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Left lateral position – a better option for patients?

Posted on: Friday, 13th November 2020 by Bridgette Love, Practice Nurse

Bridgette Love has been a practice nurse for 24 years and is passionate about offering the best possible experience to her patients. In this blog, she explains the benefits of offering an alternative cervical screening position and shares the preferences of her patients.

As sample takers, you will all have been trained by your local Cervical Sample Taker Training Programme. You will probably have been taught to offer cervical screening to patients in the dorsal position, with them lying on their back – but did you know there is an alternative position you could offer? It is the left lateral position, where patients lie on their left side, with their left leg straight out on the bed, and the right leg bent up but also lying on the bed – like the recovery position.

The left lateral position

An illustration of a patient lying in the left lateral position.

Illustration, Marion Tasker. Reproduced with kind permission of Practice Nurse. 

I have been offering both options to all my patients since I started practicing. In 2018, over 7 in 10 (77%) of my patients said their preference was for the left lateral position. This could be because the left lateral position is a more natural position for patients to lie in, and they therefore more relaxed about the procedure. 

“Left lateral was much more comfortable. I have always looked at the smear test as something to be endured and I hated having to lie there in the dorsal position – highly embarrassing, even for an old dear like me who has had a lot of them over the years. What a treat to be tested in the left lateral position.” 
- One of Bridgette’s patients, aged 65

For my patients who had a tilted cervix, over 9 in 10 (92%) said they found lying in the left lateral position more efficient in locating their cervix. This is because, as a sample taker, you have more room to manoeuvre with the speculum handle at the patient’s bottom, rather than the pubis. When lying in the left lateral position, the tilted cervix does not fall further posterior and, if you aim the speculum towards the patient’s spine, there should be minimal effort to locate a tilted cervix. 

If you are confident doing cervical screening in the dorsal position, it really isn’t much different to try the left lateral position – but it could make a big difference to your patients, especially if they have struggled with painful experiences of screening, have hip or back issues, are a survivor of sexual violence, or have a tilted cervix that professionals have struggled to find in the past.  

“I find smear tests or anything dealing with my nether regions very traumatic. At my recent smear test, I felt almost no discomfort and I felt a lot less vulnerable in the left lateral position. Unless someone can perform a smear test in the left lateral position, I don’t want it done.” 
- One of Bridgette’s patients, aged 34

In 2020, the Cervical Screening Programme in England updated its sample taker guidance to include both the dorsal and left lateral positions as options for the sample taker to offer. For more tips on supporting your patients, read our good practice guidance before, during and after cervical screening.

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