Smear test: Everything you need to know about smear tests and what to expect during your appointment

Does it hurt? What should I expect? Do I REALLY have to have one... ?

Gynaecologist holding vaginal speculum for a smear test
(Image credit: Getty Images)

Despite the importance of getting a smear test, one in three women under the age of 35 are still refusing to have their screening. 

Lots of women find the idea of going for a smear test embarrassing or have heard on the grapevine that it's going to hurt. With our busy lives, it's so easy to put the need to book in for a smear test to the back of our minds and not get it in the diary.

While feeling nervous or unsure about smear tests is very natural, seeing as it's not talked about very often, those feelings shouldn't stop you from going for one. Smear tests are relatively quick, painless and most importantly could detect cervical cancer early enough to treat it. Thousands of lives are saved every year thanks to cervical screenings.

So, here's everything you need to know about getting a smear test and what to expect during your appointment:

What is a smear test and how is it done?

According to the NHS, a smear test checks the health of your cervix. Your cervix is the opening to your womb from your vagina. During the screening, a small sample of cells will be taken from your cervix to be tested.

Smear tests look out for abnormal cells well before they become cancerous. Consultant gynaecologist at London Gynaecology, Narendra Pisal, explains: 'By treating any abnormality, the risk of developing cervical cancer is reduced significantly.'

'Smears are something offered to females who do not have symptoms, are well, and are part of well-woman care – designed to help you and keep you safe,' says Dr Deborah Lee from Dr Fox Online Pharmacy. 'However, no tests are ever 100% effective or 100% reliable, and there are still occasional cases of cervical cancer, but these are rare.'

What happens when you go for a smear test?

A smear only takes about 5 minutes at most and is usually done by a nurse. You'll be asked to undress from the waist down and lie on your back (with your knees up and apart) on the couch.

(If this position is difficult, see if they can do the smear with you lying on your side, knees up in the foetal position.)

Once you're lying down comfortably, a doctor or nurse will insert a speculum (this looks a bit like a duck's bill) into your vagina so that the nurse can get access to your cervix. The good news is that speculums are often plastic these days - so no more of those nasty, cold, metal ones!

A small brush or spatula is used to gently scrape cells from your cervix. More good news - there's a new design of brush (a bit like a mascara brush) being introduced that's much softer and more effective at getting the cells. This might be a little uncomfortable but shouldn't be painful and takes less than 5 minutes.

The cells are then put on a slide and sealed in a container that's sent off to the lab, where the cells will be looked at under a microscope.

How to prepare for a cervical screening

Once you have booked your appointment to have a smear test, make sure you note it down so you don't forget the date or time. On the day of the smear test, make sure you turn up for your appointment promptly.

'Wearing a skirt that you can pull up easily or bottoms that you can easily remove is helpful,' says Dr Shirin Lakhani of Elite Aesthetics.

Narendra also suggests:  'Also, you can take a friend with you if the clinic allows. You can take some paracetamol 30min before your appointment if you have found it uncomfortable in the past.'

What age do you start getting smear tests?

‘According to the NHS guidelines, all women from the age of 25 should have a smear test, up until the age of 64,' says Dr Lakhani. 'Women over the age of 64 are only invited for smear tests if they’ve recently had abnormal tests.'

'This is because mild abnormalities found on smears are very common,' says Dr Deborah Lee. 'When these are detected it causes confusion and anxiety and can lead to unnecessary treatments.' Fortunately, cervical cancer is extremely rare in people under the age 25, which is why people with a womb do not need to go for a smear test until they are over this age.

'Cervical cancer has a long pre-invasive period, often lasting 10 years or more,' says Dr Lee. 'Not having a smear until you are 25 is safe because, at this young age, there is still ample time to detect any pre-invasive cancers and treat them successfully.'

How long does it take to get smear test results?

You will usually get your smear test results in two weeks. These will arrive by post.

What does it mean if your test shows abnormal cells?

Getting abnormal results can be scary but Macmillan Cancer Support points out that this does not mean you have cancer and the majority of people who get abnormal results will not develop cancer. However, what the screening will do is find the small number of people who need treatment to prevent cancer.

You will have the chance to discuss your results with your GP or practice nurse and you can also call the Macmillan Cancer Support specialists for free on 0808 808 00 00.

How often do you need a smear test?

How often you need a smear test depends on your age and your results. 'The NHE Cervical Screening Programme advises that women aged 25-49 have a smear test once every three years, and women aged 50-64 have one every five years,' says Dr Lakhnai. 'However, if Human Papillomavirus (HPV) is found in your test you may need another test within a year.’

'The biggest risk factor for cervical cancer is not having a smear test and remaining unaware of the development of the pre-cancer,' says Mr Pisal. 'It is of concern that so many young women are not going for their smear tests, and it is important that we combat this so that the figures do not rise.'

Female patient talking to doctor before a smear test

Your smear test will be carried out at your GP surgery.

Can you get a smear test on the NHS?

Absolutely! Tests can be carried out in the GP surgery, usually by a practice nurse, or at some sexual health clinics.

'Anyone who has a cervix should have a cervical smear test,' says Dr Ellie Rayner (find her on Instagram @maternitymedic). 'There are some specialist clinics who offer additional support for anyone who is particularly anxious or worried about attending a smear test, such as anyone who has previously experienced sexual assault or trans men for example and your GP can direct you to a specialist clinic in your area if you would like.'

Following reality star Jade Goody's cancer diagnosis in 2008, the NHS experienced a huge surge in those looking to book in a smear test.

How do you book a smear test?

'To have a smear test you need to registered with a GP,' says leading gynaecologist, Dr Rayner. ' You will be sent a letter when your first or next test is due to remind you to make an appointment.'

Don't ignore the letter!  'This is one of the best things you can do for yourself to be sure you stay well,' says Dr Lee. 'Prevention is always better than cure.'

A young woman holding an envelope.

You receive a letter in the post prompting you to book your smear test.

Does a smear test hurt?

Here’s the good news  - the majority of women say that smear tests are not painful.

'In one 2014 study from the Netherlands, 789 women were questioned about their recent smear test and 88% said it was not painful,' says Dr Lee. 'However, 12% said it was either fairly painful, or very painful.  Overall, this means you have about a 9/10 chance of not finding your smear test painful.'

In general, the whole process of having a smear taken seems to be well tolerated. 'Only 2% of those questioned in the above study, said they found the process of having a smear stressful,' says Dr Lee.

Doctor holding cervical smear equipment.

A soft brush will be used to collect cells from inside your cervix

Here are some tips from Narendra Pisal, to make your smear test more comfortable:

  1. Listen to music or watch TV: Nowadays with smart phones, watching a movie or listening to music or a podcast is easy to do in any location.  Take your headphones and your phone and get prepared to zone out.  And don’t worry, if you do forget your headphones ask the nurse if she minds you watching or listening anyway.
  2. Equipment:  Ask, if available, for the nurse to use a plastic speculum or a small speculum. Plastic is often warmer than metal and it’s clear so it’s easier for the nurse to see the cervix and a smaller speculum is more comfortable. They aren’t always available but don’t be afraid to ask.
  3. Count from 1 to 100: Paula Radcliffe used to use this strategy towards the end of her marathon and many patients have found it useful. Often the smear is done well before you get to 50.
  4. Paracetamol: Take a dose of paracetamol 30 minutes before your smear which will take some of the discomfort away.
  5. Numbing gel: If all else fails, ask the nurse to use a small amount of numbing gel.  Previously there was a concern that the gel would affect the smear cytology but with liquid based cytology which is used nowadays a small amount of gel will not interfere with the quality. Nurses understand that smears aren’t the most pleasurable of experiences and will often do as much as they can to help.  If your smear test is overdue, please don’t delay, book it today with your GP or gynaecologist.

Can you get a smear test while on your period?

You shouldn't have a smear test during your period as the blood makes it difficult to see the results.

However, some doctors will do a smear if you have a light period. There are also new, liquid-based smears that can separate the cells from the blood and mucus. If you're not sure or suddenly start your period, call your surgery to see what they suggest. There's nothing more annoying than turning up, only to be sent away.

'It’s always best to have your smear at least two days after your period has finished, or several days before you are expecting it to start,' says Dr Lee. 'If you are not having periods, perhaps because your periods have stopped due to your current method of contraception, you can have a smear at any time.'

However, take care. 'If you are bleeding in between your periods, or after sex, you must see a doctor and have this assessed,' says Dr Lee. Do not put off going to see the doctor or going to have your smear if you have abnormal bleeding. 'If this is the case, the doctor may well not take a smear, but is likely to simply refer you to the colposcopy clinic (a specialist gynaecology clinic) for your cervix to be carefully examined,' says Dr Lee. Most women will not have a serious cervical abnormality, but this does warrant an urgent assessment.

Pregnant woman having a consultation in hospital

Usually you will wait until 12 weeks after giving birth before having your smear test.

Do you get a smear test while pregnant?

According to the NHS, you will not usually need to have cervical screening if you're pregnant, or might be pregnant, until at least 12 weeks after you've given birth. This is because pregnancy can make it harder to get clear results.

If you are invited for a cervical screening whilst you're pregnant, let your GP know and you are likely to be advised to reschedule the rest for a date around 12 weeks after your baby is born.

However, if you have previously had abnormal results, you may need to have your smear test whilst you're pregnant. This may be done during your first antenatal appointment and won't affect your pregnancy.

Are a smear test and pap smear the same thing?

No. Whilst both tests involve a sample being taken from the cervix, the pap smear used to look for abnormal cells in the cervix, while the cervical screening test looks for the HPV infection.

'From April 2019, Primary HPV (Human Papillomavirus) screening was implemented in UK.' This is new way of examining cervical smears, where the sample is checked for abnormal cells only if HPV is detected. 'Nearly all cervical cancers are caused by HPV infection,' says Mr Pisal. 'Screening for HPV is a more sensitive method for identifying those at a higher risk of developing cervical cancer.'

The actual test remains unchanged. Women still have a cervical smear. The benefit would be reduction in the number of women having unnecessary colposcopy examination.

If high risk HPV is absent then chances of developing cervical cancer is extremely low. 'When you compare the pre-primary HPV screening era, many women were referred to colposcopy when the smear had borderline or low-grade changes,' says Mr Pisal. 'These will not be referred now on the basis of HPV negative smear and therefore reduction in colposcopy referral eventually.'

Can a smear test detect an STD?

No, a smear test cannot detect STDs. ‘A smear test helps to prevent cervical screening by checking the cervix and detecting abnormal cells,' says Dr Lakhani. 'It doesn’t include tests for chlamydia or other sexually transmitted infections so if you’re concerned about these you should speak to your medical practitioner who can arrange for another test to rule these out.’

If you are concerned about your sexual health, use this NHS postcode search to find support services and clinics near you where you can seek further advice, help and get tested.

Do I need a smear test if I'm not sexually active?

You don’t usually need a smear test if you’re not sexually active. 'This is because precancerous changes and invasive cancer of the cervix are both caused by a combination of factors that are present in seminal fluid,' says Dr Lakhani. 'However if you’ve got a cervix and have had any kind of sexual contact with a man or woman, you could get cervical cancer.'

This is because nearly all cervical cancers are caused by infection with high risk types of HPV.

'You can get HPV through vaginal, oral or anal sex, any skin-to-skin contact of the genitals, sharing sex toys,' says Dr Lakhani. 'If you’re unsure if you need a smear test or not it’s always best to speak to your GP who can advise you.’

Rose Goodman

Rose Goodman joined Future Publishing in 2020 and writes across, Woman & Home, Woman, Chat and Woman’s Own magazines. Prior to pursuing her career as a writer, Rose obtained a degree in psychology and went on to work in adult mental health for five years at Addenbrooke’s Hospital, Cambridge, specialising in eating disorders. She is fully trained in first aid, medical emergency response and motivational interviewing – a directive, patient-style counselling approach to address ambivalence in recovery. She graduated with a MA in creative writing from the University of Brighton in 2017. In her spare time she enjoys writing poetry and attending literary events, and offers weekly support to those living with homelessness. Rose has a passion for raising awareness around mental illness and the importance of prioritising our wellbeing.