26/08/2026
A thought-provoking case I saw in clinic today…
A patient with vaginismus.
And it got me thinking about the news this week that NHS England is rolling out at-home HPV self-testing to almost 4 million women who are overdue their cervical screening.
I think this is genuinely a game changer.
Because vaginismus is not “all in her head”.
Neither is pain during a gynaecological examination.
And for some of the women I see, being asked to have a speculum examination isn’t a simple 5-minute appointment. It can bring up trauma, fear, shame, memories of previous painful or frightening procedures, psychosexual difficulties, or a body that has learned to protect itself because pe*******on has previously been painful.
I see women with PTSD and sexual trauma. Women who have had previous gynaecological procedures that were painful. Women with chronic pelvic pain. Women with vaginismus. Women whose bodies tense up before they’ve even consciously registered what is happening.
And then we wonder why they don’t attend cervical screening.
We talk a lot about screening uptake and “non-attendance”.
But sometimes I think we need to ask a different question:
What has happened to this woman that makes attending feel so difficult?
The new HPV self-sampling test doesn’t replace cervical screening — if high-risk HPV is detected, a woman will still need to attend for a clinician-taken sample from the cervix. But for someone who has been unable to face that first step, being able to take a vaginal swab privately, in her own home, without a speculum or clinician present, could be the difference between screening and not screening at all.
And that matters enormously.
Because prevention only works if people can actually access it.
For some women, choice, control and feeling safe aren’t “nice extras” around healthcare.
We should recognise that one approach does not fit every body, every history or every nervous system.
www.berkshiremenopauseclinic.com
