Cervical screening in women with a Learning Disability

The Public Health England (PHE) screening team have collaborated with screening nurses, practice nurses and clinicians to improve the uptake of cervical screening by women with a Learning Disability. They aim to improve this by improving the information available and signposting other useful resources.

This guideline contains guidance for GPs and easy read documents for patients.


Suggestions that may help to increase a woman's understanding of cervical screening
  • Find out how the woman communicates - you may need to ask carers.
  • Find out which word the woman uses for vagina so that you don't get misunderstandings.
  • Offer a pre visit so that that the woman can feel safe whilst you explain about the test.
  • Show the speculum and sample broom to the patient. Let her handle it and explain how they work. For example "You will feel the speculum being inserted."
  • Show her the position that she will need to be in when she has the test.
  • Encourage her to get onto the couch to see what this feels like.
  • Suggest that she practices the position at home so she feels more comfortable about it. This can be done with her clothes on in her bedroom where she feels relaxed, so that she gets the feel of the right position. Carers may need to support this.
  • If she wishes to have somebody present during the test, reassure her that it's her choice.
  • Offer a longer appointment.
Remember the woman
  • Needs to have an understanding of what will happen at the test.
  • Needs to be able to remember this information for as long as it takes to do the test.
  • Needs to be able to understand that by having the test that it will help her to stay healthy.
  • Needs to be able to tell you by any communication mean that she would like to try to have the test done.
  • Still needs to have an understanding of the signs and symptoms of cervical cancer. There is an easy read guide in the supporting information section below.

Consider prescribing your patient something to help her to relax if you think this is indicated.

If you have decided that your patient has not understood enough to make her own decision on cervical screening you need to make a best interest decision for her. See " Useful advice for making a best interest decision"

To defer or cease women without capacity to consent to cervical screening see the Mental Capacity Act guidance

Mental Capacity Act Deferral form

GP letter template to carer's

Supporting Information

Patient Information

An Easy Guide to Cervical Screening
(Department of Health)

Easy read guide to having a Smear Test
( Family and Advice Information Resources)

Easy read Cervical Cancer Information leaflet

Easy read guide to having a Smear Test
(Jo's cervical cancer trust)

' The Smear Test Film' is a health education resource for women eligible for cervical screening (smear tests) who have mild and moderate learning disabilities. It has been made by Public Health England in association with Jo's Cervical Cancer Trust.

Pathway Group

This guideline has been signed off by the Northern Locality on behalf of NEW Devon CCG.

Guy Bradley-Smith - NEW Devon CCG Clinical Commissioning Lead for Learning Disability

Publication date: May 2016


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