Cervical Screening

HPV is a very common virus. Most people will have HPV at some stage in their lives, often without knowing because it doesn’t usually cause any symptoms. 

There are more than 150 strains of HPV. Over 40 of these affect the genitals, including 14 strains that can cause cancer and other strains that cause warts.  

HPV can be passed on in a variety of ways including skin-to-skin contact, sex toys and all forms of sexual contact. Using barrier protection methods such as condoms and dental dams can help minimise HPV being passed on during sex; however, HPV can spread through skin-to-skin contact in areas the barrier may not cover.  

There is no treatment for HPV and the body’s immune system usually clears it naturally.  

Cervical cancer occurs when there is a significant growth of abnormal cells in the cervix. Most cervical cancers are caused by specific strains of HPV, typically HPV 16 and 18.  

If HPV does not clear naturally, it may cause changes to the cells of the cervix. HPV-related changes to cervical cells can sometimes develop into cervical cancer. This generally happens slowly, sometimes over 10 to 15 years.  

Cervical screening every 5 years is the most effective way to detect HPV and monitor any cell changes that might become cervical cancer. Screening works by testing the cervix and/or vagina for the presence of HPV, helping monitor the risk of cervical cancer developing.  

Not everyone who has HPV will get cervical cancer. In fact, 80% of people who test positive for high-risk HPV strains won’t develop cervical cancer.  

When someone has a strain of HPV that may lead to cervical cancer, extra steps can be taken to monitor the cervix for cell changes. Any cell changes that are found can then be treated early.  

The Cervical Screening Test (also called CST) screens for both HPV and, in some circumstances, cervical cell changes. The Cervical Screening Test is more sensitive than the previously used Pap test, which only examined cell changes. This increased sensitivity means the frequency of cervical screening has moved to 5 yearly. 

The Cervical Screening Test uses a swab (a bit like a COVID-19 swab) that is circled in the vagina and/or over the cervix. The swab collects a sample of cells which are used to find out whether HPV is present. 

Depending on how you do your test and the results, the test may also check for cervical cell changes. This means cervical cells can be monitored or treated to prevent cervical cancer from developing or progressing further. 

Cervical Screening Tests can be completed by trained doctors, nurses and midwives. Generally, cervical screening is available at your GP clinic, some health centres (such as Aboriginal health centres) and some sexual health centres. They may also be offered at pop-up clinics in your local area.  

You can also ask your regular healthcare provider if they offer cervical screening or can refer you. 

There are 2 ways to get a Cervical Screening Test. For most people, self-collection is now the first option offered. Many people prefer self-collection as it offers more control and does not involve a speculum. 

Self-collected Cervical Screening Test 

Many people don’t know there is a version of the Cervical Screening Test where you collect the sample yourself. It’s a simple, safe and quick test and is just as accurate at detecting HPV as having a healthcare provider conduct it. Self-collected cervical screening can be more comfortable for some people as it provides privacy and control, and may feel less invasive as it does not involve a speculum. 

The self-collected test is available for most people. It’s not recommended for a small number of people with a higher cervical cancer risk, specifically if you have symptoms of cervical cancer, as it does not allow for cervical cells to be tested for changes. If you’re asymptomatic, it is your choice how your test is performed. However, it is important to have a discussion with your healthcare provider on the best option for you, depending on your history and personal circumstance. 

You might be worried about doing it incorrectly. It's unlikely to do the test incorrectly, but a few people may be asked to repeat it. 

Healthcare provider-collected Cervical Screening Test 

A Cervical Screening Test can also be collected by a healthcare provider. This option may be recommended in some situations or preferred by some people. 

For example, if you have symptoms of cervical cancer, a higher-risk history or are receiving specialised follow-up care, you may need to have your screening test collected by a healthcare provider. 

When a cervical screen is collected by a healthcare provider, it can test for both HPV and changes to cervical cells.

From the community: “Now that I know what it’s actually like it’s much less stressful to think about, and I can tell other people in my community too.”

There are 2 ways a Cervical Screening Test can be done. What happens will depend on how your sample is collected. 

If you’re collecting the Cervical Screening Test yourself (self-collected)

You’ll be given a swab, instructions on how to collect your sample and a private space such as behind a screen or in a bathroom. Make sure your hands are clean and dry. When you’re ready, remove any clothing needed to access your vagina, including your underwear. You might find it helpful to place one foot on a raised surface. Hold the cap of the tube that contains the swab and undo the lid.

While continuing to hold the cap, insert the swab into the vagina. Most swabs have a marked line to guide how far it needs to be inserted. If your swab doesn’t have a line or you’re not sure, your healthcare provider should explain how far it needs to be inserted. You can ask them if you need more guidance. Gently rotate the swab inside the vagina for around 10 to 30 seconds. This is similar to a vaginal swab used for STI testing. The process is the same even if you have a differently shaped or angled uterus.

Remove the swab and place it into the tube, sealing it securely. Place it aside while you get dressed. Return the sample to your healthcare provider. If you’ve been given a pathology bag, place the tube into the bag and return it as instructed.

If your healthcare provider is collecting the Cervical Screening Test

A healthcare provider, such as a doctor, nurse or midwife, collects the sample by placing a lubricated speculum into the vagina so they can see the cervix. They then insert a swab through the speculum and gently rotate it over the cervix to collect a sample of cervical cells. They remove the speculum and swab and place the sample into a tube, which is sent for testing. The healthcare provider will usually offer tissues afterwards so you can remove any remaining lubricant. It is rare for a sample to be inconclusive. If this happens, you may be asked to repeat the test in 6 to 12 weeks.

You deserve to feel respected, informed and in control during your cervical screening.

From the community: “My best experience was with a practitioner who acknowledged my pain and was good about staged consent.”

A safe and inclusive experience may include: 

• being treated with respect and having your identity affirmed by all staff involved in your care 
• being asked what terms for your body feels right for you, and having that language used throughout the whole appointment 
• having the process explained before and during the test 
• being offered options, including self-collection where appropriate 
• being able to ask questions and pause or stop the test at any time. 

If something doesn’t feel right, you can questions, request changes or seek care from another provider. 

It’s understandable you might feel nervous about getting a cervical screen. There are lots of options to help you feel more comfortable through the process: 

• Write out a list of questions you want to ask your healthcare provider. 
• Read and learn about cervical screening before your appointment so you know what to expect. 
• Discuss any concerns or questions you have with your healthcare provider before the Cervical Screening Test, to ensure they can help you as you need. 
• Talk to your healthcare provider about the possibility of inserting the speculum yourself. 
• Take a fidget object with you so you’ve got something to focus on. 
• Take a support person into the appointment with you. It’s a good idea to have a chat with them before the appointment so they know what to expect and what support you’d like from them. 
• Listen to music. Music that feels good before, during and/or after the appointment may help you feel regulated. 
• Meditation may help create feelings of safety. You could try a simple box breathing exercise:  
  • Breathe in slowly through your nose for 4 seconds. 
  • Hold your breath for 4 seconds. 
  • Exhale slowly through your mouth for 4 seconds. 
  • Hold your breath for 4 seconds. 
  • Repeat the cycle for a few minutes. 

What happens after a Cervical Screening Test depends on your results. 

Most people will receive a result showing that HPV was not found. This means you can return to routine screening and you’ll receive a reminder from the National Cancer Screening Register to screen again in 5 years. If you’re unsure about your result or haven’t received it, you can follow up with your healthcare provider. 

If HPV 16 or 18 is found, you’ll be contacted and referred to see a gynaecologist for a colposcopy. This is the case regardless of whether your test was self-collected or collected by a healthcare provider. 

A colposcopy uses a speculum and a magnifying instrument called a colposcope to allow closer inspection of the cervix. The healthcare provider may take a biopsy (sample of tissue) of the cervix. A colposcopy is a standard part of follow-up care to look for abnormalities and cell changes of the cervix that weren’t picked up during the Cervical Screening Test. 

If other types of HPV are found, a sample of cells must be tested for any changes. 

• Self-collected samples can’t currently be tested for cell changes. If you self-collected, you’ll need to return to have a healthcare provider collect a sample. 
• If your sample was collected by a healthcare provider, it will be tested for cell changes.  

Depending on those results, you may be recommended a colposcopy or a repeat Cervical Screening Test in 12 months. 

If HPV is found, cervical screening is usually repeated after 12 months. In many cases, the body will have cleared HPV in this time. If not, appropriate follow-up care will continue based on your results. 

This does not mean you have cervical cancer. It means that further checks may be needed to keep you safe and well.

It’s okay to have different emotional responses after a cervical screening experience. You might feel fine, relieved, uncomfortable or distressed. All of these responses are valid. 

If you need help immediately, there are supports available: Crisis Contacts and Other Supports

Take some time to process what has happened, what was said and any actions you might need to follow up on. You might like to review any notes you took or make a plan for any next steps. If you’re feeling at capacity, it’s okay to come back to these things later by setting a reminder or asking someone you trust to support you. 

Some people find it helpful to do small things that support their body and mind after an appointment. You might like to: 

• go for a short walk, moving intentionally 
• take a nap with your favourite or weighted blanket 
• practice deep breathing exercises 
• meditate with a guided meditation app 
• eat a balanced meal with colourful, nourishing foods 
• talk with a supportive friend or partner 
• express your feelings 
• take your mind off things through an activity such as drawing or painting 
• have a bath or shower 
• spend some time in nature. 

You can add anything else that feels good for you here. Self-care can be whatever you need or want in the moment. 

The Cervical Screening Register (Register) is part of the National Cancer Screening Register and gets information from Medicare. You are automatically added to the Register if you’ve ever had a Pap or Cervical Screening Test at any point in your life. You’ll also be automatically added to the Register when you turn 25 if your gender in Medicare is ‘female’. 

If you’ve never had a Pap or Cervical Screening Test and have changed your gender in Medicare to ‘male’ before you turned 25, you won’t be automatically added to the Register.  

If you’re under 25, you can ask your healthcare provider to send you a reminder to do a Cervical Screening Test when you turn 25.  

If you’re over 25, speak to your healthcare provider about having a Cervical Screening Test. Having your first Cervical Screening Test will then add you to the Register and you can nominate how you receive your reminders to manage privacy. 

You will stay on the Register (even if you change your gender in Medicare) unless you manually remove yourself or until your exit screen around 74 years of age. 

The National Cancer Screening Register sends reminders when a screen is due. These can be received by SMS and/or by post. Reminders are non-gendered. The SMS reminder doesn’t use a name and you can provide a pseudonym for paper reminders. Paper reminders arrive in a plain, unbranded envelope to mitigate privacy concerns. 

Screening reminders and personal details (such as name changes and reminder preferences) can be made through the National Cancer Screening Register Participant Portal. This portal can be linked to your MyGov ‘linked services’ for ease of access. 

For more information, contact the National Cancer Screening Register on 1800 627 701.

Yes. HPV can be passed on by any person regardless of their anatomy. This means all people with a cervix who have ever been sexually active are at risk of HPV infection and cervical cancer.

If you have a cervix, are between 25 and 74 years old and have had sexual interactions of any kind then yes, cervical screening every 5 years is recommended (or more often if your test results require closer follow up). You might like to consider how you talk about your anatomy with your healthcare provider before your appointment. 

If you’ve had a vaginoplasty and don’t have a cervix, you don’t need cervical screening. However, you may like to talk to your healthcare provider about vaginal HPV screening.

If you have a cervix, are between 25 and 74 years old and have had sexual interactions of any kind then yes, cervical screening every 5 years is recommended (or more often if your test results require closer follow up). Being on testosterone doesn’t change the risk of cervical cancer. 

Testosterone can cause changes in the genitals that may make cervical screening less comfortable (such as dryness or irritation). A doctor can provide a prescription for an oestrogen-based product to be used inside the vagina for a short period of time before the cervical screen. This can make the test more comfortable by directly addressing these changes. There are no systemic nor feminising effects from using this treatment and it won’t impact testosterone treatment.  

Alternatively, you may choose a self-collected test if you’re eligible.

If you have a cervix or cervical tissue, are between 25 and 74 years old and have had sexual interactions of any kind then yes, cervical screening every 5 years is recommended. You might like to consider how you talk about your intersex variation and anatomy with your healthcare provider before your appointment. If you’re unsure if you have a cervix or cervical tissue, consult your care team to get advice about your recommendations for cervical screening specific to your anatomy. This may include having a test which checks for HPV in the vagina if there is no cervix or cervical tissue and there is a risk of vaginal cancer.

Cervical screens are required if you’ve had a partial hysterectomy and your cervix was not removed as part of your hysterectomy. If your cervix was removed, you may need a different test of the vaginal walls to check for the presence of HPV. You’ll need to confirm this with your healthcare provider as it’s based on your individual circumstances.

You may need to screen every 3 years instead of every 5 years. This monitors any potential risk if your immune system takes a bit longer to clear HPV. Speak to your healthcare provider to get the right information for you and get your screening reminders at the correct interval.

Yes, cervical screening is still recommended even if you’ve been immunised against HPV. The HPV vaccine, like all vaccines, doesn’t stop you from getting a HPV infection. It helps the body fight the infection, which means HPV is generally cleared faster, reducing the risk of cervical cell change and cervical cancer.

The HPV vaccine is free for people up to 26 years and routinely provided to year 7 high school students. It is not generally recommended for people over 26 years due to the potential of prior exposure to HPV. 

If you didn’t get this vaccination at school or anywhere else, you can get it anywhere you get vaccines such as GP clinic and health centres. 

Some people at higher risk of HPV may be recommended the vaccine even if they are over 26. Talk to your healthcare provider to see if this is right for you.

If you’ve had any sexual contact that involved your genitals and you have a cervix then yes, cervical screening is recommended. HPV can be passed on in several ways including through skin-to-skin contact, fingers and shared sex toys. This means you can get HPV and be at risk of cervical cancer even if you haven’t had penetrative sex.

Everyone has a unique experience of cervical screening. Our bodies vary and each healthcare provider does things slightly differently. For some people, cervical screening is quick and painless. For others, it may feel uncomfortable, pinchy or painful. Some people may experience discomfort or pain for a range of reasons. This can include people: 

• taking testosterone 
• who are post-menopausal 
• with genital or pelvic pain conditions 
• who experience dryness, sensitivity or anxiety 
• who have any other condition that may cause additional pain during a Cervical Screening Test. 

Many people’s understanding or expectations of cervical screening are based on past experiences when screening was only done using a speculum. Self-collection is a newer option that many people find more comfortable, as it does not involve a speculum. People who have used self-collection often report feeling more control and comfort during their screening. 

Most people are eligible for self-collection. However, in some situations, a collection by a healthcare provider may be recommended. If you think this option may reduce discomfort for you, you can ask your healthcare provider about your options.

If you need a test collected by a healthcare provider, there are ways to make the experience more comfortable. You can talk to your healthcare provider about options such as using a smaller speculum, taking more time, using lubrication, trying a different position or inserting the speculum yourself. In some cases, oestrogen-based treatments (which are local and not feminising), pain relief or anti-anxiety medication may also be recommended.

Your healthcare provider should be open to hearing about your needs and working with you to make the experience as comfortable as possible. You can also ask to pause or stop the test at any time. 

In Australia, the Cervical Screening Test replaced the Pap test (also known as Pap smear) in 2017. The Pap test only tested for cell changes (not HPV). 

Testing for HPV is considered more sensitive in early detection and monitoring, as HPV causes the majority of cervical cancer cases. This means screening has changed from 2 yearly to 5 yearly for most people. 

• Swell, Meridian’s guide to being sexually well for lesbian, bisexual and queer+ women. This website has resources to navigate sexual health and wellness from STIs and testing to protection and self-care.
• Messy Meridian website created for and by trans and gender diverse folks and their allies, made in collaboration with A Gender Agenda. This website embraces the beautifully complex and messy intersection of sex, intimacy, relationships and identity in safe and pleasurable ways.
• National Cancer Screening Register’s page on the National Cervical Screening Program 
• Australian Government Department of Health, Disability and Ageing’s page on the National Cervical Screening Program 
• Cancer Council’s summaries of the National Cervical Screening Clinical Guidelines. 

The information in this resource has been collated with input from diverse communities and made with assistance from the ACT Government under the LGBTIQ+ Community Health Services Program.

We gratefully acknowledge the support of A Gender Agenda (AGA), Sexual Health and Family Planning ACT (SHFPACT), Capital Health Network and Canberra Sexual Health Centre in the creation of these resources.