by JK, UK
I recently had a few routine health checks that came around at the same time, a cervical smear examination, a few blood tests and breast screening (as now I am over 50 and breast screening is available every three years). Each experience gave me an opportunity to deepen my awareness, not only of myself but more so about the way women undergo these kinds of routine health checks.
My Cervical Screening experience 3 years ago
I had a cervical screening 3 years ago (and 3 years before that) and I was aware of the procedure. In the past, I had gone along to the surgery dreading this, as I have always found it extremely painful and uncomfortable but knowing it was something that needed to be done. I would tighten up my whole body at the door of the surgery, almost as though to protect myself and get it over with, grit my teeth and bear it, let the procedure take place and then as quick as possible get on with my life afterwards – as if it was just something I had to accept, grin and bear.
I now realise how many times I have done that, not just for cervical screenings but also for other things in life that I was dreading. I have in recent years become more aware of how I tighten up my body to protect myself and how this has never actually protected me from anything – as if something was painful, it was still painful! And by tightening up the body I would even feel exhausted and off balance for a day or so afterwards.
My recent Cervical Screening experience
This time though I made a different choice. I was feeling tender and gentle as I entered the surgery and I choose to stay open, relaxed and to just allow the procedure. I walked into a lukewarm clinical room and spoke with the nurse, who said to me ‘I bet you want to get this over with – let’s just do it as quick as possible’ and I said ‘No thanks, I’d prefer a caring and tender approach, with no rushing’.
We talked a little more and I asked her if she was going to warm the speculum (the doctor or nurse uses a device called speculum to open up the vagina and then a small soft brush is used to ‘sweep’ around the cervix and take a sample of cells from its surface), she said ‘no’ – so I asked her if there were other options and she said she had a plastic speculum, to which I agreed as this would not be as cold as a metal speculum.
The nurse then allowed me time to settle onto the couch in the surgery prepared for the procedure and as gently as she could, she undertook the smear test. This time I actually felt more pain than on my previous experiences and I sobbed, even though the actual smear test was momentary. The plastic speculum was not cold which was one positive, but it was still an extremely uncomfortable experience: lying on a hard clinical couch in a chilly room. I also realised how sore I felt afterwards (for days after in fact) and it was then that I realised the many times I had ignored this soreness. This time as I got back off the couch I took my time, and I then treated myself tenderly for the rest of the day, moving gently to honour my body where it felt sore.
Something struck me after this experience.
Cervical Screening Brief History
In England, cervical screening was introduced in 1964. In the 49 years since, whilst some of the technology in the laboratories has changed in terms of the analysis of the specimens, the procedure itself has changed very little; using for the most part a metal or nowadays a plastic speculum. I asked other women after my smear test whether their surgery used plastic or metal speculums and whether the metal speculums were warmed first. A few had experienced their surgery warming up there metal speculums.
Also our buildings, surgeries and so on have become a little more sophisticated and we now have more central heating available to us too. Insulation for buildings and windows has also improved, yet the room I had the smear test in was chilly and clinical. I understand that due to infection control the room needs to be clean and clinical to some degree, but it was chilly and uninviting, especially for an examination that requires us to be undressed from the waist down.
I also asked other women of their experiences of cervical smears, to which most replied that it is painful and they dread it. Interestingly, I looked up some websites for more details about cervical smear testing and was surprised to see the information that ‘most women consider the procedure to be only mildly uncomfortable’, which doesn’t seem to represent my own experience or that of other women I’ve spoken to.
What struck me and what I am curious to wonder about further is, why is it that in 49 years, with fast paced technology, warmer buildings, the availability of softer more comfortable healing couches and with the technology for some surgical instruments to have advanced for instance, that nothing very much has changed for cervical smear tests?
Why has the use of a speculum not have a compulsory ‘heating up’ aspect, for instance? Why is it not a reality that when women book for cervical smears it is always undertaken in a room that is extremely well heated (even if for a few hours a week for that time when the cervical smears are being undertaken)?
Why is it that the cervical smear tests are undertaken ‘to get it over with’ like a sheep dip rather that it being a tender and loving time for a woman to have this much needed check up?
On further considering this I was a little grumpy.
Who exactly was I grumpy with? What I realised is that I couldn’t really be grumpy with the National Health Service for instance, if women like me had been having cervical smears and had been ‘putting up and shutting up’ about it without expressing the need for a warm room with a heated speculum for example.
How would the Managers of those services (or the designers of speculums) know that it was no longer acceptable to ‘put up and shut up with the environment/manner in which the examination is conducted?’
How many times had I just gritted my teeth without expressing how I felt, or did not take action in writing to the local surgery to ask if there was a different way?
How many times could I have written to other parts of the NHS or elsewhere to express my feelings?
The fact is until this moment I have never spoken up about it. I have moaned about it with other women, but never actually felt that it was as much my responsibility as anyone else to raise my concerns, and ask for alternatives.
For the first time in my experience of having cervical smears I sat with the nurse and had a long chat with her and expressed what I felt about the smear procedure. She shared her experience of how some women come in for their cervical smears and they behave like men, all hard and tough. It was only because I raised how I felt about having the cervical smear and that I didn’t want a cold metal speculum that she went to find me a plastic one, especially for me, and also because we sat and talked she allowed extra time with me on that day.
The little things – The future of Cervical Screening?
Maybe in time, if more and more of us women raise our concerns and ask for cervical smears to be undertaken in a different way with more conducive surroundings, we may find we can have our regular cervical smear test in a warm room, gently lit, on a soft clinical couch, wearing a warmed dressing gown while the procedure is being undertaken, with a warm speculum (or even a newly designed more comfortable speculum), with a sitting room after to sit and have a cup of tea before rushing on with the day, and leave with the feeling that we can take all the time in the world to honour ourselves deeply for this much needed procedure.
References:
Cancer Research UK. A brief history of the NHS Cervical Screening Programme – Retrieved October 26, 2013 from http://www.cancerresearchuk.org/cancer-info/cancerstats/types/cervix/screening/briefhistory/
Public Health England. NHS Cervical Screening Program – Retrieved October 26, 2013 from http://www.cancerscreening.nhs.uk/cervical/about-cervical-screening.html
Related:
Cervical Cancer at 19 to True Health at 40
Endometriosis – Experiences and Observations on Women’s Health – Part 1)
Healing Choices and Abnormal Pap Smears
Mastitis – Experiences and Observations on Women’s Health – Part 2