Nearly three-quarters (72%) of women who have experienced sexual violence have either not attended or delayed having a smear test because of their experience, new research reveals.
The study from Jo’s Cervical Cancer Trust found that sexual assault – which a fifth of women over 16 have experienced – can mean they avoid the intimate screening, which can cause distress and often means needing to explain difficult experiences to a medical professional.
Sexual-violence survivor Pavan Amara, who founded the My Body Back Project, said this meant “the rapist has managed to take the most important thing from them – which is their life in some cases”.
Over half (61%) of the 143 people interviewed surveyed said there was no support to help them prepare for the potentially life-saving test, which is the best way to prevent cervical cancer, while almost all (91%) wanted doctors and nurses to have more information on how to give smear tests to survivors.
According to Jo’s, 890 women die a year from cervical cancer, but one in four people invited do not attend screenings, which are offered to women aged 25-49 every three years and women aged 50-64 every five years.
Pavan Amara, whose My Body Back charity runs clinics offering contraception, STI tests and cervical screening to survivors in an empathetic environment, welcomed the findings but said she wasn’t surprised: “It’s something that we’ve seen for years. At the clinic we run, we had to close the waiting list because we were so overwhelmed by the number of women wanting screening in a specialist environment.”
She started the charity after her own experience of sexual violence meant she didn’t feel she could attend medical appointments – “anything that was invasive and that was basically obstetric and gynecology stuff a lot of the time, and sexual health”.
A woman had gone for a smear test and a nurse said to her, ‘If you relax, it’ll be over more quickly.’ Those were the same words her rapist had used
“After you’ve had amazing counselling from a service like Rape Crisis, sexual violence affects people’s lives in so many other ways in terms of long-term health care.
“In an assault, you’ve had somebody else be in charge of your physical being. And a lot of the time when you go to a health professional, that is what it feels like, too.
“A woman said to me she had gone for a smear test and a nurse said to her, ‘Look, if you relax, it’ll be over with more quickly.’ Those were the same words her rapist had used.
“There’s so much work that needs to be done with this.”
She told The Pool that survivors face “huge barriers” for other medical services beyond smear tests. “For the same reasons, women will have lots of issues when it comes to maternity care, vaginal examinations, IUD and IUS fittings. We even get lots of emails from women who have a hard time attending the GP – it’s the same dynamic.”
“We’ve learned that a lot of people are choosing not to have children because they don’t feel they could attend the vaginal examinations.”
Better communication for survivors and doctors was key, she said. For example, women might have internal scarring and fear that a speculum can’t be used as a result. “There are ways of dealing with that medically – quite often it feels like a speculum won’t be able to go through, but it’s not impossible at all,” Amara said.
Jo’s Cervical Cancer Trust has worked with Rape Crisis England & Wales to create resources to give information to women who are concerned about having smear tests, and to train health professionals in how to carry them out in a way that won’t trigger trauma.
Imogen Pinnell, health information manager at Jo’s, said: “Cervical screening provides the best protection against cervical cancer and we want every woman who wants to take up their invitation to feel able to do so.
“One in five women will sadly experience sexual violence in their life and it is important that healthcare professionals understand the profound impact this can have on women and feel comfortable supporting those affected.”
My Body Back is working on an app that, Amara hopes, will go live by the end of 2019, to help survivors create a plan of what to discuss with doctors or nurses at a screening, including a note explaining why this woman needs a special plan. “The most difficult part for women is disclosing [the fact they have been assaulted] to a clinician that they don’t know,” she said.
A third (33%) of interviewees in the Jo’s research said they would benefit from having a card to show a doctor or nurse that explains their experience so they don’t have to to talk about it.
Amara said making appointments more comfortable for survivors could be “life-saving”.
“If women who have experienced sexual violence are not attending long-term healthcare procedures, then basically what the rapist has managed to do is take the most important thing from them – which is their life, in some cases.
“If they don’t attend, the rapist really does control them for ever, to the extent that they may die earlier in some cases, because that preventative work hasn’t been carried out.”
Jo’s Cervical Cancer Trust gives support and information to women and their loved ones affected by cervical cancer and cervical abnormalities. The national helpline is 0808 802 8000.
Rape Crisis England & Wales gives specialist sexual violence and abuse services in 55 locations across England and Wales. The national helpline is 0808 802 8999.
My Body Back Project helps women a year or more after their assault(s), offering cervical screenings, STI testing and contraception. Book an appointment at its London or Glasgow clinic here.