You’re not alone in this experience. Many survivors of sexual violence are fearful of cervical screening and worry the process will be retraumatising. 

A Pap smear procedure is both intimate and intrusive, and can understandably trigger flashbacks. We can completely empathise with the anxiety this must have caused you over the past ten years. 

The good news is there are lots of ways to complete cervical screening which can make it more comfortable and achievable. 

For one thing, all people with a cervix now have the option of a self-collected vaginal swab instead of requiring a speculum examination by a doctor or nurse. 

This has come about recently because we now know that a self-collected sample is just as effective as the conventional method of an endocervical smear for detecting the human papilloma virus (HPV). 

With a self-collected sample you are 100% in control, it eliminates the element of a power dynamic which can arise with a health practitioner touching your body and removes the need for a speculum examination which some people find uncomfortable and confronting.

Self-collection can be done at home or in a private space at a health clinic. It involves inserting a swab, which is like a cotton bud with a long handle, into the vagina and swirling it around a few times. It’s over in under 30 seconds.  

Otherwise, there are lots of strategies that survivors often use which can help to reduce distress around the conventional cervical screening process. 

1. Choose a health practitioner you can trust and share your concerns with them. 

Many survivors in our community can recommend doctors we have seen ourselves for gynecological procedures who are experienced in providing a trauma-informed approach. 

You don’t have to disclose your history of sexual assault if you dont want to, but a lot of people find it helpful to let their doctor know about their fears of cervical screening. This helps your doctor be sensitive to your needs and do what they can to make it a more positive experience. 

It can be useful to arrange an initial preparatory visit to meet the clinician and talk through the procedure in advance. Make a list of any questions or preferences you have and take it with you to this appointment. This can help both you and them plan for the process and build an understanding in order to feel more comfortable about undergoing the cervical screening test on a subsequent visit. 

2. Bring a support person 

It’s often helpful to have a trusted friend, partner or family member with you in room. It can make us feel more safe knowing we will not be alone. Your support person can hold your hand or be your voice to speak up on behalf of your needs if necessary. 

3. Things you can expect or can ask for 

• Make a longer appointment, to give you and your health provider the time and space to take things at a comfortable and safe pace for you. 
• You will be given privacy to undress and a sheet or towel to drape over you. 
• Easy to understand instructions at every step and to be told what they are doing and given reassurance throughout the procedure.
• You can ask to be shown the speculum and the cervical specimen brush beforehand. You can ask to insert the speculum yourself or have them assist you to do so. You can even ask for a speculum to take home, have a play with it and if you like you can try inserting it yourself prior to the day. This can help reduce your fear associated with it. 
• You can ask the health practitioner to stop or pause at any time and they will listen to you. You can agree upon a safety word or hand signal to make this communication easier. You are in control and they will not do anything without your continued consent. 
• If you think you might have a reaction such as crying or having a panic attack, it might be helpful for you to let the health practitioner know this in advance. This can allow them to prepare to support you when this happens.

4. Tips to reduce your physical discomfort 

• Plan what you are doing before and after the appointment to help put you in as much of a calm and relaxed headspace as possible. 
• Wear comfortable clothing that will be easy to pull up or to undress from the waist down. You will be given a sheet or towel to drape over you. Consider bringing a cosy jumper or blanket to keep yourself warm if necessary. 
• Empty your bladder beforehand as this will reduce the discomfort of the speculum exam. 
• Take long, slow, deep breaths. Focus on relaxing all your pelvic muscles as much as possible. This will help the speculum to slide in easily and painlessly. You can practice some simple mindfulness techniques prior that will help you with this. 

With these approaches, a lot of people now find anticipating and delaying screening causes more anxiety than the appointment itself. Completing cervical screening can become a source of triumph for survivors as a way of reclaiming agency over our bodies and our health. 

Sexual violence was a means for our perpetrators to dispossess us of bodily autonomy. They created feelings of fear and shame associated with our sexual organs. We are able to rewrite these stories for ourselves. Making decisions and being in control of our bodies and our health care is a part of that healing process. 

You are deserving of care, safety and dignity with respect to your sexual and reproductive health. Cervical cancer screening is a vital part of preventing this disease to safeguard your future health.

That said, know your limits and be patient and gentle with yourself. Its totally fine if you don’t go through with your cervical screening on the first attempt. You can always try again on another day or with a different practitioner or using a different approach. Be kind to yourself and take as long as you need to get through this.