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Practical ways to support survivors of sexual violence through cervical screening

We created this information in partnership with Rape Crisis.

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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.  

Read about offering emotional support to survivors >

"The procedure may be 'routine' for [the smear taker], but for some people it is anything but routine and can be terrifying, no matter what happens."

-       A survey respondent and survivor 

Offer alternative methods of disclosure

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. 

“Telling someone you don’t know one of your deepest and most difficult secrets is a complete leap of faith and is only done out of necessity. Survivors only disclose because they know they have to in order to get the treatment they need. They are likely to be intensely anxious and how professionals react will have an immense effect on whether they attend future appointments.”

-         Rosie, a survivor 

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.

Tell them they can bring someone they trust

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.

Allow them to book a longer appointment

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.

Make time for them

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.

Give them control

It's really important that they feel in control of the procedure and there are things you can do to help that:

  • Avoid starting the test unexpectedly. Tell them when it is about to begin and get consent before proceeding.
  • Explore whether there are alternative positions in which the patient could lay or sit.
  • Check whether they want a step-by-step explanation of the test and what you are doing, or whether they would find distraction more helpful. If they choose the former, make sure they are prepared and comfortable before each step. Tell them what you are about to do and give them time to acknowledge it, rather than explaining something as you do it.
  • Make sure you are aware of any areas they would prefer not to be touched.
  • Ask about any words that may be triggering, and agree more neutral alternatives to use instead.
  • It might be helpful to agree a word or gesture they can use at any point during the test to indicate that they need to pause or stop.
  • Check whether they would feel more comfortable inserting the speculum themselves.

“Telling me to relax is one of the worst parts about a smear. It never helps and, in fact, every time it happens makes it more difficult.”

-         A survey respondent and survivor  

Give them privacy

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.

Date last updated: 
25 Jan 2019
Date due for review: 
30 Jul 2021
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