Cervical screening (the smear test), explained

Cervical screening (once called a smear test) checks the health of your cervix and helps prevent cervical cancer. It is not a test for cancer itself. It looks for a virus called HPV, which causes nearly all changes that can turn into cervical cancer, and for cell changes.

Who is invited, and when?

• In England, everyone with a cervix aged 25 to 64 is invited every 5 years. Your first invite comes a few months before you turn 25.
• You may be called back sooner if you have HPV, or if you were given a next date before screening changed from 3 years to 5.
• You will not be invited under 25, because cervical cancer is very rare and cell changes often go back to normal on their own.
• From 65 you are only invited again if a recent test was abnormal. If you are 65 or over and have never been screened, or not since 50, you can ask your GP.
• If you have had a total hysterectomy (womb and cervix removed) you do not need screening.
• Scotland, Wales and Northern Ireland run their own programmes, so check NHS Inform, Public Health Wales or nidirect for local timings.

Trans men and non-binary people with a cervix should be offered screening too. The NHS says how you are invited depends on the sex you are registered with at your GP, so if you are not invited, ask your surgery. If you are a trans woman or non-binary and do not have a cervix, you do not need screening.

What happens at the appointment?

You will undress from the waist down behind a screen and be given a sheet. The nurse or doctor gently puts in a smooth, tube-shaped tool (a speculum) and uses a soft brush to take a small sample of cells. The test itself takes less than 5 minutes and the whole appointment about 10. It does not usually hurt, but it can be uncomfortable. You are in control and can ask to stop at any time.

• Wear something you can leave on, like a skirt or long jumper.
• Bring someone with you for support, or ask for a chaperone.
• Ask for a smaller speculum, a different position (such as on your side), or to put the speculum in yourself.
• Tell the nurse if you are anxious or have had bad experiences. It helps them look after you.
• Light spotting for a few hours afterwards is normal. See a GP for heavy bleeding or bleeding that does not stop after a few hours.

What do the results mean?

• HPV not found: your risk is very low and you will be invited again in 5 years.
• Unclear result: you may be asked to repeat in 3 months. This does not mean anything is wrong.
• HPV found, no cell changes: you will be invited back in a year, and again a year later if you still have HPV. If it is still there after 2 years, you will be asked to have a colposcopy.
• HPV found with cell changes: you will be offered a colposcopy, a hospital check that looks at your cervix in more detail. Cell changes will not get worse while you wait for the appointment.

The NHS stresses that having HPV does not mean a partner has been unfaithful. HPV is very common and can stay in the body for years, so it is possible to have it even without a new partner.

Home testing

NHS England has started offering some people who have not taken up cervical screening a home HPV test they do themselves, instead of a sample taken by a nurse. Cancer Research UK reports it is aimed at some 30 to 65-year-olds. If you are overdue, ask your GP surgery whether you are eligible.