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The information on this page is aimed at professionals who want to understand barriers to cervical screening.
There is a broad and complex range of reasons why women and people with a cervix find cervical screening difficult. We call these reasons ‘barriers’ because they often factor into someone’s decision not to attend. Barriers can vary hugely between different groups or communities.
It is important to be aware there are lots of reasons patients may avoid cervical screening and that those reasons may not always be obvious – so assumptions can be unhelpful or even harmful. It can be helpful for all staff to understand this, including reception staff, nurses and doctors.
This list of barriers isn’t exhaustive, but covers some common reasons why cervical screening can be difficult for patients. Be aware that there are lots of myths surrounding cervical screening that may also create barriers to access.
Feeling embarrassed is a common obstacle to cervical screening. This can be especially true if it is someone’s first test. Any gynaecological examination or test can cause this reaction, because genitals are a part of the body that may not be shared with many others – particularly healthcare professionals.
Although cervical screening and genitals may be commonplace for you, remember that isn’t the case for your patients:
For some women and people with a cervix, cervical screening may be painful, which can be distressing. There are a number of reasons for this, including:
There are a few myths that mean some women and people with a cervix think cervical screening isn’t relevant for them, including that:
However, we know that HPV – the main cause of cervical cancer – can be dormant in the body for years and may become active again, which cervical screening can help detect.
The media also sometimes focuses on cervical cancer as a ‘young person’s’ cancer. While 30 to 45 is the peak age for being diagnosed with cervical cancer, any woman or person with a cervix can be affected at any age.
It’s natural for patients to worry about their cervical screening results. Sometimes this is exacerbated by myths, including that cervical screening is a test cervical cancer.
Anonymity, or lack of it, can be an issue in communities where there is shame about being sexually active outside of marriage. Even if a woman is married, there may be a belief in the community that only women who have had multiple partners need to go for cervical screening.
This stigma around being thought of as having sex with many people (promiscuity) means some are very frightened of being seen at their GP surgery or clinic. They may have fears about being shunned or even physically harmed as a result.
It can be difficult to get to an appointment at a time that suits. This may be even worse at the moment because of COVID-19 restrictions, if your surgery is only able to offer cervical screening at certain times.
Sometimes patients have commitments, including childcare or work, which clash with available appointments. Cervical screening will understandably not usually be as much of a priority as these other commitments, so it can easily fall off someone’s to-do list.
Women and people with a cervix who have a physical disability have told us their disability has made it more difficult for them to access or attend screening. Barriers can include:
Female genital mutilation (FGM) is when parts or all of the female genitals are deliberately cut, changed or removed. It can make any gynaecological examination, including cervical screening, painful or distressing for the patient.
If you see a patient who is affected by FGM, you should follow the guidelines in your area about recording or reporting it.
Our Public Health Engagement Coordinators have found familiarity with sample takers can be a problem in rural areas with tight-knit communities. Understandably, this can feel challenging with such an intimate test. Similarly, patients may find having screening at the same surgery as their family may feel embarrassing.
This can be an issue for a number of patients, including:
Try to make sure you and other staff are aware of those who may need a different type of support to understand and cervical access screening.