What Happens After The Feared Smear?
The ease of the smear test has been campaigned for years. It takes less than five minutes - I even remember seeing some celebrities have theirs done live on air amidst the Jade Goody campaign. And they're right. Five minutes. Pants off, hop on the bed, speculum up, twiddle the brush and you're done. Right?
Going in for my first official smear I was calm and collected, so to speak. Having been at work all day, it was actually the last thing on my mind. And it was like they said, in and out- five minutes. The nurse was lovely, welcoming and made me feel completely at ease. She asked if I had received the HPV vaccine when I was a young teen. I had. I remembered it vividly. Twelve year-old me was overly dramatic and refused to write at school for the rest of the day as it "hurt" too much. The nurse reassured me that my cervix looked healthy and even 'beautiful'... I didn't know a cervix could be described in such a way. She informed me the likelihood was that I would have a completely normal result, considering I had the vaccine and was only twenty-five. So I went home, rather flattered with the compliments of my cervix and the weeks went by without me giving a second thought to my inbound results.
The inevitable happened and the letter arrived. I opened it carelessly as I was trying to hug the excited pup and take my shoes off, reading it without much concentration. 'Abnormal'. Well obviously that got my full attention and the panic set in. I've been called abnormal and strange before, but knowing my cervix, a vital part of the female anatomy, was being accused of abnormality, wasn't quite the same. What on earth does it mean? Why was it "abnormal"? What was "abnormal" about it?
Of course the letter was rather detailed, including a helpful information pack reassuring the bearer not to jump to conclusions- which I inevitably did - and not to assume the C word yet - which I inevitably did - and not to look online- which I inevitably did- oh, and an appointment date for a colposcopy; a procedure that takes a closer look at your cervix with a microscope that remains outside your body, four weeks away. Apparently that was a short waiting period when I called but it felt like a lifetime away in all honesty. Fear was looming over me, the way a cloud hangs when full of damning rain. But it wasn't just fear I was experiencing, there was a strong sense of shame. I suddenly felt extremely conscious of my cervix, like it was infected, spreading something toxic in my body like a disease, because that’s what it was, in my mind. I thought the HPV I had was dirty.
Although 80% of sexually active women and 90% of sexually active men in the UK have the HPV virus, through a lack of education and stigmatised ideologies (no doubt to oppress the natural desires that most humans experience and in particular, females) my preconceived idea was that I was now somehow tainted and worthless. It was like a tidal wave crashing over all aspects of my life- can you tell I catastrophise? I felt like it reduced my value, but is this so surprising when women have been made to feel as though our reproduction and sex appeal is our only value? Of course, my brain was telling me this wasn’t true, I was more than that. But that sinking black hole of anxiety and self criticism made me feel like it did somehow make me less. What a cliche! So I told only three people; my sister, my best friend and my boyfriend - the less people knew the less I felt judged. Of course the group chat was blowing up as we were all turning twenty-five, reminding each other to book our smears, people saying they had got their results and all was fine. I remained silent. I felt like I was extremely alone in something I was later to learn is actually very, very common.
The appointment eventually rolled around. I sat with my sister in the waiting room which was just off a cancer ward. Part of me started spiralling, contemplating how this could be my foreseeable future. Was I being dramatic? Probably. But it was what I felt. I was scared.
As time ticked by, more young women started entering the waiting room. And I was, well, surprised! My brain started to ponder; why hadn't anyone I knew experienced this then? There were so many women waiting, either in the same situation I was in or further down the treatment line, yet I had felt so alone like the odd one out who’s vaccine didn't work. And then the rational, I-told-you-so-but-you-didn’t-want-to-hear-it voice in my mind spoke, "Well maybe they just didn't tell you". That really got me thinking. For weeks I had allowed my imagination to run wild. Soaring through my mind were the most extreme and awful outcomes, which involved me dying young and leaving all that I loved behind, and the only person to blame was myself because I had caused this. Maybe if I had spoken to more females about it, and been more open they may have revealed that they had been through the same thing. That they were ok. That it wasn't anything to feel ashamed about, it was actually quite common, at some point, to get an abnormal result.
The colposcopy itself was actually very easy and relaxed. As I was getting undressed behind a screen (because obviously my dignity must be protected, it’s not like they were all about to see my internal organs on a massive Samsung screen), the two nurses chatted to me about my job. “Wow, a secondary school teacher? You must be mad!” Yes. Yes I am. We spoke about Shakespeare (why not!) as their children were studying Macbeth and they did their job by distracting me from what was happening. The speculum in, microscope having a good look around, gyno concentrating on the screen until…there it was. My cervix made it to the big screen. I was most baffled by it because I'd actually never looked at one before- definitely not a real one, up close, with a magical scientific lens. Horror did strike at the prospect that the tiny hole in my cervix could, potentially, one day stretch to squeeze a watermelon out of it but alas, the female body is a powerhouse. But I’d never actually seen this part of the female anatomy before. It was really not what I expected. What I was expecting to see was a tainted, ugly and infected piece of flesh. But I didn’t. It was surprisingly fascinating. I think I even said “Wow”. Why haven't I seen one before? We studied the human body in Science when I was a teen. Why didn’t we see this?
The Gyno put the iodine solution on my cervix that stung slightly and as it spread, it clung, dark, to a part of my cervix. A tiny part probably no bigger than a nose stud. That was it. That's what I thought was the disgusting disease ravaging my body and reducing my worth. How ridiculous! The Gyno explained that he would take a small biopsy and remove that area where the dye had clung because they were the abnormal cells. He explained how the biopsy would be taken, with a loop, and I may feel some pain. As I am being completely transparent, it did hurt, but I've had more painful period cramps. I was told no sex, no high impact sports, no baths for a week and then I should be right as rain. However, the second wait began. At least another four weeks of pondering if this was my new normal; routine smears, colposcopy appointments, biopsies taken. Or even worse; something more intimidating and life changing.
And whilst waiting, albeit frightened, I was more frustrated than anything. I felt that so few people discuss an abnormal smear. We are encouraged to go and get one because it is important and potentially life saving (which it undoubtedly is!) through sporadic media endorsements but we don’t tend to hear about the after bit, the “what happens next” section of the process.
From my experience, I had only heard of the good stories where the smear was instantly clear or the stories where it wasn’t and it was cancer. I didn’t know about the inbetween results. I didn’t even know what a colposcopy was or the different CIN (cervical intraepithelial neoplasia) numbers from 1-3 which refers to the grade of the abnormal cells which are not cancerous. I didn’t know about the next steps or treatment. I thought the result was normal or cancerous. And for some people it is, but not all.
I realise I am one of the luckier women who got a result that was not cancerous, it was CIN 1- a HPV infection which tends to go away without treatment, but sometimes can spread to nearby tissue and become cancerous. But, at that moment in time, it was not cancer. I would have to have a smear the following year to ensure that it had gone on its own, which suited me fine- it was a good result! Relief, absolutely, coursed my veins but my frustration remained- at myself for being so harsh and for not knowing these things, at education for not teaching these important things, and equally at people for not sharing their own experiences. Yes, it is personal. Yes, people are entitled to keep their health private. But are women reluctant to share this specific experience because, like me, they believe it is a reflection of them? A reflection of their worth?
So I found some courage. Courage to write it all down, courage to confide in more friends and family, courage to recognise I am not tainted because of three letters and courage to accept that I had no control over what my next smear may say or the next one. But I have control over making another woman feel less alone, less intimidated and less to blame for their "abnormal" smear by sharing my own experience. It is common. It is not your fault. You are not infected, dirty or worthless. You are not alone.
