Older people

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.