Why have a smear test? The chances of there being anything wrong are less than 10%, yes - but it's still worth doing. Cervical cancer is caused by the HPV virus - about 75% of people have this 'silent' virus at some point in their lives; if you've ever had sex, you're therefore likely to have been exposed to it. But only in a very few cases does this otherwise harmless virus cause cells in the cervix to go strange. If they only go strange on the surface, it's graded as CIN 1 (this level of change is often left untreated). If the abnormality goes a bit deeper, CIN 2. If there are problematic cells existing throughout the full depth of the skin covering the cervix, it's known as CIN 3. A smear test takes some of the cells from the cervix for analysis to see if they look normal or not. If cells at the CIN 3 depth are left untreated, there's around a 30% chance that 20 years later you'll have cervical cancer. However, if they're treated (in a 20 minute, local anaesthetic operation), there's 93 - 95% chance of a total cure. Simple.
If you're reading this, you probably haven't had a test before. And if that's the case, they'll usually encourage you to have a "full screen" rather than just the smear. That checks for chlamydia, syphilis and all sorts of other problems as well as cervical cancer. So I'll describe the full screen experience - the physical aspects are essentially the same.
So, assuming you've never done this before, you ring the Genito-Urinary Medicine (GUM) clinic (if you live in Oxford, 01865 231231) and ask for a doctor's appointment (you can also get it done at your local GP centre if you prefer). They tell you to allow 90 minutes (it's worth making that up to 2 hours in case they're running late); to turn up 10 minutes beforehand and to make sure you'll be able to give a urine sample when you get there (NB - you may not be asked to produce the sample for about an hour after you arrive, so don't plan to arrive bursting!).
The 10 minutes beforehand is very useful - the Churchill is a very clean and attractive hospital with lots of nice art, but it has miles of corridors and the GUM clinic is at the opposite end from the main entrance.
If you have a supportive partner or a very good friend, it can be nice to take them with you - they're allowed to come everywhere with you and stay in the room (though on the other side of a curtain) while the test is actually being done. A lot of the questions you're asked are pretty personal though, so make sure it's someone trustworthy who's going to make you feel more rather than less comfortable!
Having reached reception, you fill in a form (name, date of birth, ethnicity etc), and you can at this point ask not to be called in the waiting room by your real name, if you're worried about that. Everything, by the way, is completely confidential - you'll be asked if you're happy for the test results to be communicated to your GP, but you have the final say. Even if you're under 16, your parents, teachers, etc, will not be contacted without your permission. More info on confidentiality.
Unless you've previously specified, the doctor can be male or female (before they do the test, if the doctor's male, they'll also check that you're comfortable for the test to be done by a man, so, if you're not, you can ask for a woman instead).
The doctor will ask you for your sexual history (number and type of partners, past pregnancies, any shared needles etc) and will also ask if you have any particular concerns you want to talk about. He or she will then suggest what tests he or she feels are necessary and explain what they involve. If you're not sure about anything, ask!
You go and produce a urine sample, have another brief wait in a sub-waiting room, then you're called to one of the test rooms. This is bright, friendly and very clean looking, with an NHS platformy bed, a desk and a couple of chairs. Here they may take a blood sample (from your arm, like normal!) and the nurse will explain further. You can, if it hurts or if you simply feel too freaked out by the whole process, stop the test at any time - no one's going to force you to do anything.
A full screen involves inserting a speculum (a device for holding open the vagina for greater visibility) and taking swabs inside the vagina. I had visions of a baroque metal device along the lines of the young Willy Wonka's brace in the Tim Burton Charlie and the Chocolate Factory film, but it's actually a small transparent plastic thing a bit like a curved test tube. Nor are there scary 1950's-style abortionist's stirrups hanging from the ceiling: there are merely two woolly heel-rests at the end of the bed.
So they pull the curtain round the bed, you remove your trousers/skirt and pants and perch on the end of the bed and the doctor turns up and they ask you to lie down and put your heels in the heel-rests. This is a stable but not a restricted position - you feel able to sit up easily and remove yourself from it at any time.
The doctor then comes and sits at the foot of the bed, with, well, his or her face right there facing your bits. Yes, this is kind of weird. We're trained from a young age to keep that area for the attention of an intimate partner, so this is definitely an unusual experience. The staff, of course, realise that, and are very good at keeping a kind of apologetic, chirpy patter going, like the best kind of school nurse or vet. This is very sound psychologically: "Don't patronise me,", you think, "I'm big and adult and..." not actually that bothered by this, you discover later. Or, of course, you can just relax and regress for a bit to an age when it didn't matter who saw what bits of your body.
The speculum feels a bit weird (like extremely slow sex with a large vegetable) but not painful; the actual smear test does hurt (they have to remove cells) - about as much as a vigorously misplaced tampon. But it doesn't hurt for more than the few seconds while they're actually doing it. It helps if you take deep breaths. There's a bit of prodding and swabbing of other areas, and then the whole thing's over within about two minutes.
Back to the waiting room, and your blood test and urine results are ready in about 20 minutes (I told you you should bring a book). And then you have a final consultation with your doctor, who will be able to tell you the results so far and answer any questions you haven't yet asked. It really, really helps seeing the doctor back in the first room rather than the test room: keeps everything psychologically separate in a good way. The other test results come through in about ten days, and you can ask to have them posted or texted to you, or to be given a time to phone up for them.
You may bleed a bit for the next couple of days (like the end of a period), and you may feel twinges in the same place as period pain for an hour or so, but basically it's over and you don't have to do it again for three years! You may want to go home for a cup of tea and some chocolate - don't plan this for the day of an important meeting or an exam! And it's seriously worth it when it's this easy to avoid cancer.
Jo's Trust - www.jotrust.co.uk. A helpful guide and community website with lots of information on cervical cancer and pre-cancer.
This information is based on personal experience at the Churchill hospital, Oxford, UK, in spring 2009, and cannot be taken as conclusively representative of anyone's experience but the writer's.