Content Warning: This article contains discussions around sexual violence, PTSD, and medical trauma.
I’ve long known that as the owner of a cervix, it’s important to go for my cervical screening. My mother had an abnormal smear when I was a child, and has always been an advocate for me getting the health treatments I’m entitled to.
For many people who have vaginas, their first experience with a speculum, a device used to gain access to the cervix via being inserted into the vagina, will be their first smear test. Mine, however, was in the aftermath of a sexual assault, undergoing a medical examination to gather evidence of my abuse.
Smear tests are a routine screening, offered by the NHS to people with uteruses aged between twenty five and sixty four, every three to five years. A sample of cells is taken in order to test the health of your cervix, thus preventing the development of several forms of gynecological cancer.
In September 2020, five months before my 25th birthday, I received my first screening invitation. I booked in almost straight away, but for many survivors of sexual assault, the decision to attend a smear test is not an easy one.
Alix Fox, a journalist and broadcaster specialising in sexual wellbeing, explains why this is: “For survivors of sexual trauma, smear tests can be very painful – not just emotionally, but physically, for example, if they’re coping with a condition such as vaginismus as a result”, she says, adding “Everyone deserves good gynaecological health, and to be optimally protected against the development of issues like cervical cancer, no matter their gender, sexuality, heritage, current situation or past experience.
“Many awareness campaigns and much well-meaning public discourse about cervical smears concentrates on how they’re “simple, quick, painless” and how “the doctors have seen it all before”, in an effort to make the majority of people feel more relaxed, and to encourage them to attend these vital check-ups. But lots of abuse survivors feel alienated by this framing. I’ve seen talk in spaces like Twitter that’s naively and deeply unhelpfully shaming of people who struggle to attend smear tests. We need to recognise that there are valid reasons why some patients find attending justifiably hard, and work to cater to and comfort them, not vilify.”
As I sat in my GP Practice’s waiting room on the day of my appointment in late October, I thought about the crisp autumn breeze and blue sky outside: “What a lovely day it is to go and have a stranger take cells from my vagina”, I jovially texted my boyfriend. I sat scrolling through social media, my glasses fogging above my mask, until the nurse called my name. When she did, I jumped violently, throwing my phone to the floor.
After surviving sexual violence, I was left with PTSD. This means that even when I’m not consciously remembering what happened to me and other events associated with it – my body is, causing me to be tense and jumpy, amongst other things. I spoke to Olivia James, The Harley Street Coach, who specialises in treating trauma and PTSD, about why this is.
After a traumatic event, the human brain will always be ready go to into “freak-out mode, just to be on the safe side”, she says, explaining why survivors of sexual assault often experience tenseness and panic when faced with situations which have the potential to be distressing. It’s a process known as neuroception that creates a trauma loop in our brain, and leads us to fear things even when we know that logically there is nothing to fear.
It is natural that someone who’s suffered intimate abuse will be nervous about attending a smear test. Olivia says “most of the time, it isn’t conscious, it isn’t a rational thing”. Anything can form a trigger, from having to lie back, to having someone tell you to relax.
My appointment went without a hitch (and no abnormal cells were found), but some survivors aren’t as lucky. Alix keenly states: “survivors may justifiably worry that the local practice nurse they visit for their smear won’t have seen someone before who blacks out because the sound of the curtain being drawn around a hospital bed is so frighteningly triggering for them”.
Claire Hedges, a GP practice nurse from Sheffield, tells me that after 11 years of conducting cervical screenings for the NHS, she’s gotten good at recognising when a patient is in distress, from their body language or medical notes. She’s treated survivors of assault, FGM, and birth trauma, and does her best to make it easy for them every time.
Before the screening, she’ll talk through the process with them, and will explain that they’re entitled to have a chaperone with them on the other side of the curtain if needed. Some patients like to listen to music on their phone, or hold a speculum first and get to know the equipment. You can even make an initial appointment just to discuss everything, and go ahead with the screening another day.
It will always be a woman who conducts the appointment, and it’s your right to say no to any extra personnel such as trainee nurses being present too. Before the swab is taken, you’ll get undressed and place a cover over yourself, so you don’t have to see what’s going on.
Olivia and Alix also offer helpful tips and point to valuable resources:
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Olivia is a certified advanced IEMT (Integral Eye Movement Therapy) Practitioner, and recommends this treatment for survivors of sexual assault who stuggle in medical settings or suffer from PTSD. IEMT neutralises the connections between trauma loops in your brain, but is a content-free therapy, meaning that you do not have to relive the trauma whilst treating it. Another therapy she offers is called Tension and Trauma Releasing Exercises (TRE), a form of body-based therapy designed to release deep muscular patterns of stress, tension and trauma. You can find a TRE provider near you here, and IEMT practitioners here.
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Alternatively, a self-use technique that Olivia recommends is called Meridian Tapping, or EFT. It’s recommended by NICE for sufferers of PTSD, and Olivia even tells me of an anesthetist who uses it to calm his patients before putting them under anaesthetic for operations. You can use tapping not only to desensitize yourself to triggers before an appointment, but also to send calming signals to your brain during your smear test or other triggering experiences.
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Alix, who is also ambassador for The Eve Appeal: a charity dedicated to raising awareness of the signs and symptoms of the five types of gynaecological cancer, recommends the charity’s Ask Eve service, which is operated by nurses qualified to answer your questions and give trauma-informed advice. Call 0808 802 0019 (free from UK landlines and mobiles and does not show on itemised bills).
She also says there’s nothing stopping you from bringing your own lube to your appointment, and inserting the speculum yourself, if this makes you more comfortable.
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Alix adds: “You can also access The VulvalPainSociety.org’s free downloadable leaflet, Smears Without Tears, or look into attending a Tips and Tricks Workshop run by the My Body Back Project, who support women who have experienced rape or sexual assault to love and care for their bodies again, and have a number of other amazing resources on offer for survivors too.”
Finally, Claire reassures me that the patient is completely in control of the procedure – they can ask to stop at any point.
Remember, it’s your body and your choice, but cervical screening saves lives, and it’s important that survivors of sexual assault feel comfortable to get the medical care they deserve.
