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Breaking down barriers to cervical screening

In this blog Dr Sonia, a GP based in Tottenham, writes about some of the barriers people face to attending their cervical screening test and what we can do to help overcome them for Cervical Screening Awareness Week 2024.



Cervical screening saves lives. Get it done. Easy, right? 


Maybe not.  


As a GP, I know for many people, getting their cervical screening is anything but easy. Can you remember your first cervical screening appointment? You may recall feelings of anxiety, embarrassment or fear. Now, imagine if you didn’t speak English or come from a country where screening isn’t routine, and you have no idea what to expect. Or have been told that cervical cancer is associated with ‘promiscuity’. Lack of exposure and knowledge leads to misconceptions and can make the process daunting or feel like something not meant for you. Although progress has been made, much more can and needs to be done, such as communicating with people in different ways and ensuring information is readily available in different languages. As GPs, we need to proactively reach out and listen to people so they have the right information to make informed decisions.

 

The narrative that cervical screening tests are easy and painless can be unhelpful, especially if you have a condition such as vaginismus (where the vaginal walls involuntarily tense during sex), lichen sclerosis (a skin condition that can affect the genitals), or post-menopausal atrophy (vaginal dryness that can occur after menopause). For women with these conditions, the speculum examination that happens during the cervical screen can potentially be uncomfortable or painful. If you are a survivor of sexual trauma or violence, the intimate and physical nature of the screening could also be distressing, traumatic or triggering. If you’re affected by any of these, I would advise booking a double appointment with your doctor or nurse to give yourself the time to discuss your concerns, and we can make adaptions, such as using a smaller speculum.

 

If you’re from the LGBTQ community, trans or non-binary, going for a cervical screen may not feel easy. The process may feel distressing or uncomfortable. You may be worried about discrimination or being misgendered. Or you may not even be sure whether or not you need the screening. Support is available to help you take control of the process and make it as comfortable as possible. My general advice would be to speak to your GP beforehand about any concerns and your pronouns, which can also be done by email if you prefer. And remember you are always welcome to bring to companion to your appointments.

  

The uptake of cervical screening amongst people with learning disabilities continues to be low. Multiple barriers persist. The process may be confusing or frightening. There may be difficulties in communicating, not knowing the language to use. There is also sometimes misunderstanding among healthcare professionals and families as to whether the screening is needed. GP surgeries have a legal duty to make reasonable adjustments to support people with learning disabilities. If you work at a GP surgery and are supporting patients with a learning disability, you can find information here on how to make the process easier.


Alongside personal factors, I’m aware that accessing GP appointments is not always seamless (to put it lightly). I recall a conversation recently with a mother who worked night shifts. She was a year overdue with her screening as she simply couldn’t get an appointment that worked for her. The barriers to screening are multiple and often overlapping. As a GP, I know I am responsible for ensuring that we are doing our bit to address these barriers. That includes proactively reaching out to people, making it easy for people to book appointments, ensuring there is space for conversations and having all the information readily available. We need to ensure screening is flexible, adaptive and convenient to everyone’s needs.

 

A cervical screen is not always easy. Acknowledging that is just the first step. It’s up to all of us to work together to bring down those barriers.

  

The Eve Appeal is here to provide support, guidance, and information so everyone can feel supported through the process and make the right decisions for them. A cervical screen can save a life, but it’s not always easy. So it’s on all of us to get talking, share information, and support each other to get checked.

 


If you have any more questions on cervical screening, you can Ask Eve for free and confidential advice and information on nurse@eveappeal.org.uk or 0808 802 0019. 

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