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Friday, March 5, 1999 Published at 04:47 GMT


Vulnerable women miss out on smear tests

Women with learning difficulties are much less likely to have smear tests

Women with learning difficulties are more than five times less likely to be screened than other women.

According to a report in the British Medical Journal, part of the reason may be due to NHS staff assuming people with learning difficulties are not sexually active.

Studies have shown that women who become sexually active at an early age or have several sexual partners are more likely to develop cervical cancer.

Researchers from Southampton and South West Hants Health Authority studied statistics on 389 women with learning difficulties who lived in one health district and who had had contact with social or health services.

They found that 13% of the women aged 20 to 64 - the age when women are routinely screened for cervical cancer - had had a smear test in the previous five years.

Four per cent had had inadequate tests and one woman had had a follow-up for a previously abnormal test.

Coverage for women in the general district population was 88%.


The researchers say it is unclear why the rate for women with learning difficulties was so low.

However, they speculate that it could be because health professionals wrongly assume people with learning difficulties are sexually inactive.

Other factors, they say, may include:

  • Low demand for screening from the women themselves;
  • Perceived difficulty in gaining consent for screening;
  • Problems using appointment systems and waiting rooms;
  • Uncertainty about whether the service should be provided by GPs or specialists;
  • Pressure of competing demands from other patients;
  • Inadequate training of GPs in how to communicate with people with learning difficulties.

Sexual abuse

Mencap, a leading charity for people with learning difficulties, said it was not surprised by the results.

Its report, The NHS - Health for All?, published last year, found an average of 8% of women with learning difficulties had been screened for cervical cancer, compared with 85% in the national population.

Women who lived at home were much less likely to be screened than those who lived in care homes.

Only 3% of people living at home had had a smear test, compared with 17% of those in care.

Mencap agrees that women may not be offered screening because they are assumed to be virgins.

"This assumption is a common one," it says in the report.

"Though the risk is diminished, there is still some incidence of cervical cancer among celibate women."

Mencap also says it may be difficult to know if a woman with learning difficulties has never been sexually active.

For example, people with learning difficulties are at risk of sexual abuse, which may sometimes never come to light because of problems telling others about it.

Mencap says it may be that women find the smear test distressing and may need to build up trust in health workers conducting the test.

This could be done through a series of visits before the test is carried out.

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