A smear test may be performed because of symptoms, an abnormality seen by the GP during an examination or as follow-up after a previous abnormal result. This is different from a smear test performed as part of the Dutch cervical cancer screening programme.
When might a smear test be needed?
Make an appointment with the GP if you:
- experience bleeding during or after sex;
- have vaginal bleeding when you are not having your period;
- develop vaginal bleeding more than one year after your periods have stopped;
- have discharge that is clearly different from usual, for example blood-stained, brown or dark red;
- previously had an abnormal smear test or HPV infection and require a follow-up test.
These symptoms are usually not caused by cervical cancer. Nevertheless, it is important to investigate their cause.
If you have symptoms, do not wait for your next cervical screening invitation and do not use a self-sampling kit instead of making an appointment with the GP.
Initial assessment by the GP
A smear test for symptoms is generally not performed without an initial assessment. The GP will first discuss:
- your symptoms;
- how long you have had them;
- when the bleeding occurs;
- your menstrual cycle;
- whether you could be pregnant;
- any medication you use, including hormonal medication and blood-thinning medication;
- previous abnormal smear tests or treatments;
- other symptoms, such as pain, itching or unusual discharge.
Depending on your symptoms, other tests may be needed in addition to a smear test. The GP may, for example, test for an infection, examine the vagina and cervix or perform another physical examination.
Sometimes a smear test is not the most appropriate investigation and the GP will refer you directly to a gynaecologist.
Difference from the cervical screening programme
Smear test for symptoms
A smear test for symptoms is requested by the GP for a medical reason. The laboratory examines the sample for abnormal cells and HPV.
A self-sampling kit is not suitable if you have symptoms. A self-sampling kit only tests for HPV and does not allow the GP to examine your cervix.
Even a normal result does not always explain the cause of your symptoms. Further investigation or a referral may still be needed.
Cervical cancer screening programme
The cervical screening programme is intended for people without symptoms who receive an invitation to participate. Its purpose is to detect HPV, precancerous changes and cervical cancer at an early stage.
As part of the screening programme, depending on your situation, you can choose between having a smear test at the GP practice or using a self-sampling kit.
Read more on our page about the screening programme.
Preparing for your smear test
Tell the GP or practice assistant beforehand:
- if you are pregnant or could be pregnant;
- if you take blood-thinning medication;
- if you have previously experienced significant pain during an internal examination;
- if you have had distressing or traumatic sexual experiences;
- if you find internal examinations difficult;
- if you have a physical disability that we should take into account.
You remain in control throughout the examination. You may ask questions beforehand and can ask to pause or stop the examination at any time.
A smear test can sometimes be more difficult to assess during your period. If you have a scheduled appointment and your period has started, contact the practice for advice. If unexpected bleeding is the reason for the examination, do not postpone the appointment without discussing this with us.
If possible, do not use vaginal creams, tablets or douches during the 24 hours before the smear test, unless the treatment cannot be interrupted or you have been advised otherwise.
What happens during a smear test?
A smear test is performed by the GP or a suitably trained practice assistant.
The examination usually involves the following steps:
- you remove the clothing from your lower body;
- you lie on your back on the examination couch;
- you position your legs or feet as agreed with the examiner;
- the GP or practice assistant gently inserts a speculum into your vagina;
- the speculum is carefully opened so that the cervix can be seen;
- a small brush is used to collect cells and mucus from the cervix;
- the brush is placed in a container with fluid;
- the speculum is removed and you can get dressed again.
The smear test itself usually takes only a few minutes. The entire appointment generally takes approximately ten minutes.
Does a smear test hurt?
A smear test should not usually be painful. Inserting and opening the speculum can cause pressure or discomfort. The brush may briefly feel uncomfortable.
Tell the examiner immediately if the examination is painful or if you feel uncomfortable. They can pause, adjust the speculum or stop the examination.
You may have a small amount of blood or blood-stained discharge after the smear test. This is usually not a cause for concern and should stop on its own.
Laboratory testing
The collected material is sent to a laboratory. It is tested for:
- abnormal cells;
- types of HPV associated with an increased risk of cervical cancer.
HPV is very common. Almost everyone who is sexually active will become infected with HPV on one or more occasions. The body usually clears the virus by itself.
A positive HPV result does not mean that you have cervical cancer. Abnormal cells are also usually not cancerous. However, follow-up testing or monitoring may be required.
The results
The results are usually available within a few weeks. The GP will explain how you will receive them.
Depending on the results, the next step may be:
- no abnormalities found, with further investigation into another possible cause of your symptoms if necessary;
- another smear test after an agreed period;
- additional tests;
- referral to a gynaecologist for further examination of the cervix.
Contact the practice again if your symptoms persist, return or worsen, even if the smear test did not show any abnormalities.
When should you contact the practice sooner?
Contact the practice sooner if:
- the bleeding clearly increases;
- you are losing a large amount of blood;
- you develop severe or increasing abdominal pain;
- you develop a fever or feel unwell;
- you are pregnant and experience vaginal bleeding;
- you are concerned for any other reason.
In the event of heavy bleeding, fainting or severe symptoms that cannot wait, contact the practice immediately. Outside our opening hours, contact the out-of-hours GP service.
Further information
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