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My smear test dilemma: How do I confess that this is my first one, at the age of 41?

It wasn’t a deliberate path of avoidance. It just sort of spiralled

'The nurse smiled at me, and we both laughed, but part of me felt like crying.' Photograph: iStock
'The nurse smiled at me, and we both laughed, but part of me felt like crying.' Photograph: iStock
Niamh O'Reilly
Wed Dec 11 2024 - 06:00

The fluttery prickles of embarrassment swirled in my stomach as I waited in the doctor’s surgery for my appointment with the practice nurse. Should I just come right out with it at the start or drop it gently into the conversation nonchalantly? Should I just gloss over it, as I’d done before, and wing it?

I sighed and felt incredibly stupid and ashamed. How do you confess that you’ve never had a smear test before at the age of 41?

I still wasn’t sure how I’d got to this point. It wasn’t a deliberate path of avoidance; it just sort of spiralled. What started as some trepidation and reluctance over going for the physical test itself, had now morphed into a huge sense of shame for putting it on the long finger for so many years. For putting a simple test and my own health to the bottom of my list of priorities. For saying “Jesus, I must do that,” every time a cervical check letter arrived but never actually doing it.

When I got my first letter at the age of 25, I remember thinking that I’d put it off. Just this once, mind. It was so easy to do.

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As the years went on, the reasons to put it off became easier and easier. I was busy, or I was away. I had to commute in and out of the city centre and my local GP surgery was never open late. I’d have to take time off work to get it done and that was a hassle. I didn’t want to go to a nurse or doctor I didn’t know for something so intimate either.

“Next time,” I said to myself.

Many times I did make an appointment, but predictably had to reschedule due to a commitment or something urgent that came up, or my period would arrive. I had every intention of rescheduling. But it was a case of “out of sight, out of mind”. Life was hurtling by at light speed. Building a career. Saving for a house. Organising a wedding. Following up on my missed smear was the last thing on my mind, and I simply let it fall off my radar altogether.

Then as the cervical check letters went from three years to five, I had landed in the baby years. I was asked if my smears were up to date at antenatal appointments. It was only then it hit me; I’d never actually been. A deep sense of shame washed over me. Flustered and embarrassed, I muttered something like, “Oh God, I can’t remember”, and that was that.

Then Vicky Phelan passed away from cervical cancer in 2022. So brave, so strong, so bright and far too young

Becoming a mum for the first time in 2016 was eye-opening. I battled through perinatal depression and was so focused on survival in the early years that any routine healthcare appointments went out the window. Having two babies in three years was full-on and, in the years that followed, I lost myself to motherhood. Like many mums, my own healthcare needs tended to come second to those of my family.

I distinctly remember prizing the last letter before my most recent one out of the letterbox in 2019. I was carrying my newborn in the baby carrier in one hand and trying to wrangle my two-year-old toddler with the other. I waddled in the door, like a pack mule, the letter in my teeth. It got put on the counter along with a million and one other things and when I eventually got around to opening it, I simply laughed knowing I’d never get a spare minute to go and do it.

A few months later Covid came and changed the world. I sat by and watched all but one of my newborns’ public health nurse appointments get cancelled, so the idea of a little thing like a smear test wasn’t even on the agenda.

Then Vicky Phelan passed away from cervical cancer in 2022. So brave, so strong, so bright and far too young. I promised myself that for my two young boys when my next letter came, I’d go, come hell or high water.

My five-year letter arrived on schedule the other week, and I made good on my promise. As I sat, castigating myself for my own stupidity, I wondered if something else had been holding me back all these years. Something under the surface I couldn’t quite name, but something serious enough to have an impact all the same.

I thought about growing up in the 1990s and hearing about the anti-D/Hepatitis C scandal, which saw contaminated blood products given to mothers in maternity hospitals. I thought about hearing the testimony of women who had their wombs ripped from them by the monstrous acts of former obstetrician Michael Neary. I thought about my utter horror learning about the countless women who were subjected to symphysiotomies; a vicious practice that saw labouring mothers’ pelvises broken, often without consent, instead of being offered a Caesarean section, and the legacy of pain that followed them all their lives.

I can’t turn back the clock, but maybe by writing about it, I’ll help another woman find the courage to put her healthcare at the top of her list

I thought about the friends in recent years who had had their endometriosis misdiagnosed and dismissed as simply “bad period pain”, given two paracetamol and told to suck it up. I thought about my first labour experience and that feeling that things were being done to me, rather than me being an informed party.

I thought about my mum’s generation who were put off HRT due to cancer scares and left unable to utter anything about perimenopause or menopause, lest they be told they were simply depressed.

[ CervicalCheck patients have improved healthcare with their advocacy, study finds ]

I thought about the countless women too embarrassed to seek treatment for incontinence or pelvic pain after living through a system that dismissed them all their lives.

I wondered then if the decades of ill-treatment, scandal, and overarching patriarchal nature of women’s healthcare in this country had any unconscious bearing on how I’d viewed my own smear test.

Back in the waiting room, the nurse called me in, and I decided to spill my guts from the off. I sat there and waited for a barrage of well-deserved shame and judgment to come my way.

Instead, she smiled, full of compassion; “Well, you’re here now and that’s all that matters.”

I felt like a bag of bricks had been taken off my shoulders.

“Five, four, three, two, one. And you’re done,” she said.

“You’re kidding?” I laughed. “That can’t be it? That was literally nothing. I mean it was completely painless.”

The nurse smiled at me, and we both laughed, but part of me felt like crying.

I couldn’t go back and reassure the 25-year-old me that the physical test itself was a cinch. I couldn’t go back and convince the younger, busier me to make her healthcare a priority. I couldn’t go back and tell myself there was no need to be ashamed.

I can’t turn back the clock, but maybe by writing about it, I’ll help another woman find the courage to put her healthcare at the top of her list, let her know she has nothing to be embarrassed about and reassure her that there is compassion to be found in women’s healthcare.

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