All
    Colposcopy
    HPV
    HPV Vaccination
    Cervical Screening
    Cervix
    Cervical Cell Change

    Colposcopy FAQs

    What is colposcopy?

    This is a test to take a closer look at the vagina and cervix. A colposcopy uses lights and a microscope to examine the cervix from outside your body. It is performed to detect and treat pre-cancerous cell changes to prevent the development of cervical cancer 23,24.

    During the test a small sample of cells may be taken (a biopsy) that will be sent for further testing 23,24.

    Why have I been invited to colposcopy?

    There are several reasons why you may be invited for colposcopy. They include:

    • If abnormal cells (cell changes) are found during your cervical screening. It is important to note that cell changes are not cancer, but there is a risk that these abnormal cells could turn into cervical cancer if left untreated 24.
    • If you have an HPV infection that hasn’t gone away 24.
    • Having had several cervical screening tests that could not give a result can also mean you are invited 24.
    • If the nurse who carried out your cervical screening appointment noticed your cervix did not look as healthy as it should 24.
    • You have symptoms such as bleeding between periods, during or after sex, after the menopause or changes to vaginal discharge.

    It is important to remember that most people who have colposcopy do not have cervical cancer 24.

    If you are in doubt and have questions, speak with your healthcare provider.

    You will also have a colposcopy appointment if you have had a biopsy that showed you needed treatment or if you are being monitored for CIN 2.

    Cervix FAQs

    Is my cervix normal?

    Everybody’s bodies are different and that includes cervixes. It is possible to have a lumpy or tilted cervix that is identified during a pelvic exam with your GP/healthcare provider or nurse.

    This can sound worrying but it is common.

    Lumps are usually small growths called Nabothian cysts or cervical polyps. They do not cause harm.

    A tilted cervix means a cervix that leans backwards. This can make it harder to see during cervical screening. In this case your nurse may ask you to lie in a different position.

    If you are worried about lumps or a tilted cervix you can speak with your GP/healthcare provider or even the nurse during cervical screening.

    Can you be a female born without a cervix?

    There is a rare condition called Mayer Rokitansky Küster Hauser (MRKH) syndrome. This affects the development of the female reproductive system. People with MRKH syndrome may be born without a cervix, vagina or womb.

    Contact your GP/healthcare provider if you are worried or have questions.

    Can you be born with more than one cervix?

    A rare condition called Müllerian duct anomalies affects the development of the female reproductive system. People with this condition may be born with 2 wombs and cervixes.

    If you are worried or have any questions about Müllerian duct anomalies it is best to speak with your GP.

    Cervical Cell Changes FAQs

    Will my cell changes develop into cancer?

    With the right monitoring or treatment the risk of cell changes developing into cervical cancer is low.

    What are pre-cancerous cells?

    There are many terms used by different people to describe cell changes. Pre-cancerous cells is another term used it does not mean the cells will turn into cancer.

    The term pre-cancerous can be misleading and cause extra and needless worry so we try to avoid using it in our information.

    What does dyskaryosis mean?

    Dyskaryosis is a change to cells. The changes are found during cervical screening and then the descriptions of CIN CGIN etc go on to describe the grade of the changes. These grades can only be determined during colposcopy 29.

    What are the risk factors for cervical cancer?

    In the UK less than 1 in 100 women and people with a cervix will develop cervical cancer in their lifetime 30.

    Cervical cancer is usually caused by high-risk HPV infections (in 99.8% of all cervical cancer cases) 6.

    Not attending cervical screening regularly is a big risk factor for developing cervical cancer as high-risk HPV infections can be left undetected. Cervical screening can detect high-risk HPV infections before they cause cancer if had regularly. Detecting cell changes early means they can be treated or monitored as needed 7.

    Other risk factors include:

    • HPV infection and therefore risk factors associated with HPV infection
    • Being under 45 years of age 31
    • Immunosuppressive disorders including HIV and AIDS 31
    • Having children at a young age 31
    • Having multiple children 31

    What are the symptoms of Cervical Cancer?

    The symptoms of cervical cancer include:

    • Vaginal bleeding that is unusual for you including bleeding between periods, during sex or after the menopause 22
    • Changes to vaginal discharge 22
    • Pain or discomfort during sex 22
    • Lower back pain that cannot be explained, between your hip bones and lower tummy 22

    These symptoms can happen for other reasons but should you experience any of them it is best to seek the advice of your GP or healthcare professional.

    What tests are there for cervical cancer?

    If cell changes are seen in your cervical screening then you will usually be referred to colposcopy.

    Don’t forget it can take several weeks to get your results and not hearing back does not mean something is definitely wrong.

    Tests for cervical cancer help determine:

    • If you have cervical cancer
    • What type of cervical cancer you have
    • The stage of your cancer – the size of it and if it has spread
    • The grade of your cancer – what it looks like and how it might behave
    • If treatment you have had has worked

    Tests you may have include:

    You will be told by your healthcare provider how long you will have to wait for your results. If you have any questions it is good to ask them at the time of your tests.

    I’ve been diagnosed with cervical cancer, who can I talk to?

    Getting a cervical cancer diagnosis is likely to be a life changing event. We understand that you will want and need support at this time. We encourage anyone who wants to reach out to contact Jo’s Cervical Cancer Trust on 0808 802 8000.

    What is grading and staging of cervical cancer?

    The grade of cervical cancer describes how quickly the cancer might grow or spread. It shows how different the cancer cells are compared to healthy cells and how they may behave in the body.

    Grading is done by a pathologist or histopathologist. They look at your cells under a microscope and give them a number between 1 and 3:

    • 1 means the cells look a lot like healthy cells and they aren’t growing quickly
    • 2 means the cells are different in appearance to healthy cells and they are growing faster
    • 3 means the cells look abnormal and they may grow and spread quickly

    The stage describes the size and how far it has spread 33.

    There is a system used to describe the stage of cervical cancer called the FIGO system 34. This was updated in 2018 so if you were diagnosed before this your stage may be different to that described here. Speak with your specialist if you are worried.

    Cervical cancer is staged from 1 to 4:

    • Stage 1 means the cancer is only in the cervix and hasn’t spread to the surrounding tissue, organs or anywhere else in the body.
    • Stage 1A is when the cancer is only small and can only be seen with a microscope.
      • Stage 1A1 means the cancer is less than 3mm deep into the cervix
      • Stage 1A2 means the cancer is between 3-5mm deep into the cervix
    • Stage 1B is when the cancer is slightly bigger and can be seen without a microscope.
      • Stage 1B1 means the cancer is 5mm or more deep into the cervix but it is less than 2cm wide
      • Stage 1B2 means the cancer is 2cm or more deep into the cervix and it is less than 4cm wide
      • Stage 1B3 means the cancer is 4cm or more wide
    • Stage 2 means the cancer has spread a small distance outside the cervix.
      • Stage 2A is when the cancer has spread into the top of the vagina.
        • Stage 2A1 means the cancer is less than 4cm wide.
        • Stage 2A2 means the cancer is 4cm or more wide.
      • Stage 2B is when the cancer has spread into the top of the vagina and into the tissue.
    • Stage 3 means the cancer has spread to the lower part of the vagina, the pelvic wall, or the lymph nodes. It may also be causing the kidneys to swell or stop working.
      • Stage 3A is when the cancer has spread into the lower part of the vagina but not the pelvic wall.
      • Stage 3B is when the cancer has spread into the pelvic wall or has caused the kidneys to swell or stop working.
      • Stage 3C is when the cancer has spread to the lymph nodes.
        • Stage 3C1 means the cancer has only spread to the lymph nodes in the pelvis.
        • Stage 3C2 means the cancer has spread to lymph nodes above the pelvic area.
    • Stage 4 is when the cancer has spread to the bladder, rectum, or further areas of the body.
      • Stage 4A means the cancer has spread to parts of the body close to the cervix, such as the bladder or rectum.
      • Stage 4B means the cancer has spread to parts of the body further from the cervix, such as the lungs, liver or bones.

    These stages can sometimes be grouped into terms such as Early stage (1A to 1B1), locally advanced (1B2 to 4A), or advanced/metastatic (4B).

    HPV Vaccination FAQs

    What type of vaccine will I/my child get?

    There are 3 types of vaccine available in the UK. Up until recently Gardasil was used in the NHS vaccination programme. However, this is being changed to Gardasil 9 11.

    Gardasil – protects against high-risk HPV types 16 and 18, as well as low-risk HPV types 6 and 11.

    Gardasil 9 – protects against high-risk HPV types 16, 18 plus 31, 33, 45, 52, and 58 as well as the low-risk types 6 and 11.

    The third type of vaccine is Cervarix. This vaccine was given prior to 2012 and now is only available privately. This vaccine protects against the high-risk types 16 and 18 12.

    How does the vaccine work?

    The HPV vaccines contain viral-like proteins that imitate the different types of HPV. This does not mean they are live viruses; however, they do still cause the immune system to respond. The immune system senses the viral-like particles and creates antibodies. These antibodies will then attach to a real viral particle if you get infected and stop it infecting cells.

    Why is the vaccine given at such a young age?

    Due to the way HPV spreads, it is best to give the vaccine to children at a young age, before they become sexually active 5.

    In 2007 researchers from the Health Protection Agency found that by the age of 16, 10% of girls in England had become infected with one or more types of HPV 14.

    Getting the vaccine at a young age will ensure children are protected during their teenage years and beyond.

    I/My child missed their first dose of the vaccine, what do I do?

    In England, if you’re eligible and miss your first dose you can get the vaccine through the NHS until the age of 25 as long as you’re born after the 1st September 1991 (girls) 2006 (boys).

    Contact your GP surgery or healthcare provider to make an appointment.

    Can gay, bisexual and transgender people get the HPV vaccination?

    Gay, bisexual and men who have sex with men (MSM) are eligible for free HPV vaccination on the NHS when they visit a specialist sexual health services or HIV clinic.

    Trans women (people who were assigned male at birth) are eligible if their risk of getting HPV is similar to the risk of MSM.

    Trans men (people who were assigned female at birth) are eligible if they have sex with other men and are aged 45 and under. If they have completed the HPV vaccination programme for girls previously, no further doses are required.

    A leaflet is available from the NHS for MSM regarding HPV vaccination.

    How is the HPV vaccine given?

    The vaccine is given in 2 doses as injections in the upper arm, spaced at least 6 months apart.

    It is important to have both doses of the vaccine 11.

    How long does the vaccine protect for?

    Studies have shown that the vaccine provides protection for at least 10 years. It is expected that protection lasts longer.

    It is important for women to still attend regular cervical screening once they reach 25 years of age, even if they are vaccinated. This is because the vaccines do not provide protection against all types of HPV 11.

    How effective is the HPV vaccine?

    Vaccines can only be given if tests, called clinical trials show they are safe and effective.

    The HPV vaccine has been used in many countries around the world including Australia, Canada, the UK, and most of Western Europe.

    A Scottish study found 89% reduction in severe cervical abnormalities in vaccinated women 13. There has also been a large drop in infections rates of HPV16 and HPV18 as well as genital warts in the younger population 12.

    Can the HPV vaccine cause long-term (chronic) conditions?

    There have been many clinical trials and studies looking at the safety and links between the HPV vaccine and other conditions (including chronic fatigue syndrome/ME, complex regional pain syndrome, postural tachycardia syndrome, premature ovarian failure, Guillain-Barre syndrome). These have found no increase in cases among those who have been vaccinated against HPV compared to those who have not.

    How safe is the HPV vaccination?

    The Medicines and Healthcare products Regulatory Agency (MHRA) monitors the safety of medicines and vaccines in the UK.

    More information about the NHS vaccination programme and the HPV vaccine can be found in this leaflet.

    Cervical Screening FAQs

    Who is invited for cervical screening?

    If you have a cervix and are registered with a GP surgery as female, then you will be invited by letter, for cervical screening every 3 to 5 years (depending on your age) from 25-64 years old 7. In England, Scotland and Wales primary HPV screening is performed on your sample taken at the cervical screening appointment.

    It is also possible to be invited every year or you may be sent straight to colposcopy for more tests.

    If you are not registered as female at their GP surgery but have a cervix, you should speak with their GP about cervical screening.

    If you are not registered at a GP surgery, you can do so on the NHS website.

    If you do not have a cervix there is no test available on the NHS for HPV.

    You do not need to attend cervical screening if you have had a total hysterectomy to remove all your womb and cervix. However, if you have had a sub-hysterectomy, you may still need to attend. Speak with your healthcare provider or visit the NHS website for more information.

    What if I need to cancel my appointment?

    If you have made an appointment for cervical screening it is important that you cancel, should you no longer be able to attend. Providing a reason for cancelling is optional but it is important to remember healthcare professionals are always willing to support patients in any way possible, so being honest and frank about any concerns will be beneficial.

    What happens during my cervical screening (smear test) appointment?

    A video on how cervical screening is performed in your appointment can be found on the NHS website.

    You will be given a private space to undress from the waist down. If you are wearing a dress or skirt, you can leave this on and just remove your underwear.

    The nurse (or sample taker) will ask you to lie down on the examination bed and they will give you a new, clean covering for the lower half of your body. You should lie back with your legs up and bent, placing your ankles together but knees apart. Sometimes you may be asked to lie on your left side with your knees bent. This position can make visualising the cervix easier for the nurse.

    The nurse will begin the procedure by placing a new, clean instrument called a speculum into your vagina. A speculum is a plastic type of tube with a rounded end. For some people the insertion of the speculum is sometimes uncomfortable. Once inside, the nurse will open the speculum so they can view your cervix.

    The nurse will take a sample of cells from your cervix. They do this using a small, soft brush. This should not feel painful, just a little strange.

    The brush is then placed into a small tube of liquid that preserves the cells whilst they are sent to the lab for testing.

    That is the end of the test! The speculum will be removed, and you will be asked to redress. The nurse will then explain how you will receive your results.

    Although the test only takes a few minutes itself you should plan to spend around 30 minutes at your GP surgery.

    What does the lab look for?

    The cervical screening appointment itself has remained the same for patients, however in England, since 2019 the test performed on the sample taken during the appointment changed to primary HPV screening 7.

    When will I get my results?

    You should receive your cervical screening results in the post within 4 weeks of your test.

    It is possible that your results may be delayed. This has especially been the case during the coronavirus pandemic where labs have been asked to process coronavirus tests.

    Waiting for results can be worrying and make you feel anxious. Speak with your GP/healthcare provider if you are worried. Alternatively, you can contact Jo’s Cervical Cancer Trust on 0808 802 8000.

    What do my results mean?

    No HPV found

    This means you do not have a high-risk HPV infection.

    This means in England you will be invited again for cervical screening in 3 years if you are aged 25-49, or 5 years if you are aged 50-64.

    In Scotland you will be invited again in 5 years regardless of your age.

    HPV found – no cell changes found

    This means you have tested positive for a high-risk HPV infection, but you do not have any changes to the cells in your cervix.

    You will be invited for screening again in 1 year. This will check to see if the HPV infection has gone.

    If you get the same result 3 times in a row you will be invited for colposcopy.

    HPV found – cell changes found

    This means you have a high-risk HPV infection and there are changes to the cells of your cervix.

    You will be invited for colposcopy.

    Inadequate

    This means that the sample taken during your cervical screening appointment could not be tested properly. This can be because it doesn’t contain enough cells, or the cells cannot be seen properly under the microscope.

    You will be asked to attend another cervical screening appointment in 3 months.

    Cytology results

    Cytology is currently used in Northern Ireland.

    Normal

    This means no changes to the cells of the cervix. You will be invited for cervical screening in 3 to 5 years.

    Abnormal

    This means you have changes to the cells of the cervix. The results will go on to specify if the results are borderline, low grade or high grade.

    You will be invited for colposcopy if you have low grade cell changes with HPV, or high-grade cell changes.

    Inadequate

    This means that the sample taken during your cervical screening appointment could not be tested properly. This can be because it doesn’t contain enough cells, or the cells cannot be seen properly under the microscope.

    You will be asked to attend another cervical screening appointment in 3 months.

    What is the difference between cervical screening and a smear test?

    Nothing. Cervical screening and a smear test are the same test. Smear test is the older name for cervical screening. It was called this because of the way the test used to be done.

    The letter you receive inviting you to attend testing will refer to cervical screening which is why we use that term now.

    What is cervical screening?

    In the UK there is the NHS Cervical Screening Programme that screens people with a cervix for Human Papillomavirus (HPV) infections and then examines the cells of the cervix if a high-risk HPV infection is found. This means those at high-risk of developing cervical cancer can be identified.

    Cervical screening is also sometimes called a ‘smear test’.

    Will cervical screening check for other things?

    No. Cervical screening checks for high-risk HPV infections and if present, will then look for changes to the cells of the cervix. No other conditions or cancers are checked for.

    Is cervical screening a test for cancer?

    Cervical screening is not a test for cancer. It is a free (in the UK) health test to help prevent cancer 7.

    Cervical screening checks for a virus called high-risk Human Papillomavirus (HPV). If you have a high-risk HPV infection, then it will also check the cells from the cervix for any changes (abnormal cells).

    If you believe you may have symptoms, then contact your GP surgery/healthcare provider. Cervical screening is not for people who have symptoms, and you should not wait for screening to get checked.

    Who is invited for cervical screening?

    If you have a cervix and are registered with a GP surgery as female, then you will be invited by letter, for cervical screening every 3 to 5 years (depending on your age) from 25-64 years old 7.

    Should LGBTQ+ people attend cervical screening?

    All women or people with a cervix should attend cervical screening every 3 to 5 years (depending on your age) from 25-64 years old no matter their sexual orientation or gender identity 7.

    If you are not registered as female at their GP surgery but have a cervix, you should speak with their GP about cervical screening.

    If you are not registered at a GP surgery, you can do so on the NHS website.

    If you do not have a cervix there is no test available on the NHS for HPV.

    HPV is spread via skin-to-skin contact of the genital area during sexual contact i.e., vaginal, anal, or oral sex.

    It is also important to note that, although rarer, the spread of HPV infections does not need penetrative sex to occur. It can also occur through sharing of sex toys without physical contact with another person at all.

    Do I need cervical screening if I have had a hysterectomy?

    If you have previously had treatment that affected your cervix for any reason, you may no longer be invited for cervical screening. These treatments include:

    • A total hysterectomy. This is an operation that removes the womb and cervix. If you have had a total hysterectomy, you will not be invited for cervical screening as there is no cervix to take a sample of cells from.
    • Pelvic radiotherapy. This is a treatment that directs radiation at the part of the body between the hipbones (pelvis). It can damage the cells of the cervix and make it harder to tell if there are any changes, so you may not be automatically invited for cervical screening. Your GP/healthcare provider may do a separate follow up appointment with you.

    After these treatments, your healthcare provider may want you to have a different test called a vault smear. This takes a sample of cells from your vagina and tests them to check that they are healthy. Whether you are offered vault smears and how long you are offered them for depends on your individual situation.

    Should I attend cervical screening if I am pregnant?

    Usually, it is recommended that you do not attend cervical screening if you are or think you may be pregnant. This is because pregnancy can make the result difficult to interpret.

    If you receive your invitation letter whilst pregnant, tell your GP/healthcare provider you are pregnant. Cervical screening should only be performed 3 months after your baby is born 15.

    If you need a follow-up cervical screen or treatment for cell changes then you may need to have the test whilst pregnant. Speak with your GP or midwife about when to have this performed. The test will not affect your pregnancy 15.

    If you are planning a pregnancy speak with your healthcare provider to arrange your cervical screening around your pregnancy.

    Read the Royal College of Obstetricians & Gynaecologists Patient Information Leaflet regarding cervical screening and pregnancy here.

    Should I attend cervical screening if I have HIV?

    Yes. If you have HIV, your immune system may not be able to get rid of a high-risk HPV infection as easily. Speak with your healthcare provider about having cervical screening once a year outside of the usual screening programme.

    Can I access cervical screening if I live in residential care?

    Yes, all women and people with a cervix between 25-64 years of age should attend cervical screening. Contact your healthcare professional to make an appointment.

    Can I access cervical screening if I’m not registered at a GP surgery in the UK?

    Yes. All women and people with a cervix between 25-64 years of age are eligible to attend cervical screening. You should still get an invitation letter even if you’re not registered with a GP surgery.

    You can attend a walk-in clinic or sexual health service if they offer cervical screening. To find a sexual health service visit the NHS website.

    Visit the NHS website to find out how to register with a GP.

    Can I access cervical screening if I’m not registered as female at my GP surgery/healthcare provider, but I still have a cervix?

    Yes. Anyone with a cervix aged between 25-64 years are eligible to attend cervical screening.

    Contact your GP surgery or healthcare provider to ensure you are registered to attend cervical screening.

    Can I access cervical screening if I reside in secure or detained settings i.e., HMP service?

    Yes. All women and people with a cervix between 25-64 years of age should attend cervical screening. Speak with your prison healthcare team about cervical screening.

    Can I access cervical screening if I have a learning disability?

    Yes. We know cervical screening or ‘smear tests’ can be confusing and worrying, but you are not alone in feeling this way.

    Read our information about what happens at your test appointment. If you want a friend, relative, carer or learning disability nurse with you that is fine. Speak to your healthcare provider or GP.

    Can I access cervical screening if I have a physical disability?

    Yes. All women and people with a cervix between 25-64 years of age should attend cervical screening.

    We understand physical disability causing many eligible women and people with a cervix to face inequality when it comes to cervical screening. With many GP surgeries not having the necessary equipment to support those in need.

    We also understand there is a gap in the system as far as sufficient training, policies and levels of care are concerned. This is putting many at increased risk of cervical cancer.

    We support the introduction of self-sampling for HPV testing and the inclusion of training to sample takers in the NHS to include the needs and adjustments for those with a physical disability.

    If you want to be a part of the work we are doing to help make changes like these globally then visit our ‘Get involved’ page.

    Can I access cervical screening if I have no fixed address?

    Yes. All women and people with a cervix between 25-64 years of age are eligible to attend cervical screening.

    You can attend a walk-in clinic or sexual health service if they offer cervical screening. To find a sexual health service visit the NHS website.

    Can I access cervical screening if I am a member of a Travelling community?

    Yes. All women and people with a cervix between 25-64 years of age are eligible to attend cervical screening. If you wish to register with a GP surgery, you can find out how via the NHS website.

    You can also attend a walk-in clinic or sexual health service if they offer cervical screening. To find a sexual health service visit the NHS website.

    Can I access cervical screening as a migrant?

    Yes. All women and people with a cervix between 25-64 years of age are eligible to attend cervical screening.

    Visit the NHS website to find out how to register with a GP.

    You can attend a walk-in clinic or sexual health service if they offer cervical screening. To find a sexual health service visit the NHS website.

    Can I access cervical screening if I don’t speak English?

    Yes. All women and people with a cervix between 25-64 years of age are eligible to attend cervical screening.

    Visit the NHS website to find out how to register with a GP.

    All screening documents are provided in the most prevalent languages in local areas. Translation services can be arranged prior to your appointment at with your healthcare provider.

    A Language Identification Chart can be used to help your healthcare professional identify your preferred spoken language if needed.

    You can attend a walk-in clinic or sexual health service if they offer cervical screening. To find a sexual health service visit the NHS website.

    I am under 25, but sexually active can I access cervical screening?

    If you are under 25 the medical and scientific advice is that you do not need to attend cervical screening until you reach this age. This is still the case even if you are sexually active.

    You may get your invitation letter to attend cervical screening 6 months prior to turning 25.

    Cervical screening has been shown to not reduce the number of cervical cancers in under 25s. In countries where cervical screening starts at 20 years old, the number of people under 25 diagnosed with cervical cancer is not significantly different than in countries where screening starts at 25.

    It is also likely that the number of under-25s diagnosed with cervical cancer will fall in the next 10 years due to the HPV vaccine.

    It is also the case that cervical cell changes are often found in under-25s, and these changes very often go away on their own. This means causing unnecessary worry, upset and anxiety if screening occurs before 25 years of age.

    It is important however to know the symptoms of cervical cancer and be able to recognise them, even if you are under 25.

    If you have symptoms, it is important to see your healthcare practitioner as soon as possible.

    Here is the Clinical Practice Guidance for the Assessment of Young Women aged 20-24 with Abnormal Vaginal Bleeding. It may be helpful to print off a copy and take it with you to your appointment.

    I am not sexually active/am a virgin, should I attend cervical screening?

    It is still recommended that if you have been invited to attend cervical screening but have not had sex, you make an appointment.

    High-risk HPV infections can be passed on without the need for penetrative sex. Skin-to-skin contact is enough and not attending screening can mean an infection can go undetected.

    If you have doubts speak with your GP/healthcare professional.

    What can I do if I feel embarrassed going to my cervical screening appointment?

    Some people find it embarrassing to talk about gynaecological problems and attending their cervical screening appointment. It is not uncommon to feel like this, so you are not alone.

    It is important to remember that doctors, nurses, and healthcare practitioners talk about and see these things all the time. They are not embarrassed. You can also take a friend or someone you trust with you to your appointment.

    Does cervical screening hurt?

    Everyone is different so although for many cervical screening does not cause any pain, there are some who do find it uncomfortable or even painful.

    Reasons cervical screening may be painful include:

    • Clenching, or feeling unable to relax, perhaps due to nerves, anxiety, a previous bad experience during cervical screening, or experience of sexual violence
    • Vaginismus is when the vagina suddenly tightens as you try to put something into it 16
    • Endometriosis 17
    • Cervical ectropion (cervical erosion) 18
    • Vaginal dryness and other post-menopausal symptoms 19
    • Female genital mutilation (FGM), which is when the genital area is deliberately cut, injured or changed 20
    • Other gynaecological issues.

    If you are worried about experiencing pain, then you can read our comfort checklist that has helpful suggestions for cervical screening appointments.

    How do I book my cervical screening appointment?

    You should receive an invitation letter via the post when it is time for your cervical screening appointment. When you receive this letter, you can call your GP surgery/healthcare provider and make an appointment 21.

    If you’re not registered at a GP surgery then you can visit the NHS website and find out how to register.

    Why do I stop getting invited for cervical screening when I turn 65?

    Once you turn 65 you will no longer be invited for cervical screening unless you are being followed up for cell changes.

    This is because the benefits of cervical screening become less as we get older.

    Cervical cancer usually develops very slowly. In fact, it can take between 10-20 years for high-risk HPV infections to develop into cell changes and then into cervical cancer. It is very unlikely that if you have been attending cervical screening regularly up until 65, that you will develop cervical cancer after this age 21.

    If you have never been for cervical screening before 65 then you are entitled to attend a cervical screening appointment. Speak with your healthcare provider about making an appointment 21.

    What if I have symptoms?

    If you have symptoms of cervical cancer, it is important to see your GP/healthcare provider as soon as possible regardless of your age 22.

    Symptoms include:

    • Vaginal bleeding that is unusual for you including bleeding between periods, during sex or after the menopause 22
    • Changes to vaginal discharge 22
    • Pain or discomfort during sex 22
    • Lower back pain that cannot be explained, between your hip bones and lower tummy 22

    These symptoms can happen for other reasons, but should you experience any of them it is best to seek the advice of your GP or healthcare professional.

    HPV FAQs

    What are the high-risk types of HPV?

    There are 12 high-risk types of HPV known to cause cancer and a further 8 linked to cancer 1. Two of these types (16 and 18) being responsible for almost 80% of all HPV related cancers including cervical cancer 5.

    Will I get cancer if I have HPV?

    Most HPV infections will be cleared up by our immune systems without the need for us to do anything at all. These types of infections cause minimal problems. In fact 9 out of 10 people will get rid of an infection naturally within 2 years 4.

    Cervical screening and being vaccinated when eligible help reduce your risk of developing cell changes or cervical cancer.

    How common is HPV?

    HPV infections are very common in fact most people will have an infection at some stage in their life 2-4. Although there is currently no treatment for HPV infections most HPV infections will be cleared up by our immune systems without the need for us to do anything at all in fact 9 out of 10 people will get rid of an infection naturally within 2 years 4.

    Am I at risk of getting HPV?

    Most people will get an HPV infection in their lifetime some get repeated infections. If you have ever had any kind of sexual contact you may have HPV 4.

    Can I get the same type of HPV more than once?

    With many other viral infections it is possible to develop an immunity to a particular virus that can last for years. However it has been shown that natural immunity to HPV is very poor meaning it is possible to get the same type of HPV infection again.

    We understand this leads to uncertainty which can be worrying. It is important to remember your body will likely get rid of HPV infections by itself. If you are concerned still then speak to your healthcare provider.

    Can the HPV virus be inactive in my body or dormant?

    Most HPV infections will be cleared up by our immune systems without the need for us to do anything at all in fact 9 out of 10 people will get rid of an infection naturally within 2 years 4. However it is possible for your immune system to not always get rid of an HPV infection. That means it can stay in your body without you knowing and sometimes without it being detected in a test. This is known as dormant or clinically insignificant HPV.

    It is possible for dormant HPV to become active again meaning it may be detected in a test and can cause cervical cell changes. It is not known why HPV becomes active again.

    Dormant HPV can mean you got the infection years before even decades without you knowing.

    How do I find out if I have an HPV infection?

    Is there a test for HPV?

    There is a test for HPV. In the UK there is also the NHS Cervical Screening Programme that screens people with a cervix for HPV infections.

    At 10zyme we are developing the first test that will provide you with a result in your home. Find out more here

    Can men get tested for HPV?

    HPV testing is not available on the NHS for men. 10zymes new at home HPV test could change that offering men the chance to find out their HPV status for the first time ever.

    Can I get tested for HPV at any time?

    Cervical screening is only available for free as part of the NHS Cervical Screening Programme or after you have had treatment for cervical cell changes. You will be invited for screening every 3 to 5 years depending on your age.

    10zyme are developing the first ever test for HPV that can be used and will provide results in your own home. Find out more here

    If I have HPV can I ask for my partner to be tested as well?

    If your partner has a cervix and is registered with a GP surgery as female then they will be invited for cervical screening every 3 to 5 years depending on their age. In England, Scotland and Wales primary HPV screening is performed on your sample taken at the cervical screening appointment.

    If your partner is not registered as female at their GP surgery but has a cervix they should speak with their GP about cervical screening.

    If your partner is not registered at a GP surgery they can do so on the NHS website.

    If your partner does not have a cervix there is no test available on the NHS.

    How can I protect myself against HPV?

    HPV is present on our skin so this means it is very difficult to protect yourself against infections completely 1. There are ways you can reduce your risk of getting HPV or developing an infection that your immune system cannot get rid of.

    Ensuring the use of a condom or dental dam does help reduce your risk but it doesn’t offer complete protection. HPV lives on the skin around the genital area that may not be covered by such products 2.

    Stopping smoking can help strengthen your immune system so it can fight HPV infections. If you want to quit smoking information can be found on the World Health Organisation website.

    In the UK there are NHS programmes that can help:

    Vaccination is the best way to protect yourself against high-risk HPV infections 11.

    How can I get rid of an HPV infection?

    How is HPV treated?

    There is currently no treatment for HPV infections and infections are usually cleared by the immune system. These types of infections cause minimal problems. In fact 9 out of 10 people will get rid of an infection naturally within 2 years 4. However symptoms such as genital warts and cervical cell changes can be treated.

    What if I have HIV and get HPV?

    If you have HIV your immune system may not be able to get rid of the infection as easily. Speak with your healthcare provider about having cervical screening once a year outside of the usual screening programme.

    What are the symptoms of HPV?

    HPV infections can have no symptoms. This means many people can have HPV without knowing it. As worrying as this sounds remember most HPV infections go away by themselves 23.

    In England, Scotland and Wales cervical screening (sometimes referred to as a smear test) now tests for high-risk HPV infections. This means anyone who tests positive can get the right care and advice. In Northern Ireland testing for high-risk HPV will be offered in the future 29.

    Other symptoms such as genital warts and cervical cell changes exist.

    What are genital warts?

    Genital warts can be caused by low-risk HPV infections 1. They are commonly small growths on the skin that can appear on their own or in clusters that can look like a small cauliflower 10.

    Genital warts can appear like a colour change or difference on the skin. They can cause itching and bleeding especially if affecting the skin around the penis, vagina or anus. They do not cause pain or serious problems 10. However any changes to our bodies especially in genital regions can cause upset and worry.

    Both men and women can be affected by genital warts. They can affect different areas 10:

    • Upper thighs
    • Skin around the genital area
    • Anus around the opening and inside

    For women:

    • Vulva (the external genital area including the labia and clitoris)
    • Vagina
    • Cervix

    For men:

    • Penis (outside and inside the urethra where urine comes out)
    • Scrotum (skin covering the testicles)

    How are genital warts treated?

    Genital warts can be treated either by prescribed creams and liquids or by removing the warts. It is important to note the treatment for genital warts is not the same as the wart treatment from a pharmacy 10.

    If you think you have genital warts it is important to visit your GP/healthcare provider or local sexual health/GUM clinic. They will be able to diagnose and treat the infection.

    For information how to contact these services visit:

    NHS Choices

    Or if you are under 25 years old in the UK Brook

    What do I do if I think I have genital warts?

    If you think you have genital warts it is important to visit your GP/healthcare provider or local sexual health/GUM clinic. They will be able to diagnose and treat the infection.

    For information how to contact these services visit:

    NHS Choices

    Or if you are under 25 years old in the UK Brook

    Should I feel embarrassed or ashamed of testing positive for HPV?

    The relationship between HPV infections and sexual contact can make people feel embarrassed, worried or even ashamed if they test positive. However because infections are so common this needn’t be the case. It is estimated that 8 out of 10 people will get an HPV infection in their lifetime.

    Who gave me HPV?

    As it is possible to have HPV for a long time without knowing it can be difficult to know when or from whom you got the infection.

    How did my wife/husband/partner get HPV?

    It is easy to assume if you are in a long-term relationship and either you test positive for HPV or your partner does that your partner has been unfaithful. This may not be the case. As your immune system does not always get rid of an HPV infection that means it can stay in your body without you knowing and sometimes without it being detected in a test. This is known as dormant or clinically insignificant HPV.

    It is possible for dormant HPV to become active again meaning it may be detected in a test and can cause cervical cell changes. It is not known why HPV becomes active again.

    Dormant HPV can mean you got the infection years before even decades without you knowing.

    This can be worrying and it can be difficult speaking to a partner about this. It may be useful to provide them with this information when speaking to them. It may also be useful to speak with a healthcare professional together.