Hidden Obstacles to Cervical Screenings
- Olivia Marsh
- 3 hours ago
- 5 min read
As my friends and I approach our 25th birthdays, we have been apprehensively awaiting the arrival of our text messages from the NHS inviting us to our first cervical screenings. These screenings, previously referred to as smear tests, are offered every 5 years to women and people with a cervix aged 25 to 64 to check cervical health and help prevent cervical cancer. During the appointment, a tube-shaped tool called a speculum is inserted into the vagina to push open the vaginal walls, and a sample of cells is taken from the cervix for testing. The sample is checked for specific types of the Human Papillomavirus (HPV), a sexually transmitted virus that can cause abnormal cell changes and significantly increase the risk of cervical cancer.
A speculum can be quite an invasive instrument for a tender muscle; while some feel only pressure, many describe insertion as uncomfortable, and for a few, it can be painful. Since the 19th century, there has been little change to the cold, metal design of the device. Only recently has innovation begun to consider comfort during appointments. Students in the Netherlands designed the ‘Lilium’ in 2024, a speculum made from rubber that allows for gentle opening, which received worldwide celebration. While alterations can be made to the device, the nature of gynaecological appointments shapes a power dynamic that reflects the vulnerability women continuously encounter. A way around this can be the option of self-insertion, which, when offered, is thought to reduce anxiety and encourage attendance.
Cervical cancer is one of the most prevalent forms of cancer amongst women, and of the estimated 880 deaths each year in the UK, 99.8% are thought to be preventable. Numerous challenges can explain avoidance of these appointments, shaped by an individual’s intersecting identities and experiences. Common examples include medical mistrust, history of sexual trauma, disability, fear, misconceptions about the HPV vaccination and the sexual transmission of HPV. Since graduating from KCL, studying MSc Psychiatric Research, I’ve been researching the lived experiences of inequalities in women’s health with the aim of spreading awareness.
Lying in the Shadow of Exploitation
Medical mistrust is steeped in a history of exploiting the female body; some of the most grotesque examples of gynaecological research were the experiments of J. Marion Sims. The lack of care and protection the ill-fittingly titled “Father of Gynaecology” showed for the enslaved Black women he relentlessly operated on without anaesthesia has left its scar. Institutionalised racism and medical stereotypes have resulted in people from Black, Asian and other minority ethnic (BAME) backgrounds suffering poorer health outcomes and turning away from routine exams.
The UK government has found that people from BAME backgrounds are less likely to attend their cervical screenings than White British people. It is believed that different cultural attitudes surrounding sex and a lack of knowledge about the necessity of these screenings could be in part responsible for this difference, evident from interviews with women from ethnic minority backgrounds, revealing that several women did not recognise the term ‘cervical screening’. For some, the language barrier poses as the greatest obstacle to access. A recent case study of a clinic in England providing care for many patients whose first language was not English found that educating staff on how to most effectively discuss cervical screenings, offering flexible appointments, and placing cervical screening leaflets in different languages in the waiting room, helped increase screening attendance rates. Implementing inclusive communication strategies across the NHS and updating cultural competence training could dramatically aid attendance, especially in the most densely populated, diverse communities.
The ‘M’ and ‘F’ Label
NHS communication systems can also affect trans patients’ screening invitations. I recently spoke to my friend about an aspect of his transition, which he is happy for me to discuss. As a trans man, he changed his NHS profile to ‘Male’ and, despite having a cervix, stopped receiving invitations for appointments. The distinction between sex and gender remains inconsistent across NHS services, and while not always the case, responsibility is often placed on trans patients to be aware of what sex-specific anatomical exams they need. My friend explained to me that trying to access gender affirming care is fatiguing enough without the added burden of requesting routine tests. Also, the nature of the appointment can cause severe dysphoria for trans patients. Ensuring staff partake in sensitive communication training is therefore essential to minimising non-attendance. Going forward, research is needed to understand the barriers present for trans patients and how clinicians can prevent dysphoria, as well as a consistent system to ensure all patients are correctly identified for their routine tests.
An Epicentre of Anxiety
One of my closest friends faces her cervical screening with an overactive pelvic floor; she agreed to discuss her experience for this article. An overactive floor can cause numerous issues in the pelvic region, including painful sex – often associated with vaginismus, the involuntary spasm of vaginal wall muscles, and vulvodynia, pain in the vulva caused by an unidentifiable source. While often portrayed in the media as associated with sexual trauma, there can be no obvious explanation. Typically described as feeling the vagina is blocked by a wall, my friend has made the distinction that her general anxiety holds itself in her body, and upon instances of possible vaginal penetration, her anxieties are directed there. She’s been attending physiotherapy to ease her pelvic floor and recommends belly breathing for anyone during their next cervical screening to relax pelvic muscles and increase comfort. While my friend still wants to attend her cervical screening, the looming prospect of the appointment has created greater anxiety for her to urgently progress in therapy.
The Future of Cervical Screenings
The Renewed Women’s Health Strategy for England was just published - echoing concerns of pain and discomfort during gynaecological procedures - acknowledgement of which should hopefully propel progress.
Furthermore, the news recently highlighted research advances being made into testing for HPV at home using samples of period blood. Collecting menstrual blood at home using pads or tampons would overcome many obstacles to cervical screenings, and for those who do not menstruate, such as post-menopausal women, other options would still be available. While this method is in early stages of testing, the NHS has been developing a self-test kit, which began rollout in early 2026 for anyone overdue for an appointment by over 6 months. A vaginal swab is taken at home, then posted to a lab for analysis of signs of HPV. However, this cannot detect cell changes that may lead to cervical cancer; therefore, an in-person appointment would be required if signs of HPV were found. These alternatives would mitigate the fear, embarrassment, and logistical challenges of attending an in-person appointment for many. Unsurprisingly, from the women who have completed both the self-test and clinical cervical screening, 85% agreed that they would like the option to choose between the two.
During the writing of this article, I had my first cervical screening, and although I was slightly apprehensive, I was pleasantly surprised by how little discomfort I felt, helped by the nurse’s friendliness. However, women lie on a vast spectrum of differences and do not conform to a one-size-fits-all model. We need greater choice in the healthcare we receive to accommodate the various challenges that are associated with accessing reproductive care; crucially, to ensure that as many people as possible attend life-saving screening appointments.
