SMEAR FEAR: When Pain (And The Fear of It) Stops You From Having A Smear Test

October 28, 2018

Cervical screening — or smear testing — is one of life’s necessary evils that leaves us feeling awkward, embarrassed and a little bit “ick”, and yet it’s potentially life saving because cancer doesn’t discriminate.

But if your vagina is a no-go area, the pap test process can be a traumatic, even painful, experience and that can be a huge barrier to overcome.

Statistics revealing the number of women not booking cervical screening appointments fail to mention the reason why some women are too distressed to consider a smear.  Sometimes the reason women don’t entertain intimate examinations isn’t just a matter of being embarrassed – it’s genuine fear.

If you have a negative emotional relationship with your vagina — due to sexual abuse or assault, childbirth trauma, previous poor gynaecological treatment or you live with chronic pain or vaginal pain conditions such as vulvodynia or vaginismus — the thought of a smear test can be frightening at best, and triggering at worst.   No wonder then that smears are avoided like the plague.

I used to dread and avoid smear tests for the very same reason, that the reality of what we’re constantly told is regular, necessary screening was in itself an experience of trauma.

Earlier this week I had a smear test, which I was relieved went well.  ‘Well’  meaning I didn’t flinch, scream or cry, like I have done for every other smear I’ve ever had.  I say this as someone who once suffered terribly with vaginismus, which meant internal examinations like the smear were virtually or completely impossible.  I cannot articulate how much I dreaded that letter dropping through the door, telling me it’s time to book my appointment.

To paraphrase why anyone would find smear tests so terrifying to someone who’s never experienced intimate problems is a difficult one.  For me, the reality of a smear was far more stressful that anyone ever suggests because a smear simply meant pain.

I’ve actually never talked (publicly) about this, but I had vaginismus for many years.  For a long time I was convinced I had something physically wrong with me, and that I’d never be able to have a smear test without feeling pain.  In fact, sex was a massive problem for me, so much so it was the reason behind why I thought I’d never have kids. I figured if I couldn’t cope with a smear or sex, childbirth was simply unfeasible.  If you noticed I said ‘had’, it’s because I don’t suffer with it anymore.  But that’s a story for another time.

Vaginismus and smear tests are not a great mix.  Knowing exactly what I was like, I’d walk into the nurse’s room with my realistic/pessimistic attitude.  I always assumed it would be a painful experience, so half the time it was just that.  Sometimes the way the brain works really does not help you.

The worst experience I ever had was going back about 9 years; I had a smear taken by the most heavy handed and sadistic old school matron-style nurse I’d ever met.  When I vocally cried out in pain and repeatedly asked her to stop, she didn’t, and when she told me that “it only hurt because I hadn’t had children” I left in tears.  She violated me and I was hurt.  Now that was a one off.  I’ve never met another nurse like her since, neither have I heard of this happening to anyone else. But it’s this kind of abhorrent bahaviour that makes smears a million times worse to deal with, while successfully doing disservice to the nurses and GPs doing the NHS proud, respectfully screening millions of women every year.

Thankfully for most people a smear test is painless.  It’s not comfortable and of course isn’t the least bit pleasurable, but it’s relatively quick, and over before you know it.  But if you have a condition that causes you pain, whether it be physical or mental, having a smear test is like writing a cheque for the pain.  Knowing you’re about to receive pain or even discomfort is really, really hard to put yourself through, and nobody, nobody, would choose to do that.  To expose your vulnerability feels like violation against your body. I want to say that’s bravery but it feels a dirty word to use in this place.

When I feared my smear test because of my vaginismus, I always made sure whoever was doing my test knew about my anxieties.  That way, I felt more in control of the circumstance.  The nurse or doctor would be extra gentle (or so it felt) and would offer to use a small speculum, explaining everything before they did it, talking me through it and encouraging me as they went.  Of course it was a horrible experience when it was asking the impossible of me, but I’ve always believed there’s just no way out of it.  Even for me.

To anyone who’s undecided about going for a smear,  I’d say even your impossible is possible, and there are ways and means to make the procedure more bearable and less uncomfortable.

You can request who you’d like to do your smear – whether that’s a trusted GP or a favoured nurse and you can have a friend to hold your hand.  You can also ask for a paediatric size speculum, like I did.  Have the speculum warmed up.  Lie in an alternative position, maybe even going around the time of your ovulation so you’re more naturally lubricated may help.  While there are certain things that do need to be done, it’s your smear – you call the shots.  And if you need it to stop, it’s stops.

However you need to prepare yourself, please tell me you’ll do it.  A smear test may be your mountain, but you can conquer it and it’ll potentially save your life.

Some helpful further reading:
Vulval Pain Society  | NHS – Cervical Screening

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