A smear test, also known as a Pap test or cervical screening, is a routine health check that women are advised to have on a regular basis. It is a simple procedure that checks the health of the cervix and helps prevent cervical cancer. Knowing the best time to get a smear test done is important for early detection and treatment.
What is a smear test?
A smear test detects abnormal cells on the cervix, the entrance to the womb from the vagina. It involves using a small brush or plastic spatula to collect a sample of cells from the surface of the cervix. The sample is then sent to a laboratory to be examined under a microscope to check for any abnormal cells.
Abnormal changes to the cells do not always mean cancer. But finding and treating these early cell changes can prevent them from ever developing into cancer. That is why having regular smear tests is so important – it acts as an early warning system.
Why are smear tests needed?
Cervical screening aims to detect abnormal changes in the cells of the cervix which, if left untreated, could develop into cervical cancer. Cervical cancer is the most common gynecological cancer among women under the age of 35.
In the UK, around 3,000 new cases of cervical cancer are reported each year. However, cervical screening prevents around 5,000 lives from cervical cancer each year in the UK. It is estimated that 75% of cervical cancers could be prevented if all eligible women attended cervical screening.
By detecting abnormal changes early, cervical screening provides the opportunity to monitor or treat these changes to prevent them ever developing into cancer. This makes smear tests vitally important screening tools for cervical health.
Who needs smear tests?
In the UK, all women and people with a cervix between the ages of 25 and 64 should be invited by letter to have regular smear tests under the NHS Cervical Screening Programme. The recommended intervals between tests depend on age:
- Age 25 to 49: Every 3 years
- Age 50 to 64: Every 5 years
Cervical screening is not routinely offered to those under 25 as cervical cancer is very rare in this age group. It is also less reliable in younger people as the cervix is still developing.
Those over 65 may no longer be invited but can request a smear test up until age 69. After 70, tests are only done for those who have had recent abnormal tests.
It is important to attend screening when invited, even if you feel well with no symptoms. Abnormal cell changes rarely cause symptoms in the early stages when they can be most easily treated.
When to book a smear test
The key is to book your smear test as soon as you receive your invitation letter. This will ensure you get screened at the recommended intervals for your age group. Don’t delay booking your test.
You do not need to wait until you have any symptoms before attending screening. In fact, going for screening when you feel well and have no symptoms gives you the best chance of getting effective treatment if any abnormal changes are found.
Avoid during your period
Although you should book your test as soon as you can after receiving your invitation, try to avoid making an appointment during your period. Booking a test when you are not on your period makes sample collection easier.
Leave 12 weeks after giving birth
After giving birth, whether vaginally or by c-section, it is advisable to wait around 12 weeks before having a smear test. This allows time for the cervix to recover and revert back to its usual state.
Avoid during pregnancy
Smear tests are best avoided during pregnancy. This is because pregnancy causes changes to the cells of the cervix which can lead to inaccurate results. The best time to book a smear test is around 12 weeks after giving birth.
If you become pregnant and a smear test is due, you should let your doctor know and they can make a note to rebook your test for after the birth.
Leave 4-6 weeks after a colposcopy
A colposcopy is a technique doctors use to closely examine the cervix if abnormal cell changes are found on a smear test. It should not be confused with a smear test itself.
You should leave a 4-6 week gap between having a colposcopy and your next routine smear test. This allows time for the cervix to heal after the colposcopy.
Can smear tests detect other conditions?
The main focus of a smear test is to check for early signs of cervical cancer by detecting abnormal cell changes. However, in some cases it may also detect:
- HPV – Some smear tests also check for the presence of HPV, a common virus that can lead to cervical abnormalities.
- Bacterial vaginosis – This common vaginal infection may be spotted during sample collection.
- Candidiasis – Yeast infections may also be coincidentally identified.
- Trichomoniasis – This STI may be detected by chance during the test.
So while the main purpose is cervical screening, a smear test sample could provide clues about other conditions too.
What happens during a smear test
Having a smear test only takes around 5 minutes. Here is what happens step-by-step:
- The nurse or doctor will ask you to undress from the waist down and lie on an examination couch with your knees bent and apart.
- A device called a speculum is gently inserted into the vagina to hold it open so the cervix can be seen.
- Using a small brush, a sample of cells is taken from around the entrance of the cervix.
- A tiny plastic spatula may also be used to take a sample from a slightly different area.
- The speculum is removed and the samples are sent to a lab for analysis under a microscope.
This simple procedure only takes around 5 minutes. You may experience some discomfort or cramping during the speculum examination but this resolves quickly.
When to expect your results
After your smear test, how long it takes to get your results back depends on where you live:
| Country | Waiting time |
|---|---|
| UK | 2-4 weeks |
| USA | 1-3 weeks |
| Australia | 4-6 weeks |
Most people who have a smear test get a normal result back. Around 1 in 20 people will need further tests as some abnormal changes were detected.
It is important to go for any follow-up appointments or repeat smear tests recommended if abnormal changes are found. This will ensure you get the appropriate monitoring or treatment.
Can a smear test be wrong?
Cervical screening is an effective technique, but no test is 100% perfect. In very rare cases, smear test results can be wrong:
- False negative – The test appears normal but abnormal cells are missed. Around 1 in 100 tests could be falsely normal.
- False positive – Abnormal cells are reported but the sample was actually normal. Less than 1 in 100 are falsely abnormal.
To help combat errors, any abnormal smear test results are always double checked by getting a second pathologist to review the sample.
If you have symptoms but a normal result, you should go back for repeat tests. Persisting symptoms need medical investigation regardless of screening results.
Reducing discomfort during the test
Although generally quick and uncomplicated, some women experience more discomfort and anxiety about smear tests than others. Here are some tips to help:
- Go when you don’t have your period – this makes insertion of the speculum more comfortable.
- Take some paracetamol an hour before your appointment to reduce any potential discomfort.
- Avoid having sex for 24 hours beforehand as this can lead to some bleeding which makes sample collection more difficult.
- Wear a skirt or loose pants.
- Ask to insert the speculum yourself so you can go at your own pace.
- Ask the nurse or doctor to explain the procedure step-by-step so you know what to expect.
- Take some deep breaths and try to relax your muscles during the speculum examination.
- If you have significant worry or past trauma, speak to your doctor about options – for some, sedation may be appropriate.
Important facts about smear tests
Some key facts to remember about cervical screening:
- Have a test as soon as you are invited, even if you feel well.
- Go at the recommended intervals – every 3 or 5 years depending on your age.
- Screening can detect changes before cancer develops.
- Results are usually normal but any abnormalities mean further tests are needed.
- Even if negative, go back if symptoms persist or worsen.
- It’s a quick and simple test that could potentially save your life.
Additional screening FAQs
Does it hurt to get a smear test?
Most women do not find having a smear test painful, but some discomfort or pressure may be felt when the speculum is inserted. This is short-lived. Taking painkillers like paracetamol an hour before and trying relaxation techniques helps.
What if I miss my smear test?
If you miss an appointment, you should rebook as soon as possible. Contact your doctor’s office to make another. Attending screening when invited gives you the best preventative benefits.
Can smear tests detect STIs?
The main purpose of a smear test is to check the health of cervical cells and look for early signs of cancer. It does not routinely test for STIs like chlamydia. However, some vaginal infections may be coincidentally spotted during a routine smear test.
What if I’ve had the HPV vaccine?
The HPV vaccine protects against the human papillomavirus that causes around 70% of all cervical cancers. However, you will still need regular smear tests even if you have had the HPV jabs, as screening remains vitally important.
Can pregnancy affect smear test results?
Yes, being pregnant can affect the results of cervical screening. Hormonal changes during pregnancy cause cell differences that may look abnormal under the microscope, but these revert back after birth. It is best to delay routine smear tests until around 12 weeks after giving birth.
The takeaway
Having regular smear tests at the recommended intervals is the most effective way for people with cervixes to get early detection and prevent cervical cancer. While screening may feel uncomfortable or cause anxiety for some, the benefits of early identification of any abnormalities makes getting tested at the right time worth it.