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PUID: 62 || PLAB 2 Mock 8 :: LGBTQ2: LGBTQ PAP Smear


Summary:

This PLAB 2 case revolves around counseling a 24-year-old woman who has received an invitation for cervical screening (smear test) and is confused or anxious about why she has been invited. The consultation focuses on reassurance, addressing misconceptions (especially around sexuality and eligibility), explaining the screening process, and discussing the updated NHS cervical screening guidelines.



Key Points:


Main Topic: Cervical Screening (Smear Test)

  • Cervical screening is routinely offered to all women aged 25–64 in the UK.

  • Invitations are usually sent just before turning 25 (around 24½ years).

  • The screening detects high-risk HPV (human papillomavirus) infection and early abnormal changes in cervical cells.

  • HPV is the primary cause of cervical cancer.


Updated NHS Cervical Screening Guidelines (July 2025)

  • Age group: 25–64 years.

  • Frequency: Every 5 years (previously 3 years for 25–49 years).

  • Primary test: HPV testing first, followed by cytology (cell changes) only if HPV is positive.

  • Follow-up:

    • If HPV negative → Routine recall after 5 years.

    • If HPV positive but normal cells → Recall after 1 year.

    • If HPV positive + abnormal cells → Refer for colposcopy.


Colposcopy

  • A microscopic examination of the cervix using a special magnifying device (no tube inserted).

  • Performed if abnormal cells are detected.

  • It is not painful; no biopsy unless visibly abnormal tissue is present.



Important Considerations:

  • The case is primarily a counseling and information-giving station, not a diagnostic one.

  • Avoid excessive medical data gathering — focus on addressing the patient’s concern (“Why was I invited?”) promptly.

  • Recognize that the patient may have misconceptions, especially regarding same-sex relationships and risk.

  • HPV transmission is possible through any sexual contact, regardless of partner’s gender.

  • Reassure that screening is for all women, not just heterosexuals.

  • Use non-technical, clear language (e.g., say “the lower part of your womb” instead of “cervix”).

  • Normalize and reassure about the routine and preventive nature of the screening.


Diagnostic Approach (for understanding):

  1. Acknowledge the concern immediately.

    • “I understand you’re wondering why you’ve been invited. Cervical screening is routinely offered to all women aged 25 to 64 to detect early changes that could lead to cervical cancer.”

  2. Explore understanding:

    • “Can you tell me what you already know about the smear test?”

  3. Clarify misconceptions:

    • Address belief that only heterosexual women need screening.

  4. Offer explanation of the procedure:

    • Outline what happens during the test and what results mean.

  5. Safety net:

    • Offer leaflets or NHS website links for further reading.


Management Plan:

1. Explanation and Reassurance

  • Explain why she was invited and the importance of early detection.

  • Reassure about the routine nature of screening and low risk of complications.

2. Address Misconceptions

  • Discuss HPV transmission in all sexual relationships.

  • Emphasize screening is based on age and eligibility, not sexuality or symptoms.

3. Explain Procedure

  • Performed by trained nurse.

  • Takes only a few minutes.

  • May cause mild discomfort but not pain.

  • Results usually sent by post within a few weeks.

4. Explain Follow-up Scenarios

  • HPV negative: next screening in 5 years.

  • HPV positive + normal cells: repeat test in 1 year.

  • HPV positive + abnormal cells: referred for colposcopy.

5. Support and Safety Netting

  • Offer NHS leaflets and website links.

  • Encourage asking questions and expressing concerns.

  • Reassure confidentiality.



Communication Skills:

  • Start by addressing the main concern immediately — don’t delay with unrelated questions.

  • Maintain a reassuring, non-judgmental tone.

  • Use colloquial terms understandable to laypersons.

  • Avoid stock phrases or overly rehearsed empathy statements.

  • Explore patient’s ideas, concerns, and expectations (ICE).

  • Use open-ended questions initially, then narrow down.

  • Demonstrate active listening and sensitivity toward sexual orientation and emotional concerns.



Ethical Considerations:

  • Maintain non-discriminatory communication — treat all patients equally regardless of sexuality or background.

  • Provide accurate, evidence-based information.

  • Ensure informed consent for discussing sexual history.

  • Uphold confidentiality and patient autonomy.

  • Provide clear and honest explanations about benefits and limitations of screening.



Additional Resources:

  • NHS Cervical Screening Programme: www.nhs.uk/cervical-screening

  • NICE Guidelines (NG12 & NG36) – Cervical screening and management of abnormal results.

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