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Many patients find the process difficult and around 1 in 3 women and people with a cervix who are invited don’t currently attend. Your advice and support can increase uptake by making people feel more comfortable and confident around screening.
How to talk to patients about cervical screening
Good communication can make a big difference to how patients experience cervical screening. Here are some practical strategies that build on your clinical expertise and knowledge to help address the concerns and questions patients often have.
Explaining cervical screening as prevention, not diagnosis
You’ll know that many people think cervical screening tests for cancer, which can cause unnecessary worry. Explain that cervical screening helps prevent cancer from developing by looking for high-risk HPV, the virus which causes nearly all cervical cancers, and, if high-risk HPV is present, the sample is also checked for cell changes. This will allow any changes to be treated or monitored, preventing cancer from developing in the future.
When discussing results, it’s helpful to avoid terms like ‘abnormal’ or ‘pre-cancerous’, as they can be scary. ‘Cell changes’ is less frightening, and you can reassure patients that most cell changes never progress to cancer. This helps them understand they’re preventing future problems rather than anything being wrong now.
Managing common fears and misconceptions
I don’t need screening because I’ve been with the same partner for years
Explain that HPV can lie dormant for many years before becoming active. Being in a long-term relationship doesn’t mean they can’t have HPV, as they may have picked up the virus long before their current relationship.
I’m too old for screening
Say that although cervical cancer is most common between 30-45, it can develop at any age, and that screening until 64 ensures continued protection.
Screening is only for people who are sexually active
Make it clear that HPV can be transmitted through all sexual activity and not just penetrative sex, and you can get it from just one sexual experience. All eligible women and people with a cervix are entitled to cervical screening.
Using clear, accessible language
We all know how confusing and off-putting some medical terminology can be. Simple swaps can make a big difference – for example, ‘cervical screening’, instead of ‘smear test’. Or explaining that the test looks for ‘a common virus that can cause cell changes on the cervix, and if present checks for any cell changes it might have caused’, rather than discussing ‘HPV DNA testing’ and ‘cytology’.
For patients with lower health literacy or English as a second language, visual aids work well alongside simple explanations. Also, describing the cervix as ‘the neck of the womb’ and explaining that the test checks ‘the health of cells at the entrance to the womb’.
Addressing pain and discomfort concerns
It can be tempting to reassure patients by saying screening is ‘quick and easy,’ but this isn’t always true for everyone. Instead, acknowledge that whilst some people find it uncomfortable, there are ways to help, such as:
- Offer a planning appointment first to discuss any concern
- Different speculum sizes
- Using more lubricant
- They can choose a position that feels most comfortable
- They can stop at any time
- A course of vaginal oestrogen may be offered to people experiencing genito-urinary symptoms of menopause (GSM).
For patients with conditions like vaginismus or who are survivors of sexual violence, birth trauma, or FGM, it’s particularly important to emphasise their control over the procedure and discuss what adjustments might help.
Building confidence and trust
You might ask what they already know about cervical screening, and what strategies have helped them in the past. Th is helps you tailor your approach to their existing knowledge and any specific worries they have.
Explaining results and next steps
Preparing patients for their results prevents unnecessary anxiety later. With HPV primary screening, patients often worry about testing positive for HPV. You can reassure them that:
- HPV is extremely common – 8 in 10 people will have it at some point in their lives.
- Most people clear it naturally within two years without it causing any problems.
- If you’re referring someone for colposcopy, explain that this is the next step to try and prevent cancer – it’s for a closer look, not because cancer is suspected. Reassure them that 4 in 10 people have a normal colposcopy result even after HPV and/or cell changes are found at cervical screening.
Supporting patients with specific needs
Some patients need extra support, whether due to past experiences, health conditions, or other factors. Small changes can make a big difference, like:
- Use gender neutral language about partners
- Ask about accessibility needs or whether they’d benefit from a longer appointment.
For patients who are survivors of sexual trauma:
- Offer alternative ways to communicate concerns
- Provide longer appointments
- Emphasise that they are in control throughout the appointment – they can ask for a break or to stop at any time.
For trans and non-binary patients:
- Check their pronouns
- Check their preferred language for their body parts
- Ensure appropriate invitation and results processes.
Follow-up and ongoing advice
After screening, it’s worth asking if patients have any questions or concerns. Explaining when they’ll receive results and what to expect helps reduce their anxiety. For those receiving high-risk HPV positive and/or cell change results, research shows that following up within three working days helps patients understand next steps and improves colposcopy attendance.
You can signpost patients to reliable information sources like The Eve Appeal website and our Ask Eve service for support. Sometimes patients feel more comfortable asking questions to an independent service.
How to answer common questions about cervical screening
Patients often have questions about cervical screening that go beyond the clinical basics. Having clear, reassuring responses ready helps build confidence and addresses common concerns. Here are some of the most frequent questions and suggested ways to answer them:
Questions about the test itself
What exactly happens during cervical screening?
You’ll lie on an examination couch. I’ll insert a speculum into your vagina to open your vaginal walls, so I can see your cervix clearly. Then I’ll use a small soft brush to gently collect cells from your cervix. The whole process usually takes just a few minutes. You’re in control throughout and can ask me to stop at any time.
Does cervical screening hurt?
Some people find it uncomfortable – similar to period cramps for some. If it is painful, let me know and we will stop. The speculum insertion may cause brief discomfort, and you might feel pressure when I take the sample. If you’re worried about discomfort, we can use a smaller speculum or more lubricant to help. Everyone’s different, so let me know how you’re feeling during the test.
What’s the best time in my cycle to have screening?
We avoid screening during a period because blood can make it harder to get a clear sample. Any other time in your cycle is fine. If you don’t have periods, you can come at any time that suits you.
Can I have screening if I’m pregnant?
We recommend waiting until 12 weeks after you’ve given birth, as pregnancy can make results less reliable. Being pregnant doesn’t make screening harmful – it’s just that we get clearer results when you’re not pregnant.
Questions about results and follow-up
What does a normal result mean?
Some people find it uncomfortable – similar to period cramps for some. If it is painful, let me know and we will stop. The speculum insertion may cause brief discomfort, and you might feel pressure when I take the sample. If you’re worried about discomfort, we can use a smaller speculum or more lubricant to help. Everyone’s different, so let me know how you’re feeling during the test.
What does it mean if HPV is found?
HPV is extremely common – 8 in 10 people will have it at some point in their lives. Finding HPV doesn’t mean anything is wrong right now. Most people’s immune systems clear HPV naturally within two years without it causing any problems. We also check your sample for cell changes. If there aren’t any changes, we’ll invite you back in a year to see if your body has cleared the virus. If there are cell changes, we’ll refer you for colposcopy for a closer look. If HPV is found three times in a row without any cell changes, you’ll be referred for colposcopy as a precaution.
What happens if I’m referred for colposcopy?
Colposcopy is a closer look at your cervix using a special microscope. It’s done because we found HPV and some cell changes that need a more detailed look or because you have had 3 positive HPV tests with no cell changes. About 4 in 10 people have completely normal colposcopy results, even after their screening found HPV and/or cell changes. The colposcopy helps us understand exactly what’s happening and whether any treatment is needed to prevent cervical cancer from potentially developing in the future.
How long should I wait for my results?
You should receive your results within 2-4 weeks. If you haven’t heard anything after a month, it’s worth giving us a call so we can chase the results. We know waiting for results can be worrying, so please get in touch if you have questions during this time.
Questions about eligibility and myths
I’ve had the HPV vaccine – do I still need screening?
Yes, you still need regular cervical screening. The HPV vaccine protects against the types of HPV that cause around 7 in 10 cervical cancers. There are other high-risk HPV types that aren’t covered by the vaccination yet, so screening is still important.
I’m in a long-term relationship – surely I don’t need screening?
HPV can lie dormant in the body for many years before becoming active again. Even in long-term monogamous relationships, the virus might have been present before your current relationship started. This doesn’t reflect on you or your partner – it’s just how this common virus works. It’s important to attend cervical screening when invited,
regardless of your relationship status.
I haven’t been sexually active for years – do I still need screening?
Yes – if you’ve ever been sexually active, cervical screening is still recommended. HPV can lie dormant in your body for many years and might reactivate later. The virus is so common that most sexually active people encounter it at some point. This is why we offer screening to everyone eligible, regardless of their current sexual activity.
I’m over 50 – isn’t cervical cancer a young person’s disease?
While cervical cancer is most commonly diagnosed between 30-45, it can happen at any age. That’s why screening continues until 64. If your last three screening tests have been normal, your risk is very low, but we keep checking to ensure your continued protection.
Why don’t we screen under-25s?
The screening programme starts at 25 as cervical cancer is extremely rare in people under 25. Until this age, it is common to have cell changes, and these will mostly revert to normal on their own, so screening before 25 can mean unnecessary investigations, treatments and worry. Starting at 25 gives the best balance of protection while avoiding over-treatment.
I’ve heard screening can cause cancer – is that true?
No – this is a myth. The test cannot cause cancer. What sometimes confuses people is that we occasionally find cell changes that need monitoring or treatment – but these changes were already there and finding them early prevents cancer from developing.
Can screening detect other cancers?
Cervical screening specifically looks for changes that might lead to cervical cancer. It doesn’t check for other gynaecological cancers like ovarian or womb cancer. It’s important to remain aware of symptoms of other cancers and see your GP if you notice anything unusual for you, regardless of your screening results.
Where can I get more information and support?
The Eve Appeal website has information about preventing and detecting gynaecological cancers, including advice on cervical screening, HPV, and HPV vaccination. They also run a free nurse helpline for confidential support and information on 0808 802 0019 or nurse@eveappeal.org.uk.
