With British Appointment Attendance Well Behind Europe's, We Asked People Why They Skip Smear Tests

"Please don’t miss your smear test. A minute of feeling awkward is nothing compared to what I’ve now had to go through."
waiting for the doctor
Catherine McQueen via Getty Images
waiting for the doctor

Women going for smears are on the up – according to data from the NHS, 3.5 million women aged 25-64 were screened in 2021/22, a 9.4% increase from the previous year.

However, despite this uptake, Britain is still behind Europe when it comes to attending appointments by a considerable amount (over 30% on average).

STADA’s 2023 health report found that only 47% of people with vaginas in the UK are attending their gynaecological screening appointments, which for many Brits normally means a smear test.

For people like Murray*, the fear of a smear can be all too overwhelming. “I skipped because honestly, I’m just a bit scared,” she says. “But it does play on my mind.”

To begin with, Murray felt uncomfortable about “letting someone see everything.” But, as time went on, the answer to her fear was clear.

“I think maybe what actually frightens me is that something could be wrong,” says Murray, “And then what?”

Fear is cited as a major reason for not attending smears. So much so, that 58% of millennial women surveyed by Joe’s Cervical Cancer Trust recorded it as a reason for not attending their appointment.

Lindsay* was just 29 when she was diagnosed with stage 1b cervical cancer.

“I had my first ever smear test when I was 29, so I had actually put it off for seven years,” she says.

For Lindsay, life got in the way – but so to did her worries about being vulnerable and embarrassed.

“I had to have a hysterectomy to treat the cancer which meant I can’t have any more children, this is still really hard to cope with,” says Lindsay.

Cancer Research UK found that, on average, there are 3197 new cervical cancer cases each year, with a survival rate of around 51%. Soberingly, 99.8% of cervical cancer is preventable.

“Please don’t miss your smear test. A minute of feeling awkward is nothing compared to what I’ve been through and there are lots of things you can do to make the test better,” she urges.

However, sometimes it’s easier said than done. For Muslim women, not attending a smear is a complicated negotiation between faith and healthcare.

Louis* tells me; “Not going to get a smear test has definitely been a hangup of the religious and cultural idea of the hymen and ‘protecting it’ for marriage.

“Even though I’ve had sex, I still find myself feeling odd or uncomfortable with getting a smear test (even though I absolutely need to),” she continues, “Maybe if I heard more Muslim women going to get their smears and sharing their experiences - I wouldn’t feel so alone or alienated.”

According to Jo’s Cervical Cancer Trust, 35% of those who do not attend their smears report body shame as a reason for not going. This is something Grace* has experienced first-hand.

“I think half of it is being a plus-size girly and not feeling comfortable in my own skin and size. I’ve put on quite a lot of weight in the last few years too so very nervous,” she says.

“But when I think about how important it is those feelings kind of go away, though not completely. And then I think about the pain of the actual procedure.”

Pain is a worry for many, so much so, that pain and fear of pain are other top reasons for not attending. However, for Lucie, the fear of what might be triggered during the pain of a smear is enough to keep her ghosting her NHS appointment letters.

“I have PTSD from sexual assault and every time I’ve gotten the guts to actually go, the nurse has been really rough, it’s been too painful and they’ve always been really dismissive of my pain,” she explains.

“I know it’s irresponsible because of my health, but genuinely, I will live longer not doing them and getting cancer than trying to do one and the feelings it brings up.”

Mental health conditions and sexual assault can make attending a smear feel daunting and frightening. Organising support before, during and after can help you manage these feelings, and ensure your personal safety following an appointment.

What you can do to make a smear less frightening

While smears can be painful and stoke embers of embarrassment within us, it’s vital that people with vaginas between the ages of 25 and 65 get them. Here’s how you can make them less frightening.

If the thought of going alone bubbles up anxiety, bring someone with you. In the UK, everyone is entitled to a chaperone for any procedure or consultation. They can also speak on your behalf if you’re unable to.

Seek spiritual support from members of your religious community who have been to have smears. They can help guide you through the procedure and prepare you for what happens next.

Should worries about how a smear might impact PTSD, or if a previous sexual assault is making it difficult for you to get through or even make an appointment, charity The Havens can help. You can reach them on 020 3299 6900 for an urgent appointment or support.

If you still feel as though you have unanswered questions, or want more information on smears, cervical cancer or how to access screenings in England and Wales, get in touch with Jo’s Cervical Cancer Trust on 0808 802 8000.