Smear test (cervical screening): how it works, results and the NHS and private routes

The NHS explains that cervical screening, which used to be called a smear test, is a test to check the health of the cervix and help prevent cervical cancer. The cervix is the opening of the womb from the vagina. The test is not a test for cancer itself. It looks for the virus, HPV, that can lead to changes in cervical cells, so that those changes can be monitored or treated before they become cancer.

The NHS describes the procedure as taking a small sample of cells from the cervix for testing. A speculum, a smooth tube-shaped tool made of plastic or metal, lets the nurse or doctor see the cervix, and a soft brush is used to collect the cells.

According to the NHS, cervical screening is for women between the ages of 25 and 64, and everyone with a cervix should be offered screening. You are invited every 5 years from age 25 to 64, and you will get your first invitation a few months before you turn 25. You may be invited sooner if you have HPV, or if you were given your next screening due date before screening changed from 3 years to 5 years.

The NHS explains why screening does not start earlier: cervical cancer is very rare under 25, and abnormal cell changes often go back to normal in younger women, so screening might lead to treatment you do not need. If you are 65 or older you will only be invited if a recent test was abnormal, and if you are 65 or over and have never been screened, or not since the age of 50, you can ask your GP for a test. You will not need screening if you have had a total hysterectomy to remove the womb and cervix.

Trans men and non-binary people with a cervix, and trans women without one, are covered in the NHS guidance: invitations depend on the sex you are registered with at your GP surgery, so speak to your surgery, sexual health service or transgender health clinic if you are not being invited and think you should be.

The NHS says invitations come through the NHS App, by text or by letter, and most screening is done in a GP surgery by a female nurse or doctor. In some parts of England you may be able to go to a local sexual health clinic or walk-in centre. If you missed your last screening you do not need to wait for an invitation.

It is best to book when you are not having a period and when you have finished treatment for unusual vaginal discharge or a pelvic infection. The NHS advises avoiding vaginal medicines, lubricants or creams for 2 days before the test because they can affect the results. If you are pregnant, contact the surgery: routine screening may be delayed until about 3 months after the baby is due, although it is safe to have during pregnancy.

You can tell the surgery if you would like a woman to do the test, a chaperone, a longer appointment, or a smaller speculum. If the test has become more difficult after the menopause, a GP can prescribe a vaginal oestrogen cream or pessary before the test, according to the NHS.

You will undress from the waist down behind a screen and be given a sheet to cover yourself. You lie back on a bed, usually with your legs bent, feet together and knees apart, though you can ask about other positions. The speculum is gently put into the vagina and opened to show the cervix, a small sample of cells is taken with a soft brush, and the speculum is removed. The NHS says the test itself should take less than 5 minutes and the whole appointment should take about 10 minutes.

Screening does not usually hurt, but some people find it uncomfortable or painful. You are in control and can ask to stop at any time. Light bleeding or spotting afterwards is possible and should stop within a few hours; see a GP if you have heavy bleeding or spotting that does not stop after a few hours.

The NHS suggests wearing something you can leave on during the test, such as a skirt or long jumper, bringing someone for support, trying breathing exercises, and asking for a smaller speculum or whether you could insert the speculum yourself.

Results are usually sent in the NHS App or by letter. If you have waited longer than expected, call your surgery. The NHS stresses that a delay does not mean anything is wrong, and that most people will have a normal result.

The NHS describes a colposcopy as a simple procedure to look at the cervix, similar to having cervical screening but done in hospital. It also says that any changes to your cells will not get worse while you are waiting for the appointment and that a positive HPV result does not mean your partner has been unfaithful, because you can have HPV even if you have not been sexually active or had a new partner for many years.

NHS cervical screening is free and invitations come to you. Some people also look at paying for a test privately, for example because they want an appointment sooner, are outside the invitation age range, or prefer a particular setting. The NHS pages read for this guide do not describe private services, so this guide does not compare providers or prices.

If you do choose a private test, ask what exactly is being tested for (HPV, cell changes or both), how and when results will be sent, and what happens if the result is abnormal. Keep the report and tell your GP surgery, so that your records and invitations stay in step and any follow-up is clear. A private result does not replace being screened on the NHS programme unless your GP tells you otherwise.

Whichever route you use, symptoms should never wait for a screening date. The NHS says to see a GP if you have bleeding between periods, during or after sex, or after the menopause, or unusual vaginal discharge.

It is your choice. The NHS says cervical screening is one of the best ways to protect yourself from cervical cancer, but if you do not want to be invited you can opt out by writing to your GP or completing an informed choice form on the Cervical Screening Administration Service website, and you can ask to be put back on the list at any time.

Cervical screening is organised separately in Scotland, Wales and Northern Ireland, and the NHS signposts to NHS Inform, Public Health Wales and nidirect for those nations.