Let’s talk about… cervical screening and FGM

Please be aware that this blog contains content that may be distressing to read.

There are lots reasons why women and people with a cervix find it hard to go for cervical screening (smear tests). The Hawa Trust work with communities affected by FGM and we spoke with Hawa Sesay, their Executive Director, about the experience of screening for women who have undergone FGM.

What is FGM?

Female genital mutilation (FGM) is when parts or all of the female genitals are deliberately cut, changed or removed. It is often done for cultural, religious or other non-medical reasons, usually before puberty begins between infancy and age 15. In the UK, FGM is illegal and is child abuse.

FGM is sometimes called cutting or female circumcision, and some communities may use local terms for it, like sunna, gudniin, halalays, tahur, megrez and khitan.

How can FGM impact experience of cervical screening?

Emotional effects

FGM can cause lifelong emotional difficulties and make attending smear tests extremely hard. The thought of going to the GP or having to disclose FGM can cause a lot of anxiety and be difficult to talk about, especially if you have had a previous bad reaction from a healthcare professional. The position the test requires you to be in, and the fact it involves the lower part of your body, can also trigger bad memories or flashbacks.

Physical effects

Smear tests can physically be very hard, even impossible, for people who have undergone FGM, especially if only a very small hole for urination has been left. This can make it difficult for a nurse to see the cervix and take a sample of cells. It can also make the test incredibly painful.

Cultural effects

Cultures that practice FGM are often outside the UK, which can mean there may be additional barriers affecting attendance. This includes language. Having English as a second language can make it even more difficult to talk about FGM and know how to ask for support. In some cultures, pre-marital sex or loss of virginity has a stigma attached to it and cervical cancer itself can be seen as a taboo topic or a disease of promiscuous people. This can lead to misconceptions – for example, that only people who have had sexual contact need smear tests and may mean young or unmarried women feel reluctant to attend.

Tips to make a smear test easier if you have undergone FGM

Before the appointment

• Tell your nurse. If you feel able to, let your nurse know that you have experienced FGM, this means they will be able to make sure the right support is in place for you. You can call your GP reception and ask to speak to the nurse about a sensitive issue before your appointment.
• Ask for a female nurse. This can help if you are feeling anxious or embarrassed.  
• Wear a skirt or dress to your appointment. Many women find this makes their smear test more comfortable and less invasive as can keep it on during the test.
• Ask for an interpreter. Your GP may have an interpreter service or a staff member that speaks your preferred language. This could help you better explain your situation and ask any questions you may have. You can also ask for your smear test invitation to be sent in your preferred language.
• Book a double or longer appointment. This lets you have your smear test in your own time, and can help make it feel less rushed. It can also give you time to process what is being done and allow you to take time out if at any point you are feeling overwhelmed.

During the appointment

• Ask to see the equipment that is going to be used. This will help you feel more in control of what is happening. If you are concerned about the size of the speculum, you can ask for a smaller one to be used.
• Remember that you are in control of your smear test. Voice any concerns that you have, ask any questions, and if you feel uncomfortable at any point then ask for the test to stop.
• Bring a friend along. Bringing a friend or loved one with you may help you feel supported or a bit more relaxed and can bring a sense of familiarity if you are feeling nervous.
• Keep talking to your nurse. Ask as many questions as you want, no matter how big or small they may seem. Your nurse will want you to feel as comfortable as possible so let them know if there is anything that they can do to make your experience better.

After the appointment

• Reward yourself. Take time to appreciate what you have gone through and readjust after the appointment.
• Talk about your experience. Talking to friends or family may help you to compartmentalise your experience.

 

If you are looking for support or information about your appointment, you might want to call our Helpline on 0808 802 8000.

The below charities are also excellent sources of information and support:

Hawa Trust - information and support to people who have undergone FGM.

FGM National Clinical Group - a charity working with women who have been affected by FGM and other related difficulties

Daughters of Eve - a non-profit organisation working to protect girls and young women who are at risk from FGM.