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It is very important to remember that sexual violence is extremely common, with an estimated to 1 in 5 women aged between 16 and 59 affected in England and Wales.
So bear in mind that – even if they don't disclose their experiences during the screening appointment – 1 in 5 patients attending may have survived some form of sexual violence.
As a practice nurse or smear taker, there are a number of practical ways to support survivors before, during and after cervical screening.
Survivors should never feel under pressure to disclose their experiences, but it's important that they feel supported to do so if they wish. For many women, it may be helpful to be able to show a card, or write down their experience, without having to speak about it directly.
A third of those who responded to our survey said they would prefer not to have to explain their situation.
Be aware that many survivors may have already had to repeatedly explain their experiences to police, healthcare professionals, and other strangers in positions of authority. Constantly re-telling and re-living these memories can be traumatic and triggering, so smear takers can help by making any potential disclosures as straightforward as possible, and minimising how much the patient has to say.
On the other hand, some survivors may never have told anyone. How you respond can have a significant impact on future healing and engagement with services.
Try not to push people too much. If a patient indicates that they have experienced some form of sexual violence, simply acknowledging that experience and having the awareness to understand its implications can make a big difference.
Many people don’t know they can bring someone to the GP or even into the appointment for support. Let people know they can bring a friend, relative or someone else they trust so they feel as comfortable and supported as possible.
Booking a double or slightly longer than usual appointment time gives survivors space both to prepare for and debrief from the test. It's important that their cervical screening appointment shouldn't feel rushed, and that they feel as safe, supported and comfortable as possible.
Having time and space to talk about their fears and anxieties ahead of the test makes a big difference. It allows them to work through any concerns and gives you the chance to offer solutions. It also helps establish a trust relationship between the two of you.
It's really important that they feel in control of the procedure and there are things you can do to help that:
The appointment room itself should foster a sense of safety, privacy and dignity – including a private place to undress, and reassurance against any intrusions or interruptions from outside.
Allow them as much control over the screening environment as possible. Seemingly small things like asking whether the patient would prefer the door locked or unlocked, or to have a curtain pulled around the couch, can all add to the survivor's sense of safety and control. If they have someone with them, they may not want their trusted person to witness the test itself, or they might prefer to have them as close as possible throughout the appointment.
After the appointment, a survivor may need some time to process the experience. If the appointment room needs to be used, try to offer another safe, private space where they can do this. This could be a spare appointment room – it should not be a public area, such as a toilet or waiting room.