Let's talk about... smear tests when you have a tilted cervix

If you have a tilted cervix, cervical screening can sometimes be more uncomfortable for you. This might make you feel anxious or nervous before your next appointment. But, did you know that there’s lots of ways to make a cervical screening appointment better if you have a tilted cervix?

We asked a member of our expert panel, Jenny Greenfield, a Specialist Practitioner in women's health who trains other nurses to deliver cervical screening, to tell us more and give us her top tips:

What is a tilted cervix?

“Cervixes are really individual, and no two are the same! Roughly 75% of them are straight. This means that when you put the speculum into the vagina, the cervix can be seen easily. However, it’s very common to have a tilted cervix. This means that the cervix curves in a different direction. It might sound strange, but it's nothing to worry about.

Tilted cervixes can be anteverted or retroverted, meaning it either points down to the spine or points back towards the belly button. They can also point to the left or the right, or double over and tilt back on itself. You may have been told that your cervix is ‘hiding’, which means the same thing. There’s no way to know this unless you’ve had a speculum examination, such as a smear test.

Tips to make your smear test better

Some people find smear tests a bit more uncomfortable if they have a tilted cervix, and sometimes it can be painful. But it’s simple to make it better.

As a sample taker, the first thing I say when my patient lies down on the couch is to lift your bottom up, and then put it down again. This pushes everything forward, and also helps you to relax, which will make the cervix come forward and be more visible.

The most common way to make this better is by making fists with your hands, and then putting them under your bum. This makes your bum higher so that your sample taker can get a better view of your cervix. It is also a big help if there are stirrups on the couch for you to put your legs in, as this tilts everything forward, but this is not in place at most GP surgeries.

"I remind every patient that, if it’s painful or uncomfortable, they can say stop at any time and I will stop"

Lots of my patients who have a tilted cervix can be feeling nervous, so I’ll try and have a chat and a laugh with them to relax them. I can also talk them through some breathing exercises. I remind every patient that, if it’s painful or uncomfortable, they can say stop at any time and I will stop. 

Sometimes, if it’s difficult to see the cervix, I’ll tell my patient to just stand up and have a jump around, and then go back to lying down – this can really help to relax them, and it often works really well!

If you’ve been told that you have a tilted cervix, make sure you tell the next person who does your cervical screening, or any other vaginal exams, or ensure that it’s written down in your notes. This is really helpful for the healthcare professional who can make the right preparations such as using a long speculum.”

Toni shares her experience of cervical screening with a tilted cervix and what has helped her: 

“I found out that I had a tilted cervix in 2018, but I’ve had lots of check-ups and smear tests before I knew. I’ve had cell changes and HPV, which meant that I had more frequent smear tests for 3 years. The HPV wasn’t clearing from my body, so the doctors decided to treat me with LLETZ, which went well so I am now back on 3-yearly recall.

"I just thought it was that way for everyone"

I found smear tests were always uncomfortable, but I think I just thought it was that way for everyone. I only found out that the discomfort was because I had a tilted cervix just before I fell pregnant in 2018.

The pain of the test coupled with having had abnormal results in the past means that I get very anxious about cervical screening. Unfortunately, I was due for my next test during lockdown in May, which was postponed and my appointment came around in September. By this time my anxiety was through the roof!

"We could do something about the discomfort"

The nurse I saw was fantastic. She spoke to me about my anxiety and told me that “if you can’t change anything then don’t waste your time worrying”, but that we could do something about the discomfort. She told me to bring my feet up to my bum, make my knees loose, clench your fists and basically sit on them. This arches your bum up a little bit, and this last smear test I had I didn’t actually feel anything. It was bizarre but so much more comfortable in comparison to other examinations. 

"Tell the nurse how you are feeling"

Explain how you feel - if you suffer with health anxiety tell the nurse how you are feeling. They listen, and no doubt have seen someone in the past who’s had the same experience. I’ve also found that deep breathing, and general chit-chat with the nurse, helps during the test. It sounds basic, but it really helps. 

Having a tilted cervix also meant that some of my examinations during pregnancy were a bit uncomfortable. But again, relaxing helps. I know it can be difficult when you don’t have a tilted cervix, but when you do it’s even more important to try and relax”

Do you have questions or concerns about cervical screening? Get in touch with our Helpline >