The purpose of adding potassium hydroxide (koh) to a cervical smear is to __________.

Overview

Cervical screening (smear test) is a quick test to check your cervix (neck of the womb) for the Human Papilloma Virus (HPV).

HPV is a common virus that can cause many different types of cancer. HPV causes 99% of all cervical cancers. Your sample is checked for HPV that can cause cell changes.

Having both the HPV vaccination and cervical screening will dramatically reduce the number of people with cervical cancer in Scotland.

If you have symptoms of coronavirus (COVID-19), or have been in contact with someone who does, call the number on your invitation to rearrange your appointment.

Cervical screening exclusion error

NHS Scotland has identified a number of people who may have been incorrectly excluded from cervical screening following a hysterectomy. Anyone affected by this error will be contacted by the NHS.

More about the cervical screening incident

Urgent advice: Speak to your GP if you experience:

• unusual discharge
• bleeding after sex, between periods or after the menopause

These are usually caused by something other than cancer but it’s important to have them checked.

Signs and symptoms of cervical cancer

Human papillomavirus (HPV)

Cervical screening tests for HPV, the main cause of cervical cancer. Most changes in the cells of the cervix are caused by HPV.

HPV is very common. Four out of 5 people in Scotland will have HPV at some point in their lives. As there are usually no symptoms, many people have it for months or years without knowing it.

Your body can clear most HPV infections by itself, but about 1 in 10 infections are harder to get rid of.

Find out more about HPV at Jo's Cervical Cancer Trust.

What is HPV? (https://www.youtube.com/watch?v=4lAtZRW1vbw)

This video has been produced by Jo's Cervical Cancer Trust with service users to help people with a learning disability understand more about HPV. 

Who'll be screened?

Cervical screening is routinely offered to anyone with a cervix in Scotland between the ages of 25 and 64 every 5 years.

You may be recalled more often depending on your test results.

You will no longer be invited for cervical screening after the age of 65 unless results from previous screenings showed changes that need to be monitored.

Learn more about cervical screening for over 65s

If the results from previous screenings showed changes that need to be monitored, you'll be offered screening until you're 70 years old.

Cervical screening for transgender and non-binary people

How often will I be invited for cervical screening?

Testing for HPV is an effective way of identifying those at risk of developing cervical cancer. HPV can go on to cause cell changes which, if left untreated, could lead to cervical cancer in around 10 to 15 years' time.

That's why, if no HPV is found, you'll be invited for your next cervical screening appointment in 5 years' time, regardless of age. This is because evidence has shown your chance of developing cervical cancer in this time is very low.

Changes to screening intervals in Scotland

In March 2020, the routine screening interval for anyone with a cervix aged 25 to 49 changed from 3 years to 5 years. This change happened at the same time as HPV testing was introduced in Scotland.

Testing cervical screening samples for HPV first is more sensitive and accurate.  

It's safe to wait for 5 years between screening tests if no HPV is present because your chance of developing cervical cancer during this time is very low.

Once you've been invited for an HPV test, your screening interval will be changed from 3 to 5 years.

The routine cervical screening interval for people aged 50 to 64 hasn't changed and you'll still be invited every 5 years if you're within this age range.

You may need to have screening more often depending on your test results.

Do I need to have cervical screening?

You should continue to have regular cervical screening, even if you:

• haven't been sexually active for a long time
• have been through the menopause
• have had the HPV vaccination
• have had a subtotal hysterectomy - the removal of your womb (uterus) but you still have a cervix
• are a lesbian or bisexual - HPV can be passed on through other forms of sexual activity

You might not need cervical screening if you:

• have had a total hysterectomy (removal of both womb and cervix)
• are pregnant
• have given birth in the last 12 weeks
• have never been sexually active (as there's less risk of you having HPV)

If you get an invitation and aren't sure that you need cervical screening, speak to your nurse or GP.

If I’ve had a hysterectomy, do I still need to be invited for cervical screening?

This depends on the type of hysterectomy you’ve had.

If you’ve had a total or radical hysterectomy, your womb and cervix will have been completely removed. Your consultant gynaecologist will make sure you have a follow up, if needed. You’ll be removed from the cervical screening programme, so you’ll no longer receive invitations.

If you’ve had a subtotal hysterectomy, only your womb will have been removed. This means you should still be invited for cervical screening as part of the Scottish cervical screening programme.

Guide to cervical screening (https://www.youtube.com/watch?v=Z-dDRgXdhgk)

Watch this short film by Jo's Cervical Cancer Trust about having a smear test.

Your screening invitation

When you get your invitation, read the information carefully and decide whether you want to take the test.

It’s normal to feel anxious, especially at your first appointment. Don’t let it put you off. Talk to your GP or nurse as they can help with any concerns, embarrassment or past experiences.

Appointments

Most people have the cervical screening test at their GP surgery. If you decide to accept the invitation, contact your GP surgery to arrange an appointment.

Try to make an appointment for a day when you won't have your period. During your period it's difficult to get a clear view of your cervix.

You can ask for extra support for your appointment. For example, you can ask for a translator, female nurse or GP. You can also book a longer appointment if you'd like a bit more time to talk things through.

Learn about what you can do to reduce your risk of developing cervical cancer

Your cervical screening invitation (https://www.youtube.com/watch?v=gyQ4pPC6g0g?)

This film has been produced by Jo's Cervical Cancer Trust with service users to help people with a learning disability understand more about their cervical screening invitation.

Benefits and risks of cervical screening

As with any test, there are benefits and risks involved in cervical screening (smear tests). It’s important that you’re aware of these before you accept a screening invitation.

Benefits of smear tests

There are usually no symptoms with HPV or changes in cervical cells, and sometimes no symptoms with early stage cervical cancer.

Screening can find changes even if you feel healthy and have no symptoms. A smear test can help to find changes so that they can be monitored or treated.

Finding these changes at an early rather than late stage means:

• they're easier to treat
• you're 9 times more likely to survive cervical cancer

Cervical screening is the best way of finding out if you are at risk of cervical cancer.

Risks of smear tests

There are some risks to cervical screening:

• false positive results might wrongly show changes in your cervix 
• the test can sometimes miss changes in your cervix
• changes can happen between screening tests

No screening test is 100% effective.

It’s important to go for a smear test every time you’re invited and visit your GP as soon as possible if you:

• have unusual discharge
• bleed after sex
• bleed after the menopause
• bleed between periods

These are usually caused by something other than cancer but it's important to have them checked.

More about the symptoms of cervical cancer

What is cervical cancer? (https://www.youtube.com/watch?v=0g9eGODk_-8)

Watch this short film, produced by Jo's Cervical Cancer Trust with service users, to help people with a disability understand more about cervical cancer. 

Taking the test

A smear test is a quick test to take a sample from your cervix (neck of your womb) and examining it for the presence of HPV.

You'll have the test at your GP surgery. The test usually takes no more than 5 minutes.

Before the test

At your GP surgery, a health professional will check your details and explain the test to you. You'll have an opportunity to ask questions.

If you’d like them to send your results to another address, please tell the person doing the test.

Your cervical screening appointment will last about 10-15 minutes from start to finish.

The test itself should take no longer than 5 minutes.

Taking the test

Before the test starts, you'll be asked to undress from the waist down (or just to remove your underwear if you're wearing a skirt). You'll also be given a sheet to cover yourself.

You'll be asked to lie on an examination bed. Your nurse or GP will gently insert a speculum (medical instrument) into your vagina to hold it open so they can see your cervix.

They'll then gently brush cells from your cervix using a soft brush.

Everyone is different. Some may feel discomfort and others can find the test painful. Tell your nurse or doctor if you experience pain as they can discuss some options to help.

You can ask for a smaller speculum if you feel any discomfort or the nurse or doctor might suggest you change your position slightly.

Cervical screening after experiencing sexual violence

The thought of cervical screening can feel traumatic or distressing if you've experienced sexual violence. There are ways that the NHS can support you. For example, you can request a double appointment, take someone you trust to the appointment, or access a specialist clinic. 

Jo's Trust has further information and support for those invited for cervical screening after sexual violence

Getting your smear test results

You’ll usually get your results in the post within 2 weeks. If you'd like these sent to another address, please tell the person doing the test.

The results will also be sent to whoever took your test, and to your GP.

If you haven’t received your results within 4 weeks, contact your GP practice.

Your test samples

Your cervical screening test sample is sent to a laboratory where it will be tested for HPV.

If HPV is found, the same sample will then be examined for cell changes.

Your sample will be kept for at least 10 years to compare tests at different times. You'll be contacted if the results suggest your care should be changed in any way.

Your sample may be tested again so the NHS can evaluate how well it's preventing cancer.

What happens when I go for a smear test? (https://www.youtube.com/watch?v=dAehxy3hzqM?)

This film has been produced by Jo's Cervical Cancer Trust with service users to help people with a learning disability understand more about what happens when you go for a cervical screening test.

Test results

There are currently delays in issuing cervical screening results from both of the laboratories in Scotland.

Please do not worry if you have not received your cervical screening result within the standard 2 week period.

If you've been waiting more than 8 weeks for your result please ask your GP practice to contact the lab to check on your sample.

Your test results letter will show 1 of 4 possible results:

We found no HPV

Your risk of developing cervical cancer at this time is very low. We'll invite you for another routine screening test in 5 years.

We found HPV but no cell changes were seen

We'll ask you to come for another cervical screening test earlier than usual. This will be around 12 months after your result to check the HPV has cleared.

We found HPV and cell changes were seen

We'll ask you to come for further tests at a specialist clinic so we can take a closer look at your cervix. We'll let you know when you'll be invited for this.

Unclear result

Sometimes for technical reasons the lab can't get a result. We'll ask you to come back for another cervical screening test. This is nothing to worry about.

What do cervical screening test results mean? (https://www.youtube.com/watch?v=PAESJo941FM?)

Watch this film by Jo's Cervical Cancer Trust to find out what cervical screening test results mean.

Colposcopy

A colposcopy is an examination of the cervix using a special microscope called a colposcope. The colposcope magnifies your cervix so that the specialist can see where the changes are and what they look like.

To do the test, the specialist will:

• gently insert a speculum into your vagina
• look at your cervix through the colposcope – it does not go inside you

Before the test, the specialist will explain what to expect and, if necessary, offer a local anaesthetic as it can feel a little uncomfortable.

More about how a colposcopy is performed

Treatment

Sometimes treatment isn’t necessary. If this is the case the specialist will explain why and will arrange for you to have smear tests more often.

In some cases you’ll be asked to come back to the clinic for further colposcopy examinations. Your follow-up appointment will be with your specialist, nurse or GP.

Further information

If you’re unsure about anything or have questions about cervical screening, phone your GP practice.

Public Health Scotland has produced the following leaflets:  

This leaflet explains cervical screening in Scotland, why it's offered and what happens next if the test finds changes that need further investigation.

It's available in: 

• English, other languages and Easy Read
• British Sign Language (BSL)
• audio

What is the purpose of adding potassium hydroxide KOH to a cervical smear?

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