some areas of the UK. This means you can take your own vaginal swab in privacy, without a speculum, and the sample is then tested for HPV in the same way. The evidence shows that self-collected samples are highly accurate for HPV detection, and I am hopeful this will encourage more women to participate in screening.

Who should be screened and when?

• Ages 25–49: Every 3 years
• Ages 50–64: Every 5 years
• Over 65: Only if a recent test was abnormal or if you have never been screened

You will receive an invitation letter from the NHS, but you can also book privately if you prefer a more comfortable setting, wish to be seen sooner, or have previously found screening difficult.

What if I'm nervous about screening?

Anxiety about cervical screening is extremely common and entirely understandable. In my practice, I spend time before the examination talking with each patient about what to expect, and I never rush. Here are some practical things that can help:

• You can request a female doctor or nurse
• Ask for a smaller speculum — they come in several sizes, and a narrower one is perfectly adequate for taking the sample
• You can ask to insert the speculum yourself, which gives you a sense of control
• Deep, slow breathing during insertion genuinely helps relax the pelvic floor muscles
• In a private consultation, there is more time and no sense of being rushed
• If you have experienced trauma or vaginismus, let your clinician know beforehand so we can adapt the approach
• The test itself typically takes under 2 minutes

What about the HPV vaccine?

The HPV vaccination programme has been remarkably successful. However, the vaccine does not protect against all HPV strains, which is why screening remains essential even for vaccinated women.