By Ceryl Davies
Cervical screening remains one of the most successful public health interventions ever introduced, preventing thousands of cases of cervical cancer through the early detection and treatment of abnormal cell changes. Yet for many women, attending a cervical screening appointment is far from straightforward. For women living with the impact of sexual violence and abuse (SV&A), the screening experience can be shaped by fear, trauma, loss of control and previous negative healthcare encounters.
Our recently published systematic review in BMJ Sexual & Reproductive Health brings together international evidence examining cervical screening care for women affected by SV&A. The review forms an important part of the wider WE CARE (Women’s Empowerment: Cervical Screening Access, Recovery and Empathy) research programme, a five-year research project led by Bangor University that aims to improve access to compassionate cervical screening through research, co-production and health and care economics evaluations.
For many women affected by SV&A, barriers begin long before they enter the consultation room. Anticipation of pain, anxiety about intimate examinations, previous traumatic experiences, fear of losing control, embarrassment and concerns about not being believed can all influence whether screening feels possible. Some women delay appointments for years, while others avoid screening altogether despite understanding its importance. Importantly, these barriers are not simply individual choices. They reflect the way healthcare systems are designed and delivered. Standard appointment lengths, limited flexibility, inconsistent communication and a lack of awareness of trauma can unintentionally make screening inaccessible for some women.
One of the strongest messages emerging from the review is that compassionate care should not be viewed as an optional extra. It is a fundamental component of high-quality healthcare. Across the studies reviewed, women consistently identified the same features of care that enabled them to feel safe enough to participate in cervical screening. They valued being listened to without judgement, receiving clear explanations before and throughout the examination, and knowing they could stop or pause the procedure at any point. Having genuine choice and control over the appointment, together with healthcare professionals who recognised and understood the impact of trauma, helped create an environment in which women felt respected, empowered and more able to engage with screening. These are often relatively small changes in practice, yet they can make the difference between someone feeling able to attend screening or deciding never to return.
This systematic review provided the evidence base for the WE CARE project to translate this evidence into practical change. Working alongside women with living experiences of SV&A, healthcare professionals, specialist support organisations and researchers across the UK and internationally, WE CARE is exploring how cervical screening services can become more compassionate, sensitive and accessible. Compassionate care is not only about improving experiences, but it also has the potential to increase screening participation, reduce health inequities and prevent cervical cancer.
The findings from this systematic review reminds us that there is no single “typical” screening experience. Women affected by SV&A are a diverse group whose experiences are shaped by many intersecting factors including disability, ethnicity, age, culture, sexuality, geography and wider social inequalities. Improving cervical screening therefore requires more than one solution. It requires flexible services, compassionate communication, genuine partnership with women and policies that recognise equity as an essential part of quality healthcare.
The publication of our systematic review marks an important milestone in the WE CARE project, but it is only the beginning. Over the coming years, WE CARE will continue working with women, practitioners and international partners to co-produce practical research and recommendations that can support services across Wales, the UK and beyond.
Dr Ceryl Teleri Davies is a Senior Research Fellow at the Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University, Wales. She is a HCRW and NIHR Advanced Fellow, a qualified social worker and health and social care researcher. Her work spans social care and health economics, women’s health, violence against women and girls, safeguarding, compassionate care and health inequities. She leads the international WE CARE project, exploring compassionate cervical screening care for women affected by sexual violence and abuse. Ceryl is also a 2026 Churchill Fellow, examining international approaches to compassionate care. Her work brings together practice, research, health and care economics and lived experience to inform policy and health and social care practice.