Non-speculum sampling for cervical screening in older women

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I just want to say thank you so much to the researchers, who have conducted a number of studies specifically looking into the barriers to screening faced by older women.^1,2 The studies go back to 2012, and the same issues have come up time and again. It’s so obvious that this is a solution for women with vaginal atrophy, who often suffer extreme pain and trauma during speculum screening.

I was a victim of harm during sample taking, caused by a poorly trained and incompetent nurse, and was then let down by three GPs and a consultant gynaecologist. The aftermath of this has left me with long-term physical and psychological harm. It took months for the provider to acknowledge this was a notifiable safety incident. I have withdrawn my consent to screening as a result. I am not prepared to let anyone from the NHS put their hands on me again. But I would be prepared to do home sampling.

While we wait for non-speculum sampling to be rolled out, please can all practices make sure their sample takers know what to do to make older women more comfortable. You should ask women over 45 about symptoms of atrophy. Then you should suggest they get prescribed topical oestrogen for a few weeks. Then you should use the smallest speculum and copious lubricant. You should never use brute force. You also need to empower women, so they know what to expect. Both Jo’s Trust (https://www.jostrust.org.uk) and Menopause Support (https://menopausesupport.co.uk) have written good leaflets that should be given to all older women.

• © British Journal of General Practice 2022