Let’s face it, smear tests are about as fun as going to the dentist and when that inevitable letter from your GP reminding you that your next appointment is due arrives, it is easy to feel cringed out. However, for Muslim women, it goes beyond five minutes of embarrassment.
Research shows that Muslim women are the least likely to go for a smear test. However, it isn’t the first generation Muslim immigrant mums missing out on their appointments.
Nope, it’s young British born Muslim women skipping their smears, with the cultural barriers of the past a present force when it comes to their health.
The trend is particularly worrying when you consider that cervical cancer is the most common cancer in women under 35, with 3,200 women diagnosed every year in the UK.
While cervical cancer is one of the most preventable cancers, thanks to effective national screening programmes which enables early detection and treatment, the cultural stigma around smears themselves means that many women from the Muslim community are missing out on a test that could potentially save their lives.
But why? Well, misconceptions surrounding the test act as a major issue along with cultural factors and social pressures.
Even though it’s clear that hymens are not CSI level proof of virginity, there is still the misconception among young Muslim women that if they have the test, they are ‘impure’ and will damage their chances of getting married.
It’s something Dr Zohra Ali, an oncologist who carries out leading cancer screening work for the British Islamic Medical Association, can attest to. She explains: “There remains a huge amount of stigma associated with cervical cancer screening in Muslim women of all ages, but particularly younger women.
“Reasons may include modesty within the Islamic faith and the significant embarrassment to genital exposure even for medical reasons, the concept of chastity in unmarried women, and the concern that speculum examination interferes with this.”
There is also the myth that smear tests are for women who have had multiple sexual partners or have been unfaithful which is a huge taboo in Muslim culture.
Dr Ali explains: “As cervical cancer is primarily but not always sexually transmitted, if found to be infected, the woman may be accused of promiscuity or unfaithfulness.”
Like a lot of Muslim women, Nylah Salam, said she received a reminder for her test, but was “petrified” about booking an appointment.
“It’s the fear of the unknown. I don’t know what to expect with the procedure, like how they do it and whether it’s a quick process or not. I have a low pain threshold, so pain is also another factor,” said Nylah, who works as a social media journalist.
“A lot of the fear is because in the Muslim community speaking about the intimate parts of your body is a big taboo and often seen as shameful to share this kind of information.
“It’s sad, but it stems from first generation parents who maybe don’t have that open relationship with their daughters to speak about such things because they probably didn’t ever have that with their own parents.”
Many women are also deterred from having the smear test due to family pressure. Often, young Muslim women will be nervous about going to their usual GP’s surgery because they don’t want family to know if they are sexually active or be wrongly accused of being sexually active when they are not.
“I avoided the test for years because I was so scared that my family would find out I have been sleeping with my boyfriend,” said Ayesha,* 24, who wished to stay anonymous. “A lot of girls who don’t even have boyfriends won’t have the test in case their parents think they are sleeping around. I’d rather risk cancer than risk my parents finding out I wasn’t a virgin.”
Tackling the misconceptions within the Muslim community about smear tests is no easy task.
When Laila*, a 26-year-old wannabe influencer decided to speak out about having a smear test on TikTok to raise awareness about the issue, she faced a massive backlash, mostly from Muslim men, but some women too and ended up closing her account.
“I had guys calling me a prostitute and asking me really intrusive questions about my sex life. There were guys calling it the slut test. My boyfriend was getting really angry that he couldn’t protect me and his family and friends also gave him a hard time.
“I am not ashamed of going public about having a smear test, but the negative attention I faced was overwhelming and affected my mental health and my relationship with my boyfriend and family.”
However, many Muslim women also feel there is a lack of cultural awareness within health services which puts them off booking the all important appointment.
“When I went for my test, I was a virgin, but the nurse didn’t discuss it with me. When she stuck the speculum in, I wasn’t prepared so it really hurt. I bled for a few days after. I wasn’t that bothered, but I can imagine a lot of Muslim girls would freak out about their hymens,” said Naima Hussain, a 28-year-old teacher.
“Health services are not completely inclusive despite saying they are. There needs to be a lot more culturally appropriate support for ethnic minority women. There is also a lack of knowledge when it comes to cultural and religious sensitivity among healthcare professions. I feel like they don’t see religion as a factor when it comes to women’s health.”
According to research by Jo’s Trust, the UK’s leading charity for cervical cancer, women from minority ethnic and disadvantaged communities are less likely to attend smear tests, with the charity warning that more needs to be done to address these cultural barriers.
“There are many barriers to cervical screening, such as past experience or trauma, or being unsure about what the test is for. There are cultural barriers too and the first step is understanding what the needs are in communities where uptake is lower and ensuring that everything is being done to make it easier for women to attend,” said Samantha Dixon, CEO of Jo’s Cervical Cancer Trust.
“This can be achieved through sharing information in home languages, having local advocates, or improving the accessibility of cervical screening.”
However, the dangers of skipping your smear test mean you could be playing Russian roulette with your health as Uzma from Glasgow discovered: “I wasn’t regular with smears because I wasn’t convinced I needed them. When I moved house, my new GP was really insistent about it so I did it. I hated the unpleasantness but it was done in five minutes.”
Three weeks later, Uzma received a call from her doctor. Her smear test had detected ‘invasive adenocarcinoma’, a rare and aggressive form of cancer and the doctor thought she may need a hysterectomy to survive.
Uzma told us: “I was only 29. I didn’t want to die. I thought I would never have kids. I fell into my mum’s arms sobbing.”
However, luckily because of the smear test, the tumour was caught early enough so she didn’t have to have the procedure. Now a mum of two, Uzma says the smear test saved her life.
“It’s frightening to think if I hadn’t had that smear I wouldn’t be alive today or had kids. That five minutes of mild unpleasantness during the smear changed the entire direction of my life. I know sometimes there isn’t awareness in our culture, but smears can save lives and the earlier women get them the better.”
If you are worried about having a test, there are a number of things you can do to make it easier.
Be open with your doctor and nurse and discuss your fears and worries, and that includes religious and cultural issues too. Also, you can always book a longer appointment if you need more time. Jo’s Trust have a handy guide on things you can do to make the experience easier.
While the test can be embarrassing, when you think about the alternative, perhaps it is not so bad after all. So next time the letter comes, we need to stop hiding it in a drawer and as a community, we can hopefully stop sweeping the issue of smear tests under the carpet.
