Smear tests after a hysterectomy: what is a vault smear?

Laura had cervical cancer in 2016, when she was 29. She had a hysterectomy to remove the cancer. Four years on from the operation and being given the all-clear, Laura has check-ups which are informally known as ‘vault smears’. Laura told us: 

“I always get asked “why are you having cervical screening (a smear test)? Surely you don’t need those?” because of my treatment and I find it difficult to explain this to people. When it’s explained to you the first time, you’re not really taking it all in - you’re only really thinking about whether or not they’re going to find cancer, rather than the details about the test.” 

So firstly, what is a vault smear? We asked Dr Andy Nordin, Consultant Gynaecologist in East Kent, to answer our questions.

What is a vault smear?

"A vault smear is a slightly misleading name. A vault smear is similar to cervical screening, but applies to taking a sample of the cells from the top of the vagina for someone who has had a hysterectomy where the cervix has been removed. The word ‘smear’ is not quite accurate, because just like cervical screening, the cells are no longer "smeared" onto a glass microscope slide for looking at under the microscope (the old fashioned "smear test"). Instead, the sample is tested for the presence of the high risk types of human papillomavirus (HPV). A modern "vault smear" is more accurately called a 'vaginal vault test' for HPV, so that’s how we’ll refer to it here.

Who has vaginal vault tests?

You’ll have vaginal vault tests if you have had a hysterectomy for either early stage cervical cancer, or persistent cell changes in the cervix (CIN or CGIN). The test is carried out because, if you have had persistent cell changes (CIN) or cervical cancer, you are at a slightly higher risk of developing cell changes in the vagina. The vaginal vault test helps to prevent any cell changes from developing into vaginal cancer by detecting high-risk types of HPV which could cause cell changes in the vagina, called VAIN.

What happens at the test?

The test is done in a really similar way to cervical screening – except it will happen in a hospital, rather than in your GP practice (practice nurses aren’t trained to carry out vaginal vault tests). A speculum is still used and a soft brush is used to take a sample of your cells from the top corners of your vagina. This is where the name ‘vaginal vault test’ comes from, as the sample is taken from the vaginal vault. These cells are then tested for HPV, and are tested for vaginal cell changes if high-risk HPV is detected in the sample.

What's the same as cervical screening?	What's different?
The test happens with a speculum and brush.	The sample is taken from the top of the vagina.
The sample gets tested for high-risk HPV, and then for cell changes if needed.	You'll have the test done in the hospital, not at your GP.

"It’s impossible not to think back to how you felt then, and all the stress and worry you felt"

Laura spoke to us about what how she felt going for a vaginal vault test and the things she wish she had known before she went:

 “People say to me that I should be used to it by now – but why would I be? Going for a check-up often means that you are physically going back to the room in which your whole journey with cervical cancer started. It’s impossible not to think back to how you felt then, and all the stress and worry you felt. 

I find that in the run up to my check-ups, even if I’m not feeling actively worried about it every minute of the day, it affects my brain in strange ways like my memory will be worse, or I’ll wake up a lot in the night. I know that the chances are low that my check-up will find something, but the chances of getting cervical cancer were low to begin with. It still doesn’t take away the anxiety.

I find that vaginal vault tests feel different to how my smear tests felt before. For me, it’s more painful than smear tests – I have scar tissue there now, so it’s a new sensation. I didn’t know that it would feel different and hadn’t been prepared for that, as I never found smear tests painful before and my doctor only talked to me about this after the test was done. I might have brought someone with me if I had known this before. 

"I’ve learnt to talk about my feelings and be open, which helps"

"I’d advise people to tell your healthcare team if you are struggling with your mental health in the lead up to check-ups, as there may be something they can do to help. I’m always emotionally exhausted after the appointment so I’d recommend you treat yourself to an afternoon in bed afterwards – I always make sure I’ve got Netflix and chocolate waiting at home for me!

I think I will always dread the check-up – that’s why this year I decided to go along dressed as superwoman, to try and bring a little bit of light relief to a situation I don’t enjoy! You go through the process of preparing yourself to potentially be told the worst... however I am always glad when the news is the best.

I’ve learnt to talk about my feelings and be open, which helps. I’ve met different communities over the years which all support me (Jo’s, the online cancer community, and other friends). While the actual check-up and these emotions don’t get any easier, I do feel more supported than I ever have done."

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