The Cervical smear is one of the best tools to help defend against cervical cancer (along with the HPV vaccine).
The purpose of cervical smear test is to detect changes on the cervix (often invisible) that may develop into cancer.
This allows for the early detection of abnormalities so that they can be treated on time to prevent cancer from developing, and to enable us to cure the cancer if it has already developed by its detection at an early stage.
Time for test results
Cost of private cervical smear
£150 (£100 if taken with another test)
How does the process work?
Step 1: Preparing for your appointment
Avoid booking on your period
An examination to take a cervical smear should be avoided during your menstrual period. It is as much for aesthetic reasons as to avoid samples contaminated by blood.
Help ensure a good quality sample
We want the cervical smear to be rich in cellular material for analysis. This is why it is recommended to avoid sexual intercourse, douching, or use of intra-vaginal preparations for 2 days before your appointment, as these may wash away or obscure the abnormal cells.
Step 2: begin with the consultation
We will begin by discussing your medical, sexual and general history with you, as well as any symptoms, questions or concerns you may have.
This is also a good time to let us know if:
- You have had a bad experience with previous smears or speculum examinations
- There has been a difficulty in locating your cervix
- You have a preference for a small sized speculum
Step 3: Taking the cervical sample
After ensuring you are comfortable and ready for the sample to be taken, they will ask you do the following in privacy to prepare for the examination:
- Remove your clothes on the lower half of your body
- Lay upon the bed with your knees bent and apart
- Cover your lower abdomen and top of your legs with a paper towel provided
Your clinician will then place a speculum inside your vagina to open it up slightly (we have 5 different sizes of speculum to ensure as comfortable an experience as possible for you).
Using a soft brush, they will then take a small sample of cells from your cervix which will be sent to be processed. The test itself should only take between 1-2 minutes.
Sometimes your clinician may ask you to put your hands behind your back to tilt the uterus forwards for easier and better visibility of the cervix.
We may, if you wish, take samples for an STI screen during the examination (we will let you know if it is clinically needed during your consultation). The specimen for cervical smear is always taken before samples for STI screen.
Step 5: After your appointment
You can resume your day-to-day life immediately after your smear. Please note that slight spotting immediately after the smear test is common, and should settle in a couple of days.
Results can take 2-3 weeks to return and we will discuss anything you may need to do (or not) in this time.
Rarely the laboratory may request for another sample before issuing the results. Such a request is not a reason to be concerned about.
Step 6: Discuss your results
Abnormal cells detected
This does not mean that you have cancer. You will be referred for a colposcopy to investigate the cells further.
Abnormal cells not detected
No abnormalities found. If you have had a positive High-Risk HPV test, your clinician will ask you to come back for another screening within 1 year to see if any abnormalities have developed, or to see if your immune system has cleared the virus.
When should I have a cervical smear?
The current recommendation in the UK is for women to have their first smear on turning 25, and then a smear every 3 years until the age of 49, and a smear every 5 years until the age of 64 years.
As such, most women will have 12 smears in their lifetime (see table below).
However, the recommendations change based on emerging evidence, adoption of testing technology and the continual assessment of effectiveness of HPV vaccination.
Why are there so many different names for this test?
The technique of detecting abnormalities by taking cells from the cervix was first invented by Dr George Papanicolaou. It is often called the Papanicolaou test, Pap smear, Smear test or simply Smear.
In clinical settings it is often called a Cervical Cytology based on the fact that it was the earliest clinical application of principles of cytology to study a disease and that it assesses cells in the cervix.
What tests can be done on my cervical smear?
Cervical smear (or more appropriately ‘Liquid Based Cytology’) is the procedure to collect the cervical material to study.
Once collected, the sample will be sent to the laboratory for one or more of the following tests after a discussion with you:
(1) Traditional cervical smear
Traditional ‘cervical smear’ test looks for evidence of abnormal changes, or potentially abnormal changes to the cells, that have already occurred. The degree of abnormality observed is classified as mild, moderate or severe changes.
This test does not look for underlying HPV infection. This is not an appropriate test if there are visible abnormal changes on the cervix, which warrants a colposcopy and possible biopsy.
This will be the most appropriate test for you:
- If you have had HR-HPV detected on your recent smear test
- If you have had a negative HR-HPV test and want an additional reassurance
- If you have on going genital symptoms attributed to cervicitis, and other STI tests have been negative
(2) High risk HPV test
This detects presence of one or more types of high-risk strains of HPV present in your cervix which can cause abnormal changes in the cervical cells which can progress to form cancer of cervix. Most advanced cervical screening programmes in the world, including NHS, have adopted this as their primary screening test.
(3) Low Risk HPV screen
It is possible to screen for Low Risk types of HPV from the same sample.
Can I have a smear test instead of a HPV test?
Whilst you can have a cervical smear test on its own, we would highly recommend having a High-Risk HPV test in addition to this, especially if abnormalities are detected. High-risk HPV types 16 and 18 causes approx. 70% of cervical cancer cases.
How has cervical screening changed, and why is this?
Previously, women would have a cervical smear as their primary test. If an abnormality was detected, they would then have a HPV test to detect the underlying infection.
Because most abnormalities in the cervix occur because of the HPV infection, and 90% of cervical cancer cases are caused by high-risk HPV, recent changes have been made to the screening process.
Now, women are tested for HPV first, and if this is detected, the lab will perform a cytology on the sample to detect any cell abnormalities which may have developed from HPV infection. This allows women to receive a quicker diagnosis, as well as quicker intervention if necessary.
Who can get the vaccine?
The HPV vaccine is routinely offered to girls and boys aged 12-13 in secondary school, as a preventative measure for those who have not yet been exposed to high-risk types of HPV. It is free on the NHS for those up to the age of 25.
It is also routinely offered to men under 45 who have sex with other men.
Anyone above the age of 18 can receive the HPV vaccine from our clinic, regardless of age, gender or orientation.
Why can’t you have a smear test under the age of 25?
The age limit for UK cervical screening is a highly debated topic, with many calling for the age limit to be lowered. Guidelines advise waiting until the age of 25 before having your first smear test because cervical cancer is very rare in women under 25. On average, there are 0 deaths from cervical cancer in women below this age.
Abnormal cells can develop in the cervix in women under 25, but more often than not, these cells spontaneously resolve themselves without requiring any treatment. Inviting women aged 25 and over is thought to prevent unnecessary and invasive treatments and procedures.
Do I still need a cervical smear test if I have had the HPV vaccination?
Yes, it’s important to continue to attend regular cervical screenings, as the HPV vaccination does not protect against all types of HPV, and HPV does not cause all types of abnormalities in cervix.
Can I see a female clinician?
Of course, yes. If you would prefer to see a female clinician to take your smear, please let us know at the time of booking.
An aside on the history of cervical smears
In its original form, the sample taken from the cervix was smeared on a glass slide as soon as it was taken before being sent to the laboratory, and hence called ‘cervical smear’ or a ‘smear test’.
Preparing good quality slides required specialist training and reading them manually in the laboratory was a laborious, time consuming process with higher rates of inaccuracy in the results.
That is why you will not be seeing slides being prepared after a smear has been taken these days. Instead the sample is dipped into a liquid container to be studied by automatic analysers in the laboratory, and appropriately called Liquid Based Cytology (LBC).
So although we may still call it cervical smear out of tradition, what we will be doing is Liquid Based Cytology!
Page reviewed by Dr. Manoj Malu (Clinical Director)
Last reviewed date: 2 January 2021
Next review due: 2 January 2021
Whilst this content is written and reviewed by sexual health specialists, it is for general guidance only. It is not intended to replace the advice of your clinician.
References & Further Reading
- NHS England: Primary High Risk HPV Testing with Cytology Triage
- Gov UK: Cervical Screening – Helping you decide
- British Journal of Cancer: Benefits and harms of cervical screening from age 20 years compared with screening from age 25 years
- Jo’s Trust: Cervical Screening Aged 24 and Under.
- Public Health England: What is the right age for cervical screening? – Public health matters
- British Journal of Cancer: Performance of cytology and human papillomavirus testing in relation to the menstrual cycle