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Emotional support to help survivors of sexual violence through cervical screening

We created this information in partnership with Rape Crisis.Over half of our survey respondents said they wanted healthcare professionals to have more emotional training to support survivors of sexual violence. It is very important to remember that sexual violence is extremely common, with an estimated to 1 in 5 women aged between 16 and 59 affected in England and Wales. So bear in mind that – even if they don't disclose their experiences during the screening appointment – 1 in 5 patients attending may have survived some form of sexual violence.

This information aims to give you an idea of how to offer the right emotional support to survivors of sexual violence. 

Read more about practical ways to support survivors > 

“[Smear takers] need to understand that having this test is traumatic for us. The way they are with us makes all the difference."

- A survey respondent and survivor

Listen, acknowledge and offer support

The most important thing is that women feel listened to, understood, safe, and supported before, during and after their smear test.

If a patient discloses an experience of sexual violence, make sure they feel heard, acknowledged, and understood – without judgement, and without intruding too much into territory they might find uncomfortable or distressing.

“The most important part was to feel I had been heard, closely followed by being offered solutions.”

- A survey respondent and survivor

Even if someone chooses not to disclose, smear takers can make the appointment more comfortable by allowing the patient to take their time, and asking general questions such as:

  • Do you have any concerns about the test?
  • Are there any words or phrases you would prefer me to use and/or avoid?
  • Is there anything I can do to make you more comfortable?

“As with all survivors, I don't want to hear too much about my abuser, or to talk about unnecessary details. The focus really needs to be on the survivor and their needs.”

- A survivor

They should be in control of what and how much is discussed, while you can support them by showing empathy and patience, and by accommodating any practical needs they might have. You do not have to be an expert in trauma, but showing warmth, kindness and compassion can make a big difference.

Respond appropriately to stress responses

Know the symptoms that indicate the patient is having a panic attack or dissociative episode, and try to remain calm, patient, and soothing rather than getting frustrated or expecting them to 'snap out of it'.

“Sometimes I dissociate. [The nurse] does not seem to understand that the discomfort and pain is so subjective or the need to take time is so important... I guess they have to get to next patient.”

- A survivor

Before the smear test itself, it might be worth discussing whether they are prone to panic attacks, dissociation, or freezing during stressful situations, and whether they have existing strategies that you can work with if the need arises.

“I have a printed timeline of photos of me up to the present, and I tell the nurse or doctor that if she loses contact with adult me, she needs to tell me it's 2018, that I survived and I am an adult now – and give me the photo line to remind me who I am. I also have a bag of items that will connect to each of my senses. These help me to anchor back in reality after dissociative episodes.”

- A survey respondent and survivor

For patients without a detailed emergency plan, try talking them through some simple breathing exercises or visualisation techniques, or chat to them calmly about something emotionally grounding. Most importantly, if a survivor is in obvious distress, do not proceed with the smear test without their explicit consent – even if this means abandoning the procedure altogether and arranging for them to return and try again another time.

Further information about stress responses:

Think ahead

As well as allowing survivors to proceed at their own pace, and collaborating with them on practical ways to make the appointment more comfortable, it might also be worth thinking beyond the immediate moment.

Remember that, unlike for many other patients, the cervical screening experience may not be limited to those few minutes in the treatment room. There may have been days, weeks or even months of anxiety leading up to the appointment and, following the test, survivors may also struggle to cope with the difficult emotions that have been brought up.

“Many women referred to the effect on coping mechanisms such as dissociation, depression and self-harm, and triggering of these responses and memories which some 'try to suppress' or avoid. Women reported having been once for their test, but that the consequences of it led to avoidance: 'I only went once… after I had to self-harm quite seriously… to help cope with the experience.'”

- Louise Cadman et al, Barriers to cervical screening in women who have experienced sexual abuse[1]

After the cervical screening is done, check in with the survivor about how they are feeling, and whether they have any questions or feedback for you. If the survivor needs some time before leaving the examination room or building, try to be accommodating and offer a space if possible.

Discuss whatever existing coping strategies and support networks the survivor may already have in place, and be prepared to signpost to appropriate support services if necessary. Without the right self-management or follow-up support, these challenges could deter survivors from attending subsequent screening appointments.

Read about other organisations you can signpost to >

“After my last screening, I struggled with severe anxiety, hyper vigilance, flashbacks and low mood for a week. It is not uncommon for a survivor to feel that they have been violated again after an appointment in which they feel they have no control.”

- Rosie, a survivor

References

1. Cadman L. et al, Barriers to cervical screening in women who have experienced sexual abuse: an exploratory study, BMJ Sexual & Reproductive Health, 2012. 

Date last updated: 
30 Jul 2018
Date due for review: 
30 Jul 2021