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***Trigger warning: this blog is about sexual violence***
We know some women find attending their cervical screening (smear test) appointment extremely difficult and there are many reasons why women do not attend or delay. Through our new series of blogs, we will be addressing some of these.
During #SmearForSmear, many survivors of sexual violence have shared their experience with us. This blog by Louise Cadman, Research Nurse Consultant at Queen Mary University of London and on the Management Committee of the My Body Back Project, addresses some of the issues that they raised.
You are not alone if you find going for smear tests particularly difficult, or even impossible, as a consequence of experiencing sexual violence. In fact, it may cause you problems in accessing many aspects of healthcare, including dental visits.
The difficulties you face having a smear could be as obvious as the physical similarities between the rape, abuse or forensic examinations and a cervical smear test. They may also be a little more subtle, such as someone having power over you and doing something to you that you do not want to happen and you feel powerless to stop. You may also believe that you do not deserve good health, especially if you used the understandable coping mechanism of freezing during the assault and do not feel that you fought back hard enough. What if you have never felt able to or wanted to disclose the sexual violence? You may be embarrassed or worried that you have signs of damage, either from the attack or from coping mechanisms such as cutting and that you may be judged or inadvertently disclose the rape. What about how your reactions to the examination will be perceived? What if you cry or dissociate – what will the smear taker think of you? You have fought so hard to keep a lid on things and function as normally as possible. Is the risk of reactivating all the thoughts and difficulties worth the benefit of having smear test? And what if you have cancer or need further tests?
Getting support
These are not unusual feelings and responses under the circumstances, but what can you do about it? Unfortunately, specialist services are few. The My Body Back Project has recognised the difficulties women face and has set up a specialist smear clinic with Barts Health. This is based on women’s suggestions received as part of a research project undertaken by the Wolfson Institute of Preventive Medicine. However, there is only one clinic currently running in London and a new clinic about to commence in Glasgow, with significant waiting lists.
You can also approach Rape Crisis for advice and support, or you can access psychological support or therapies via your GP. Another approach could be to identify a doctor or nurse with whom you feel that you can build trust and a good relationship who could carry out your smear.
Practical things that may help
There are practical things that may help:
- Book a double appointment so you have more time both before and after the smear to recover your equilibrium.
- You may want to book an initial appointment simply to get to know the person who is going to take your smear and even to discuss some of your concerns. Do not feel you must have the smear at this appointment even if it is offered, especially if you feel pressurised into saying yes.
- You could bring someone with you as support or to serve as your voice if you feel that you may lose it.
- Write a letter, or ask a trusted person to write the letter, explaining your particular difficulties with having a smear and also list some dos and don’ts for the smear taker. For example, words or phrases not to use, parts of your body not to touch, whether you prefer a soft touch or a firm touch, whether you want the door locked or unlocked, and any reactions that you may predict that you would prefer the smear taker to know about in advance.
Most importantly, please remember that having a smear should be a collaboration between you and your smear taker. You have the right to share control and tell them what you prefer and what does not suit you. You can walk away having had a smear test, or not, without feeling ashamed or that you have failed, done wrong or wasted the nurse’s time. Having a smear, like disclosure of sexual violence, is a process rather than an event and so it may take some time for you to achieve your chosen outcome of having a smear.
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We have worked with Rape Crisis and The My Body Back Project to better understand what information and support is needed for survivors of sexual violence. We now have health information for survivors of sexual violence and health professionals to support people before, during and after their cervical screening:
Categories: cervical screening let's talk