Trauma Informed Tips for a Gentle & Empowered Smear Test

Recently I had a smear test done. The nurse wasn’t trauma informed and it wasn’t the best experience to say it lightly. In fact I came out of the clinic and burst into tears.

During the appointment, I had to ask her to stop and to reschedule, recognising that my body had gone into a stress response and I didn’t feel safe with her skill set. 

She tried to convince me to take meds to relax, but I know my body well enough that that wasn’t the answer! 

I trusted my body signalling, set up another appointment with a different practitioner and it went smooth the next time.

Smear test, cervical screening, pap test - I know that these words may bring up a feeling of apprehension or avoidance.

For those who’ve experienced sexual trauma or medical trauma, it can become an even more uneasy event. 

The CSO’s figures (from 2022) show that 52% of women have experienced sexual violence. The numbers around sexual trauma are likely to be much higher, since not all trauma is caused by violence. 

And when you add medical trauma figures from childbirth or previous ob/gyn examinations on top of that, it’s understandable that most women have apprehension about getting a smear test done. 

But it doesn’t have to be a done-to-you event, which is disempowering at the least. As a woman or cervix-owner you have agency, a voice and preferences for how this procedure can be carried out. It can be a collaborative done-with-you event. 

I’ve studied Trauma and Polyvagal Theory with some of the leading clinicians and researchers in the world. I’ve also been training in the Wheel of Consent and integrate all my Occupational Therapy knowledge on sensory processing to create these guidelines for you so that it’s an easeful experience. 

Of note, most discomfort in a procedure like this is usually as a result of the PC muscle (part of the pelvic floor) tensing up. The test when done with skill and sensitivity to your needs and vulnerability should be pain-free. The role of the practitioner is key, as well as clearly communicating your needs to them.

It's also worth noting that the context of what's happening in your life in this moment of time can also have an impact - stress from job, bereavement, parenting crisis. You show up differently each time. 

Your nervous system, emotions, sensory system and bodily reactions are inherently linked. 

So here are some tips from a trauma informed perspective that can help you be an advocate and decision maker as you get your cervical screening done. 

SELF ADVOCACY

• Ask for what you need, unapologetically. Nobody knows or cares as much about your body as you do. Ask them to go very slow, to cue you to breathe, to warm the speculum, whatever you need. 

• Having some small chit chat initially with your practitioner when you arrive into the room will help you to build a rapport and make it easier to state your needs 💬

• If it doesn’t feel comfortable, ask them to stop or pause. You can say stop at any point in the procedure and reschedule your appointment ⏸️

• You can request a different practitioner for the next appointment if you like

• You can specifically ask for a female practitioner in advance 👩‍⚕️

• If you’ve experienced sexual trauma or medical trauma in the past let your healthcare provider know that you’ll need a trauma-informed approach. This can be done in advance over the phone but you’ll likely need to reiterate it on the day of your cervical check 

• Ask the practitioner to go slowly and to talk you through each step of the way - this step by step consent allows you and your body to be prepared 🐌

• Prepare a couple of sentences in advance: “I’ve experienced sexual trauma in the past, I’ll need you to go very slowly and be kind towards me. Consent is important for me. Would you mind asking me permission as you go through each stage of the procedure?  OR “The last time I had this test done, it wasn’t a great experience. I need a gentle and very slow approach. Can you talk me through each step of the way and remind me to breathe?”

• If you’re worried about going into a freeze response (dorsal vagal) and not being able to speak up, bring someone (a partner/sister/friend) with you into the room as you have the cervical check done. Ask them to support you and to notice if you’re not ok, and to advocate with you or on your behalf. 

PREPARATION 

• Be mindful of scheduling, avoid making your appointment on a busy or stressful week 📆

• Carve time out on the day of your appointment so that you’re relaxed and not rushing or stressing 

• Resource your nervous system beforehand - by walking in nature, listening to music, meditating, lifting weights. Weight lifting is a sensory strategy that gives proprioceptive input to your body which has a calming effect on your nervous system 🌳

• Avoid caffeine before your appointment which creates a cortisol spike and a stress response in your body  ✖️☕

• If penetration is something that creates tension in your body, you’ll want to be preparing your body for this and get into a daily practice of insertion - using your finger, a jade egg or a sex toy every day for a couple of weeks before the appointment. Avoid internal stimulation or sex for 2 days before the test as per your healthcare providers guidelines. 

• What many people fail to connect to this procedure is the sexual response -  sexual arousal expands and relaxes the tissues, so have your sexual response warmed up. Use external stimulation the morning of your cervical screening so that you feel relaxed in your pelvic floor

• Massage the perineum to release any tightness in the pelvic floor. Use a trigger point release technique 🌀

POSITIONING

• Avoid lying down flat on your back looking at a ceiling. This creates a dissociative effect, a common trait of trauma. Instead make sure that the bed or plinth is tilted at an angle so that you can see your own body and what your provider is doing. This ensures a more connected, present and embodied experience.

• It can be helpful to sit on your fists. This creates an angle that’s easier and more comfortable for your provider to access the cervix 🤜🏽 🤛🏽

• If you found it’s been difficult to find your cervix in the past, make sure that you get guidelines from the practitioner with directions, tips on positioning or a type of roadmap to help the next practitioner. Make a note of it yourself. 📍

SENSORY & ENVIRONMENT

• If there’s a radio on in the background in the clinic room and the music or talking bothers you, just ask to switch it off. Sounds that you find irritating can trigger a stress response in your body 📻

• You might like to soothe your nervous system by listen to calming music with an ear bud - make sure to just use 1 earbud so that you can hear and dialogue with your healthcare provider and that you’re not disassociating from the experience 🎶
• You can ask for extra pillows to prop yourself up and make sure that you feel comfortable, which will relax your nervous system in the process. You could even bring in your own favourite, soft textured cushion.  

• If the bright lights of the clinic bother you, wear sunglasses or ask if it's possible to dim the light -  intense sensory stimulation can cause a stress response 🕶️

• Use essential oils on your wrists that calm, soothe and ground e.g. lavender, vetiver, clary sage or your favourite one 🌿

• Temperature of the room - if you’re sensitive to cold, ask the receptionist in advance that the room be heated  

DURING THE TEST

• You can ask to put the lube on yourself so that you’re taking an active role in the process 🧴

• Ask them which size speculum they’re going to use - be part of that decision making process 

• Ask for extra lube if you need it 

• Breathe. I can’t over-emphasize the importance of this, breathe into your belly, breathe down into your pelvic floor. This regulates your body and brain, stimulating the ventral vagal response (rest & digest) 🫁

• If stress has built up and your pelvic floor has gone into an overly tense-protective response, remember this is your body signalling it doesn’t feel safe. It’s perfectly ok to say you’ll come back another day and make another appointment. 

• Don’t feel pressurised into taking meds to relax your muscles. You know your own body and with the right environment and approach your body can be relaxed enough 

• If relaxing meds help, by all means take them 

• If the cervical check is proving difficult, you could also ask to insert the speculum yourself part of the way so that you’re in control and responding to your bodies needs 

• Don’t be afraid to repeat what you need. This procedure is in service to you. Ask and ask again. 🙋

We’ve been brought up in a way to not speak up in the medical system. Even though it may not come naturally, find the courage within and have the confidence to speak your truth. 

You can be a decision-maker and take a collaborative role in your cervical screening. It can be transformed into a very empowering experience and it's really important to get this test done to know the health of your cervix. 

Be unapologetically you and trust your body wisdom. 

I really hope this helps anyone who’s going for a cervical screening to have an easy and gentle experience. 

Let me know your thoughts.

With heart,

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