Older people

Find information and resources on how to engage older patients in cervical screening.

Resources

You can provide these resources to patients to help them before, during and post screening. See the full resource library.

    Before screening appointment

    During screening appointment

    Post screening appointment

    Barriers

    There are general barriers that people face in participating in cervical screening. Older patients can face extra barriers relating to:

    • pain and discomfort associated with speculum insertion
    • misconceptions that people who have been in a monogamous relationship for many years or no longer have a partner, do not require cervical screening.
    • misconceptions that if you have reached this age and never had a screen that there is no need to have one now
    • misconceptions that people who are no longer sexually active do not require cervical screening
    • misconceptions that people who have had a hysterectomy do not require cervical screening.

    Strategies to engage

    Strategy

    Detail

    Explain that HPV may lay dormant

    • It is important to tell older patients that HPV is common and may lay dormant for many years, even decades.
    • Reinforce that no matter how long it has been since a person was last sexually active, cervical screening is still important to help prevent cervical cancer.

    Determine type and reason for hysterectomies

    • Patients who have had a hysterectomy should discuss whether vaginal screening is required with their healthcare provider. The answer will depend on the type of hysterectomy performed (i.e. whether the person still has a cervix) and the reasons why it was needed.

    Making the Cervical Screening Test more comfortable

    • With a loss of oestrogen after menopause there is a natural decline in vaginal lubrication. The vaginal walls can become thinner and dryer, contributing to pain or discomfort during vaginal examinations. Discuss cervical screening and determine whether your patient finds the Cervical Screening Test painful.
    • Offer self-collection as a more comfortable and acceptable option for screening.
    • If clinician-collection is chosen some of the below points may assist.
      • A short course of vaginal oestrogen cream prior to cervical screening can be effective in preparing the vagina temporarily for a more comfortable Cervical Screening Test as it reduces vaginal atrophy and dryness.
      • Some patients may prefer to insert their own speculum and it can be helpful to offer this option.
      • Providing instructions on calming and deep breathing techniques can also help the patient to relax.

    Choice of cervical screening collection method

    • Offer the choice of either self-collection or clinician-collection screening options.
    • Explain the pros and cons of each option, including follow-up requirements if HPV is detected on a self-collected vaginal sample.
    • Consider offering home-based self-collection (e.g. via a telehealth consultation) where appropriate.
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