Article written by Keighli O’Brien
Illustration by Laudine Cao
CW: Mention of sexual abuse, ableism, sexism, medical procedures, and racism.
This piece was originally published in ‘Vestige’, Bossy’s 2023 print edition.
From the 1st of July 2022, Australians with cervixes between the ages of 25-74 were eligible for self-testing swabs for Cervical Screening Tests. What does this involve, you may ask? Well, the self-collection option enables individuals to take their vaginal sample with a swab without needing a speculum to look for human papillomavirus (HPV). HPV is a sexually transmitted infection, which can present in different ways—from asymptomatic to causing cancer or genital warts. While people can still arrange for a doctor or nurse to conduct a test using a speculum, the self-testing option is more comforting and less invasive for some.
Cervical cancer is Australia’s 14th, with 72% of people diagnosed with cervical cancer being under or never screened (RACP, 2022). Currently, Australia has a 52% participation rate for cervical screening among eligible individuals. There are various reasons for this low participation rate—including cultural barriers, negative experiences with screening in the past, and fear and embarrassment of the procedure. The federal government hopes that with this new self-testing, those experiencing stigma or taboo around traditional speculum HPV tests or pap smears will be relieved.
Those benefiting from self-collection may include victims of sexual violence and trauma, people in the LGBTQIA+ community, Aboriginal and Torres Strait Islander people, people from culturally and linguistically diverse communities, and people living with a disability. Self-collection will help remove barriers facing individuals needing this necessary HPV screening. While the self-testing service does not currently enable a home-mail-out program, with GPs having to order the test, there is hope that it still may reduce uncomfortableness.
In Australia, at times, there is a lack of cultural awareness within the health sector, which can deter individuals from booking HPV testing. People of colour (POC) have higher mortality rates for cervical cancer than non-POC individuals (Cancer Research). For some cultures, cervical cancer screening is stigmatised, with myths including that only women who are unfaithful or have had multiple sexual partners should undergo such testing. However, embarrassment of genital exposure and maintaining chastity is also a concern surrounding this examination. Additionally, some people with cervixes are concerned about attending their usual GP clinic as they do not wish to be accused of being sexually active or found to be sexually active by their families. While further education is needed in the broader community about cervical screening, a self-test prevents the taboo and potential concern of genital examination.
A 2021 ABC article titled ‘Aboriginal and Torres Strait Islander women left behind in Australia’s cervical cancer elimination’, explored the journey of Ashlee Williams to receive a cervical cancer diagnosis. Identifying as a Wadi Wadi, Wandi Wandian and Dharawal woman, Williams kept going to her GP for examinations but was turned away. In 2015, she was diagnosed with stage three cancer. Now, she is fortunately in remission after chemotherapy and radiation. Williams now advocates for Aboriginal and Torres Strait Islander women’s health and the need to remove the stigma surrounding pap smears. Williams’ story is not the first, and definitely not the last of negative healthcare experiences of POC people. However, it is the hope that self-tests can assist in removing shame and other barriers that prevent HPV and cervical cancer diagnosis.
But is it effective? The self-test has the same accuracy as an HPV test conducted by a clinician if clearly explained to patients. When you visit a GP requesting a self-test, a screening kit will be provided with a swab and instructions. You can then conduct the test yourself in the medical facility, give it back to the doctor, and the sample will be analysed. If your results come back positive, you will be asked to make an appointment with a GP to discuss diagnoses.
Why should I test? Well, it takes around 10 to 15 years for an HPV infection to cause cervical cancer (Cancer Institute NSW). So, being tested every five years is necessary to monitor and manage infection.
I am pretty psyched for one. I struggle with vaginal examinations like the best of them. While I love my GP, we can all admit that a pap smear or speculum test can be awkward. As an endometriosis sufferer myself, undergoing a speculum test can be extremely painful and uncomfortable. It is all about allowing people with a cervix to take control of their healthcare and feel safe in the process.
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