Pain Chronicles is a monthly(-ish) column from Caroline McDonagh-Darwin about coming to terms with living with a chronic illness. It will include funny stories and brutal honesty, with some thrown-in chats with her mum Shaz, and other friends too, along the way.
TW: blood, medical insensitivity, medical procedure (cervical smear). Resources are available at the bottom of this column.
I still have the knickers I wore to my first attempt at a smear test, it’s been 4 years now, and the blood hasn’t ever come out. Despite the guidance saying my risk was low on account of my HPV vaccine and my never having had sex, I still wanted that peace of mind.
A smear test – or cervical smear, a pap smear, or a cervical screening – involves using a speculum (that plastic thing that looks like a duck) inserted in the vagina to get a look at the cervix (the bit between the top of the vagina and the neck of the uterus).
A small soft brush (I know exactly how soft because the student nurse brushed a demo one on my arm before I could react) collects some cells from the cervix, and these can be examined for irregularities. Sometimes these aren’t much to worry about, but they can be pre-cancerous or even cancerous – the risk of that being higher if you have HPV.
If you have a cervix (and sometimes even if you don’t, as Rachel discovered after her hysterectomy) and are listed as female on the NHS database the NHS will call you for a smear test every 3 years if you’re 25-50, and 5 years for those 51-64. Retirees will only need them if one of their last three showed abnormal cells. (As usual, the rules are different in Scotland).
I had spoken to some of the people in my life who I knew had had smears before, and the number one piece of advice was “relax” which I did try my hardest to do. A little meditation and a podcast for distraction were what I decided on, and I did really appreciate the Where’s Wally someone had stuck on the ceiling above the exam bed. It didn’t help.
As relaxed as I could be showing my vagina to a nurse who had a history of being insensitive, my smear did NOT go well.
The number two thing my friends and mum had told me was “it shouldn’t hurt”. It did. I’d expected discomfort, I’d steeled myself for that, but it hurt. She tried a smaller speculum, got a little bit further, but my cervix was elusive.
At one point, I cried out. I think it was her final attempt and as I screwed my eyes shut I heard her voice from down by my toes: “And that’s what it feels like when you have sex for the first time.”
If I hadn’t been lying down with no knickers on, I might have punched her.
She “abandoned” the test. Shortly after I cleaned myself up, unknowingly bleeding into my green stripy knickers, she tried to reassure me.
Sex would be a totally different environment (duh!). I was very low-risk anyway (there’s that statement again). She asked if I’d ever used tampons before. I just wanted to get the f*ck out of there.
I felt like I’d failed at some sort of test. I felt like all of these people I’d spoken to were somehow better at having a cervix than I was. I felt broken.
It wasn’t until I did some research that some things fell into place. I messaged Deborah Francis-White (of The Guilty Feminist) who had spoken previously about her struggles with speculum tests. I emailed Jo’s Trust – who reiterated, again, that my risk was low but said that some people do have problems with speculum-related tests. I began to feel less like I was the wrong one. When I’ve spoken about this previously, I’ve had messages thanking me for being a voice against the “it shouldn’t hurt” crowd, because sometimes it does.
The tampon question had been the one that confused me. And then I discovered the condition vaginismus through speaking with writers and charities. Vaginismus is a non-controllable tensing of the vaginal muscles when penetration is attempted. It can happen at any point, even if penetration has been your thing before. It can be total, so you couldn’t even insert a pinky finger (although I don’t know why you’d want to) or you might manage a tampon 7 years ago and then have a very painful smear test now.
I’ve never sought an official diagnosis for vaginismus, but I do think that’s what the insensitive nurse was getting at. If I was generally having sex that involved penetration, maybe I would seek treatment. Because treatments are available, and you are not alone if you are suffering with this.
I saw a different nurse about 3 months later. She asked why I was there, given my low risk (yeah, I get it) and with a little bit of effort on her part and a little bit of crying on mine, we were successful. My cervical cells were normal and I could rest easy.
I really should think about throwing out those knickers though.
We are always told that smear tests don’t hurt, but with vaginismus, they can and I wish I’d known that at the time.
Those with learning disabilities can get support from Jo’s Trust too, they have specific resources to help.
If you are LGBT, you can get information from The LGBT Society, and the NHS has specific information for trans and non-binary people who need smear tests as well. Jo’s Trust also has a great section from trans and non-binary people on smear tests too.
If you need support after sexual violence, The My Body Back Project can help with tips and tricks and specific screening centres to help survivors. Jo’s Trust also has a section about this, in partnership with Rape Crisis.
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