Cervical Screening & HPV: Taking Control of Your Cervical Health

Cervical cancer is one of the few cancers that is almost entirely preventable. Effective screening has reduced cervical cancer rates in the UK by around 70% since the national programme began — yet every year, many thousands of women miss their screening appointments. Anxiety about the examination, embarrassment, previous experiences that felt uncomfortable or hurried, or simply not getting around to booking: these are the reasons I hear most often in my clinic. I understand all of them.

In my practice, cervical screening takes place in an unhurried, expert, and completely non-judgmental space. Whether you are overdue by a few months or many years, whether this is your first ever smear test or you have had dozens, I am here to make the experience as comfortable and informative as possible. Because attending, even late, is always the right decision.

What is cervical screening?

Cervical screening — often called a smear test — is a health check designed to look for changes to the cells of the cervix (the neck of the womb) that, if left untreated, could potentially develop into cervical cancer. Crucially, it does not test for cancer itself; it is a preventative test that allows us to identify and manage early cell changes before they become a problem.

The UK national programme has recently undergone an important change. For many decades, cervical screening used cytology (the Pap smear), in which cells were collected from the cervix and examined under a microscope for abnormalities. The NHS now uses primary HPV testing as the first step. This means the sample is first tested for the presence of high-risk human papillomavirus (HPV); cytology is only performed if high-risk HPV is found. This approach is more sensitive and picks up significant cell changes earlier.

Under the NHS programme, women aged 25–49 are invited every three years, and women aged 50–64 every five years. In my private practice, I can offer screening at a frequency that suits your personal needs, your history, or your level of reassurance — including annual screening for those who prefer it or who have a history of abnormal results.

HPV and cervical health

Human papillomavirus (HPV) is extraordinarily common. Most sexually active people will acquire HPV at some point in their lifetime; in the majority of cases, the immune system clears the infection naturally within one to two years without any treatment and without any lasting effects. An HPV-positive result does not mean you have cancer, and it does not mean you have done anything wrong.

There are more than 100 strains of HPV. The majority are low-risk and cause no harm or, at most, genital warts. The strains of concern for cervical health are those classified as high-risk, particularly strains 16 and 18, which together account for approximately 70% of cervical cancers. It is the persistent presence of high-risk HPV over many years — not a single positive test — that can lead to progressive cell changes and, ultimately, cancer if unmonitored.

The HPV vaccine (Gardasil-9) protects against the most significant high-risk strains, including 16 and 18. In the UK, it is offered routinely to young people in school. I can discuss HPV vaccination in adults who have not previously been vaccinated, including catch-up vaccination, as part of your consultation.

What happens if results are abnormal?

An abnormal result is understandably anxiety-provoking, but the great majority of abnormal screening results do not require immediate treatment. Understanding the pathway helps remove some of that fear.

If your HPV test is positive, the laboratory will automatically perform reflex cytology on the same sample — looking at the cells in more detail. If the cytology is normal, you will simply be asked to repeat your screening in 12 months, as the virus will often clear by itself. If cytology shows changes, you will be referred for colposcopy — a closer examination of the cervix using a magnifying instrument, performed by a specialist.

Cell changes are classified by grade:

• CIN 1 (mild dyskaryosis): Low-grade changes. The majority resolve on their own within two years. These are usually monitored rather than treated, with a repeat screen at 12 months
• CIN 2 (moderate dyskaryosis): Intermediate-grade changes. Treatment may be recommended, depending on your age, circumstances, and the colposcopist’s assessment
• CIN 3 (severe dyskaryosis): High-grade changes. Treatment is usually recommended to remove the abnormal cells, most commonly by LLETZ (large loop excision of the transformation zone) — a quick procedure performed under local anaesthetic

I want to be clear: CIN is not cervical cancer. It is a precancerous change that is identified and managed precisely to prevent cancer from developing. The screening programme works because of this early intervention.

Making the experience comfortable

I know that for many women, the practical experience of a smear test is the main barrier to attending. Perhaps a previous test was painful or uncomfortable; perhaps you have anxiety around intimate examinations; perhaps you have experienced trauma that makes gynaecological appointments particularly difficult. All of these concerns are valid, and I take them seriously.

In my practice, I take verbal consent before each step and explain exactly what I am doing throughout. I will discuss positioning options with you — we are not limited to a single approach — and I stock speculum sizes from small to large so that we can choose the most appropriate one for your body. There is no rush. If you need a moment, we take it. If you would like to stop, we stop. My priority is always that you leave feeling informed, respected, and cared for.

The advantages of private cervical screening

Private cervical screening offers a different experience from an NHS appointment. Rather than a brief nurse appointment, your private screening with me takes place within a full consultation. There is time to discuss your history, your concerns, and any symptoms you have noticed. Results are discussed with me directly, rather than received through an impersonal letter. If further investigation is needed, I can guide you through the next steps and, where appropriate, facilitate a prompt colposcopy referral through my network.

The consultation also provides an opportunity for a broader sexual health and gynaecological discussion — contraception, any changes you have noticed, questions about HPV vaccination, or anything else on your mind. Screening need not be a tick-box exercise; it can be the beginning of a more comprehensive understanding of your health.

When to seek cervical assessment

I would encourage you to book an appointment if any of the following apply:

1. You are overdue for cervical screening, whether by months or years
2. You have experienced post-coital bleeding — bleeding after sex — which always warrants investigation
3. You have intermenstrual bleeding — bleeding between periods or after the menopause
4. You have noticed an unusual or persistent vaginal discharge
5. You have pelvic pain, particularly if it is new or unexplained
6. You have had a previous abnormal smear result and would like specialist review or reassurance
7. You have never been vaccinated against HPV and would like to discuss whether it is right for you

What to expect at your appointment

Your appointment will begin with a conversation. I will ask about your screening history, any symptoms, your general health, and any concerns you have about the examination itself. We will discuss what the test involves, what we are looking for, and how results are reported.

The physical examination takes just a few minutes. I will use a speculum — which I will show you and explain beforehand — to gently open the vagina so that the cervix is visible. A small soft brush is used to collect cells from the surface of the cervix. For most women, the sensation is one of mild pressure; it should not be painful. If at any point you experience discomfort, please tell me immediately.

Results are typically available within a few days and will be discussed with you directly. Whatever the outcome, I will explain what it means, what the next step is, and what to expect going forward.

Your cervical health matters, and so does your experience of the appointment. I am here to make both as good as they can be.