Episode 31: How to Make a Smear Test More Comfortable

Last week marked the end of Cervical Cancer Awareness Week. I was reading lots of posts about the importance of having smear tests, in order to diagnose early changes in the cervix that might lead to cervical cancer . In the UK the cervical screening programme is estimated to save over 4,000 lives each year. Numbers of women attending screening are falling though.

Some articles had a tone that I feel needs to change over time. Saying a smear test is non-invasive, or just a small thing is not true for many so women, even if they can be a quick and potentially life-saving test.

In this episode I wanted to talk about the cervix and what it does, and then share some suggestions to make a smear test more comfortable.

Apparently the founder of osteopathy Andrew Taylor Still said: “To find health should be the object of the doctor. Anyone can find disease.”

There is so much information out there about cervical cancer and other cervical dysfunction, and it’s so vital. However I wanted to talk about the cervix.

It’s important to honour what works well in the body, rather than just expecting it to go wrong. There’s an immense power in knowing about our bodies, and making choices that work for us.

What is the cervix?

It’s a cylinder shaped canal of connective tissue and muscle fibresthat connects the vagina and uterus. The cervix is the neck of the uterus with the internal os at the top and external os at the bottom. Os is the anatomical word for mouth or entrance. If you’re doing a pelvic exam, the cervix looks like a doughnut, with the external os being the hole in the doughnut. The cervix has special channels called crypts which produce cervical mucus. You can use the mucus as a sign of fertility if you’re trying to conceive or trying to avoid a pregnancy. The cervix feels like the end of a nose, with a little dip in its centre.

The cervix changes in length, position and firmness during the menstrual cycle, pregnancy and birth.

If you wanted to have a look at your own cervix, you can get a kit from ‘Beautiful Cervix’ , which includes a mirror and speculum for you to use at home.

Making a smear test more comfortable

I sometimes see a narrative about smear tests where ‘it’s not a big deal’ - but actually that only serves to silence experiences. For someone with a history of pelvic or sexual trauma, or difficult birth or vaginismus, a smear test can be very painful or distressing.

Here are things that you can do to make a smear test more comfortable.

Before the test:
If it’s at all possible, try to see the same doctor or nurse. In so many countries it’s usual to have your own gynaecologist who you have your smear tests with. The continuity of care with the right person can be really helpful.

Take a friend or partner with you as a chaperone or to hold your hand during the test.

Get to the appointment early enough so that you’re not rushing and being unnecessarily stressed. Make sure you’re hydrated and not hungry.

While you’re waiting for the appointment, listen to a guided relaxation or focus on breathing a long, slow out breath. Try not to mindlessly scroll on your phone as this can be quite a frenetic state.

Shaking the body helps to relieve tension. You can’t hold while you
shake, so take yourself to the cubicle of the loo and have a shake and shimmy, especially of the thighs and bottom.

During the test:
When you’re lying on the examination table, focus on releasing your buttocks and thighs. Imagine them melting like butter. This helps to relax the pelvic muscles.

Breathe down into your belly. You can place your hand on your belly to help focus on this area.

Practice golden ribbon or golden thread breath. This is a simple
breathing technique that helps to balance and calm the nervous system.

Either close your eyes or soften your gaze.
Take a breath in.
Purse your lips as if you’re blowing through a straw.
Exhale through the space between your lips.
Let your out breath be as long as possible
Gently allow another in breath

Remember that you can say stop or slow down at any time. You’re in charge of your own body.

Use a smaller speculum if needed. Some health professionals will
even be ok for you to insert the speculum yourself.

Things that your care provider can consider to make the experience more comfortable.

Make sure you create trust and rapport by saying your name,
communicating well and explaining what you’re going to do. Try to be calm and reassuring.

Dimming the lights so they aren’t so stark. This settles the part of the brain that gets hyper vigilant. Some clinics have a painting or image on the ceiling which can be pleasing to look at.

Use warmer lubricating gel so it doesn’t shock the body and cause a clamping in the vaginal muscles

Lying with open legs facing a door can be a very vulnerable position. If there’s the option, position the bed so that dignity and privacy is always maintained.

It’s not always easy to answer questions if you’re trying to focus on breathing or relaxing or if you have a speculum inside! So gauge the words you use - and bear in mind that some people find the silence really awkward.

Keep the pace slow and considerate so that she can let her body go as much as possible. The more pressure she feels, the harder it is to relax.

After you’ve finished your appointment, try to have some time for a warm drink or a gentle walk outside so you can settle your nervous system.

Treat yourself kindly afterwards. One technique that can help to unwind the stress and tension is non-linear movement. There’s a simple technique called ‘Moving What You’re Feeling’. Pick a song that’s 3-5 minutes long. Get on your hands and knees, or sit on a chair or stand.

Close your eyes.

Feel into your body and notice any tension or holding such as your shoulder or hip.

Allow that area to move.

Follow the sensations in your body and allow yourself to keep moving.

Resources:
Beautiful Cervix Project
Eve Appeal
Jo’s Trust

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