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There’s been a drop in women getting smear tests – prudish British sexual attitudes are costing lives

Poor sex education, fear of nudity and a stiff upper lip are all to blame for the embarrassment British women feel about cervical screening

Sarah Wilson
Sunday 27 January 2019 15:41
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Chloe Delevingne has a live smear test on BBC to encourage young women to get tested

With the number of UK women attending cervical cancer screenings at a 21-year low, Jo’s Cervical Cancer Trust recently conducted a survey to find out why. The results showed that the prevailing reason why those surveyed had avoided or skipped screening was not fear (71 per cent) or feeling vulnerable (75 per cent), but “embarrassment” (81 per cent), with women citing anxieties about the smell and appearance of their vulva.

Many have immediately jumped to lecturing women, saying that their embarrassment is “unwarranted” or even “silly”, but this fails to address quite why so many feel the same way. The fact is that in Britain, our cultural aversion to openly discussing gynaecological and sexual health is the culprit. It’s cultivated shame, embarrassment and, consequently, a dangerous decline in screening numbers.

Nothing makes the cultural specificity of this problem clearer than looking to the example set by other developed countries in Europe and beyond. Currently residing in Berlin, I took my first ever trip to the gynaecologist last year, and anticipated some pain, discomfort and a possible language barrier. What I hadn’t expected was the look of sheer horror on my gynaecologist’s face when I revealed that, at the age of 22, I’d never been checked out before. In Germany, women regularly attend the gynaecologist from the age of 20 (cervical cancer very rarely develops in women under the age of 20).

Relaying the story of this visit to a (British) friend some months later, I got a good way in before she admitted she didn’t know what a “gynaecologist” was. And who could blame her? In other parts of the world, annual gynaecologist visits begin from as young as 13. In Britain, most women won’t go until age 25, when the NHS invites them to their first cervical screening. It wasn’t from school or my peers that I learned the term “gynaecology”, but from American films, where women breezily discuss (and attend) appointments with the “gyno” like it’s the most normal thing in the world.

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That’s not to say those elsewhere are getting pap smears every time they visit the gynaecologist. But in countries where annual visits are the norm, women have the chance to develop a relative level of comfort with the process of being examined, and to feel at ease with expressing any concerns they may have. In a report on “Inequalities in cervical screening practices in Europe”, in fact, it’s noted that women who are not in the habit of regularly seeing a gynaecologist, like many in Britain, “are less likely to participate in screening”.

It’s not just a lack of these regular visits that contributes to embarrassment around gynaecology, but an absence of frank discussions in schools. From an early age, children are socialised to use fluffy, euphemistic terms for the vagina and vulva, implying that the real terms are too shameful or shocking to say out loud. In the eyes of some feminist theorists, in fact, this lack of a universal label to describe the vagina is the starting point for a lifetime of alienation and embarrassment when it comes to gynaecological health; a feeling that only multiplies with the patchy sex education that comes along later.

If this weren’t enough to sow the seeds of shame, British people also have a cultural aversion to nudity. We, as a nation, rarely see other naked bodies growing up. While in countries such as Germany, Sweden and Denmark nudity is common in spas, changing rooms and parks, in Britain people largely shy away from exposing themselves, with scant numbers of schoolchildren using school showers even after exercising.

Though there is no direct correlation, studies have shown that naturist activities can boost self-esteem, with the logic following that exposure to a greater array of body types avoids a warped sense of what’s “normal”. In the absence of this access, young Brits have turned to unrealistic pornographic videos for guidance, in which almost every vulva has “neat”, tucked-in labia, and every actor a “perfect” figure. It’s no wonder, then, that British women have the second lowest self-esteem in the world, or that the demand for labiaplasty has increased.

Self-esteem and body issues are not unique to British women, of course. But these shocking screening figures certainly point to something deeper that’s driving widespread “embarrassment”. We can wish it away all we want, but until we shift our awkward British attitude towards sexual health and gynaecology, the next generation of women will likely risk skipping their appointments too.

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