Everything You Need To Know About Cervical Screening

GP Nurse, Claire Carmichael, gives an in-depth explainer on the Cervical Screening procedure, outlining why it’s necessary, with her tips & advice for both patients and Nurses.

Disclaimer About This Training Video

This video will explain in detail what you can expect to do. It will also supplement any existing qualification and experience you have in this subject and procedures, refresh your memory and prepare you for a regulated training course. (Of course, it is not a substitute for a course.) You can also find regulated training courses on Nurses.co.uk. Our courses will build your CPD, provide you with a certificate, and enhance your CV when job hunting.

Topics covered in this article

Introduction

What Is Cervical Screening?

The Pros & Cons Of Cervical Screening

Cervical Screenings Can Be Painful And Uncomfortable

Some Patients May Have Experienced Trauma

Cervical Screenings For Transgender People

Over-Diagnosis

Nursing Tips For Cervical Screening

What Equipment Do You Use For A Cervical Screening

Introduction

Hi everyone and welcome back to another video. Today, we're gonna be talking all about cervical screening, what it is, why it is, how we do it and all that jazz. I hope you find this really, really useful. This video is also gonna come in two parts. I'm just gonna give you the lowdown of what cervical screening is and all the important facts and figures and myths and things like that at the beginning of this video.

And then the second half of the video will be me showing you the equipment. I'm gonna take you all into work with me. So I'll be in a uniform and show you the equipment that we use and the room that we use for our cervical screening, just so you can see a little bit more behind the scenes. So firstly, what is cervical screening?

What Is Cervical Screening?

Anybody who has a cervix will have this done from the age of 24 1/2 years old up until you're 64 years of age. And one of the myths about cervical screening is that it checks for cancer, but it doesn't actually check for cancer. So cervical screening has changed in the last few years. And it now checks for something that we call the Human Papillomavirus or HPV virus. A lot of people have the vaccine now at schools to prevent it, which is amazing. And actually the stats show, there has been a massive reduction in HPV virus. So the vaccines are working, but yes, the cervical screen tests for the HPV virus and it doesn't check for all the virus numbers. There's almost 200 different strains of HPV virus and it just causes things like warts on the skin normally, doesn't do any harm to the body, but there are a couple of strains that can potentially cause cancer in the future.

So that's why we check for HPV virus before it's even developed into cancer so that we can stop it early, treat it earlier, and hopefully, fingers crossed, prevent it from ever changing into cancer. However, like everything, nothing is 100% accurate. Some people do go on and develop cancer despite having their regular cervical screening and things like that. So it's never 100% accurate. So I just need to point that out. It's not gonna be 100%, it's not gonna be preventing you from ever getting cancer. There is still that chance. It's just that extra check that can detect it earlier. You can get treated earlier and hopefully prevent anything serious happening further down the line. But again, it's not 100% guaranteed. And once you're at the age to have your cervical screening, you'll get invited every three years. This will come in the form of a letter in your post. So just make sure your contact details are all up to date with your GP.

The Pros & Cons Of Cervical Screening

So now I'm just gonna talk about the pros and cons of cervical screening. So the main pro is it can save lives and cervical screening and has saved thousands of lives every single year. So that is one massive pro. Now I can't lie, there are a few more cons to discuss rather than pros, which is unfortunate, but we have to tell people all of the cons, to give them an informed decision as well. So these are just some of the things that I would discuss in clinics sometimes with people especially if it's their very first smear and they've never had a cervical screening before.

Cervical Screenings Can Be Painful And Uncomfortable

First con is pain and discomfort. So some people do find it painful or really, really uncomfortable. Some people feel that it's a very awkward sort of situation to be in because it's not something you do every day. It's not pleasant. I mean, I go for mine every single time. It's not a pleasant experience, but for me personally, I'm in and out, like, I just get it done and that's it. But for me, I personally have never had any problems. So I've been quite fortunate I think. However, other people have had massive problems with the cervical screening and it's really put them off ever going back again. So I think that's one of the biggest cons.

Next con, 'cause your cervix is a very sensitive area, so it can make you bleed after taking the sample from the cervix. And like I said, some people do find it uncomfortable or painful as well. I mean, your cervix has a lot of nerve endings and just like the majority of your body. So you are gonna feel something when they take the sample. I'm very fortunate again, where I don't really feel mine being done. I've always been okay. And all of my screenings have been amazing. So I've got no complaints. However, if you've got maybe some gynaecological issues that are ongoing, then you might find it more uncomfortable than normal. So things like endometriosis and things like that, you might find it a little bit more painful.

People that are going through menopause as well. They find it a little bit more painful. So it's really about for me as a nurse, I would take a lot more time. I mean, I take time with all of my patients. I go slow, I go at pace for them. And I treat all of my patients the same regardless of the situation. And I've had good feedback, which is really fortunate. But just to anyone else out there, just take your time with every single patient you have. Assume that they've got really sensitive areas and that you need to just go gently, slowly and just take it step by step and inform them at each step as well. That really makes a big difference.

Some Patients May Have Experienced Trauma

And also just wanted to talk about trauma as well. So another con is quite a lot of people have been through some form of trauma in their life, whether it's sexual assault, sexual abuse, that sort of a thing that's happened in the past. And that can really, really trigger some people when they go for their cervical screening. So it's really important as a nurse that we again, treat everyone the same, just assume that that person has been through something so that they don't have to disclose that to you because you could be a new person that they don't know, a complete stranger, and then they’re not gonna wanna disclose something like that, so just go gentle, listen to your patient, listen to your patient's needs and just be really respectful, keep, maintain dignity and all of that, just to help them and put them at ease a little bit.

Cervical Screenings For Transgender People

So if somebody was biologically born a female who's now transitioned and is now male and on the system, they're male, they might not get the invites because especially if they still got the cervix part of the body, but they are now male, but on the system, it says that they're male, they might not get the invites for the cervical screening. So it's really important as nurses that we recognise that. So if they're coming to me for their hormone injections, for example, so we've got a couple that are on testosterone, we will say to them, are you up to date with your cervical screening? When was your last one? Would you like to book in?

And just keep on top of it and just make sure that your patient is aware as well, that they can still have the cervical screening, they are still at risk of cervical cancer because the cervix part is still there. And just give them all of the information to make that informed decision. However, it's really important after saying that as well is respect people's wishes. If someone wants to opt out and never have a cervical screening ever in their life, they have got every right to do that. Just document it and just make it as good experience as possible for your patient.

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So just speaking about trauma and transgender patients or non-binary patients, there are special clinics that you can send your patients to as well. One of them is called Cliniq clinic. I'll put the details here and this is a special clinic, a holistic clinic for sexual health and wellbeing for trans and non-binary people. I think it's mainly based in London. So that's the con of that is people have to travel and it might not be feasible, especially if it's someone way up north and they have to travel down. It might not be feasible for them. The other clinic is for trauma informed care and it's called My Body Back Project and they have got clinics as well for people that have been through some sort of trauma and they really struggle to get the cervical screening done. And it is a special clinic set up for those people, a really nice, holistic way. I've never been to any of these clinics, so I'm not too sure the ins and outs of them, however, there are some links, have a look at their website and see a little bit more about what they do.

Over-Diagnosis

So, because the cervix is very sensitive, your cells change constantly and all of this jazz. Sometimes it can say that you've got cell changes there, but it's not the cell changes that can develop into cancer if that makes sense. So things like if you've had a coil inserted or a coil removed, for example, that will cause cell changes because there's something that's touched the cervix, it's something that's been there, it's altered the cells in a way because you know, you're inserting something and you're taking something out from the cervix, there's going to be cell changes there. So if you were to do a cervical screening within three months of having that sort of procedure, it's gonna come back abnormal because there's abnormal changes there.

So then you would get the colposcopy letter, you'd have to go to colposcopy. Sometimes they might do surgery like biopsies and things like that that aren't really needed. And that's where the biggest con is I think, 'cause people are having all these extra tests that they don't really need. And it's just because of just some abnormal changes there, it doesn't mean it's cancer, it's just, it's there. However, again, on the risk and benefits side, I suppose the benefit is if it was cancerous, then it would be better to be safe than sorry if that makes sense, however, it is quite a big risk and the damage that's done from surgery and things like that can be probably traumatic for some people afterwards. So that's just a big con as well that I just wanted to talk about. And just to make people a bit more aware about as well.

Nursing Tips For Cervical Screening

Give The Patient The Time They Need

So just some useful tips for cervical screening. So before the patient comes in, before the appointment, just make sure they've got a long enough appointment. So if you've got someone that's very anxious, very nervous. If you've got a patient with learning disabilities maybe, or mental health, you might want a double appointment for that patient just to give them the time that they need to get themselves settled, reassure them, just have as much time as possible for that patient.

Practise Speculum

Another tip that I've saw recently, which I thought was just an absolutely brilliant tip. So if you've got somebody that is transgender, non binary, someone that's been through some sort of trauma in their life, you can give them a speculum to take home so that they can practice on themselves. They know what to expect when they come on the day. And that's just a really good way apparently from what I've heard from other people, just to ease someone into the smear test. And when they come into the room, you can also go behind the curtain, leave them to just do things on their own and you can get them to actually insert their own speculum on the day as well, so that when you go in, it's already there and then you just open it a little bit and then taking your sample. Apparently that works really, really well for people as well. So they're just a couple of options that can really make a difference to a patient.

Avoid Using Trigger Words

Avoid using trigger words. So I recently discovered this, there was a video that I did and I didn't realize I was using words that I had no idea that could be a trigger for somebody, especially someone that has been through some sort of trauma in their life. So telling them to relax is one of the biggest trigger words. So do not tell your patient, relax, relax. That's not okay I know, just reassure them. And a lot of people say, relax your knees outwards. That's another trigger word again, using that word, relax. So now I've changed my language completely. So now I say, just allow your knees to fall to the side. And I find that works really, really well. So it's just about adjusting your language and just doing what's gonna make your patient feel more comfortable.

Another the tip as well, as a trigger as well, so sometimes locking the door without telling the patient you're gonna lock the door can be a huge trigger to somebody, so just make sure you say to them, are you comfortable with me just locking the door? before you even do anything like that. If they're not happy, then that's fine. You can leave the door closed, but just don't lock it with a key or anything like that. And just pull the curtains across so that you've got some privacy there. And always as always ask your patient if they want a chaperone or someone to sit in with them as well, just to make them feel a lot more comfortable.

Reassure Your Patient

And like I said, just a massive reassurance to every patient you come into contact with. Just go slow, don't make it rushed process. I know it's a busy day and it's a routine thing for you to do, but to this patient, this could be really triggering. It could cause a lot of post-traumatic stress disorder. It could bring on a panic attack. It could bring on so many things. So just make sure you're taking your time, reassuring your patient and just making it the best experience possible for them given the circumstances.

What Equipment Do You Use For A Cervical Screening

So that is all of my little bits of what is a cervical screening and all the other details. The next video is gonna be me just showing you the equipment and doing a run through of what we do during a cervical screening. So it's a new day. I'm at work and I'm gonna set up and show you as we go, what we do with the cervical screening. So first, we need a trolley. So I get my trolley ready and I get the bed ready. So I give everything a wipe down first and then I'll get the equipment. So first we get a variety of speculums, they are all different sizes. So we've got medium, long, we've got a medium, this is a shorter one. And then we've got a smaller one. And it just depends. We normally go on basically the person's height, and we go by height just because normally if someone's really, really tall, they might need a longer sort of speculum to be able to reach the cervix, just cause the vagina sort of varies in length with people. And that's just how we judge it.

Next up we have the thin prep pot. So we always check the expiry date, make sure it's in date, make sure the fluid is in there. And there's a little line, make sure the fluid hits the line and it's sealed. Next up, we have the cervical brush and this is a really soft Silicon. I'm not gonna touch it because yeah, I'm gonna use it, but it's really, really soft Silicon. And it's a lot better than it used to be. It used to be like a wooden stick that you would scrape the cervix with, but this is much better now and it doesn't cause as much discomfort as the old one. And then we have our cytology bags. So this is where we put everything afterwards. So we'll put the little pot inside and then on the back, you've got this little packet here to put your form, the cervical screening form side. Can't show you that at the minute because confidentiality in patient details, that's our cervical sample bag that we put everything in and then it gets sent to the lab.

And that is my trolley setup, ready to go. And then once everything's set up, we call the patient in, check all of the details are correct, their address and date of birth. And then we'll just run through what cervical screening is, what we're gonna do, reassure them and gain consent, but also ask if they need a chaperone to sit with them as well. And then once we've done all the screening, we just informed the patient as well, that they'll get the results within two weeks in a letter in the post to their address. And that's why it's really important to check the address of the patient as well, because if they move, they might not get the letter. Oh, that is it wit cervical screening. I hope that's been really beneficial for you and just shown you a little bit of what we do in clinics and yeah, I hope it helps see you next time, everyone.