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This is information is for primary and secondary care professionals.
Language is important – it can help your patients feel at ease and reassured, or panicked and uncomfortable. There are many medical words used during appointments that can make it hard for patients to understand. It can also be intimidating, and some patients might feel embarrassed about asking questions. Some patients might have low health literacy, or English might not be their first language, meaning it can be even more difficult.
This page is split into two sections:
AVOID – "cytology"
TRY – "smear test or cervical screening"
Cervical screening is the term used on official literature, such as invitations, and it is also referred to as a smear test, pap test or pap smear. Try to avoid using words for the methods of testing the sample, such as cytology, which can be confusing and new to patients. Instead, you can explain that all the words or phrases a patient might have heard mean the same thing. It is a test to check the health of the cervix and prevent cervical cancer from developing.
AVOID – "pre-cancerous / abnormal cells / dyskaryosis / CIN / CGIN"
TRY – "cervical cell changes"
There are a few different words or phrases that are used to mean cervical cell changes. Our community told us that this was confusing and, in some cases, they felt negatively labelled because of them – for example, the use of ‘abnormal’. Their preference was that ‘cell changes’ was used as the general term, with more medical terms, such as dyskaryosis, only used along with a clear explanation.
We suggest avoiding ‘pre-cancerous’ completely, as it can inaccurately imply that all cell changes will develop into cancer. It can also sound scary for patients and naturally cause alarm, as the focus lands on the ‘cancer’ element (not the ‘pre’).
AVOID – "sexually transmitted infection / STI"
TRY – "passed on through skin-to-skin contact"
We know that many people describe HPV as an STI, but it can create unintended stigma, fear and confusion. At Jo’s, we don’t classify HPV as an STI. With HPV primary screening now introduced across most of the UK, you will probably be asked about HPV frequently and more people will be hearing about it. You can simply describe the virus as being ‘passed on through skin-to-skin contact in the genital area’.
AVOID – "husband / boyfriend" (automatically)
TRY – "partner"
Sometimes everyone falls into a rhythm with words or phrasing, which can lead to unintentional assumptions, especially if you are seeing a lot patients back-to-back. Remember that every patient is an individual and it’s best to use neutral language about partners and, if it comes up, their sex life. If you find out they have a wife, boyfriend, or something else, you can then reflect their language choice.
AVOID – "a smear test is quick and easy"
TRY – "do you have any questions or worries?"
Cervical screening is often described as quick or easy when, for many patients, it can be the opposite. This can be for many reasons, including difficulty locating the cervix and needing more time to process the test. If the test is not straightforward but the patient has been told it should be, they may believe something is wrong with them and feel guilty or ashamed. Not understanding that the test isn’t always easy can also impact on the patient’s ability to make an informed decision.
AVOID – "it won’t be painful"
TRY – "we will make it as comfortable as possible for you"
In most cases, people say cervical screening is uncomfortable – however, there are many reasons why someone might find a smear test painful. Conditions, such as vaginismus, dryness, anxiety, a tilted womb, FGM and those that have experienced sexual violence can make the test difficult.
If someone doesn’t speak English as a first language, it is important to use a translator so you can ensure you get informed consent from the patient. However, it is still important to use simple words and avoid too many medical words because these may not translate in the same way.
Many people in the UK have low literacy – in fact, figures suggest over 7 million have ‘very poor literacy skills’. This means they may struggle to read or make sense of information.
It is important not to confuse or conflate patients who don’t have English as a first language and patients who have low literacy. Sometimes there will be crossover but other times, for example, someone who doesn’t speak or read English will have a high literacy but can’t access information in the format or language they need.
WHEN YOU SAY – "cervix"
EXPLAIN IT WITH – "inside the vagina / where a baby comes from"
Many people don’t know what or where the cervix is. Sometimes patients turn up to the appointment not knowing what to expect and are shocked that it is an intimate test.
It is important to use simple terminology when describing this area, so they understand where the test will be. Saying ‘inside the vagina’ explains that it isn’t a part of the body they can see.
You could also use visual aids as well as simple language and a translator. This may be:
WHEN YOU SAY – "vagina"
EXPLAIN IT WITH – "a woman’s intimate area / where a baby comes from"
You may assume that patients will know what and where the vagina is, but this isn’t always the case. Saying ‘a woman’s intimate area’ or even ‘private parts’ is a clearer way of verbalising the area you mean. You could also use visual aids as well as simple language and a translator. This may be a picture of the female reproduction system or putting your hands over your lower stomach to show where the test will be.
WHEN YOU SAY – "HPV"
EXPLAIN IT WITH – "a virus that can affect someone’s/a woman’s intimate area"
This may be the first time a patient has heard of HPV, so it is important to address any confusion or myths the patient might believe. We have written a suggestion for a simple explanation below, but remember you will need to adapt it to your patient.
“HPV is a really common virus. We can pick it up the first time we have any touching in the genital area [gesture to your lower body].
Almost everyone will get this virus at some point in their life. It can live inside or infect the vagina and cervix.
Most people can fight off the virus. But sometimes you might have a tricky strain of the virus that you cannot get rid of. This can cause problems inside the cervix/the vagina.”
WHEN YOU SAY – "the smear test / cervical screening"
EXPLAIN IT WITH – "an intimate health test to prevent future problems/cancer"
It is important to explain what you mean by a smear test. We have a video that you could show the patient, which is available in English and has been translated into several different languages. If you can’t use the video, here is a suggestion for how you could explain:
“A smear test is a test for a virus. It can check to see if the virus has caused any changes [inside the vagina/cervix]. This test is useful because it can prevent cervical cancer.
A nurse or a doctor will do the test for you. You can ask for a female nurse if you prefer.
You should get the results within 4 weeks, but it sometimes it can be longer. If we find any changes, we can usually take care of you so it doesn’t turn into cancer.
The test is free on the NHS, but you have to be registered at a GP surgery. You will get a letter from your GP inviting you for the test every 3 or 5 years. You can also call your GP and ask if you are due.
The test will stay between you and your nurse.”
WHEN YOU SAY – "signs and symptoms of cervical cancer"
EXPLAIN IT WITH – "what to look out for"
It is important to let all patients know about the symptoms of cervical cancer that they need to be aware of. Make sure they understand they need to look out for these things themselves and tell someone if they notice anything unusual.
“It is rare, but sometimes cervical cancer can develop. The earlier we find it, the easier it is to treat.
You should look out for any bleeding outside of your monthly period, after sex, or after you have gone through menopause, which is when you no longer have monthly periods.
You should also look out for any changes to the white or clear liquid from your vagina, which is called discharge, including if it changes colour or starts to smell bad.
You should also look out for sex that is painful and pain between the hips or in the lower back.
If you have any of these symptoms, call your doctor as soon as possible. These symptoms are usually something less serious than cervical cancer, but it is important to get checked.”
- Feedback from a Public Health Engagement session