PATH's Cervical Cancer Prevention Action Planner

Lessons specific to vaginal sampling using careHPV™

There are advantages to offering pelvic examinations beyond cervical cancer screening and treatment. However, in most countries the capacity to conduct pelvic exams is low, as is the capacity to treat conditions that pelvic exams might reveal. Furthermore, many women do not like pelvic exams because they are uncomfortable and may be embarrassing, so the exams can represent a barrier to achieving high screening coverage.

PATH studies in India, Nicaragua, and Uganda have shown that vaginal sampling, including self-sampling, is an attractive option for many women. Providers may initially be skeptical of self-sampling in particular, but in PATH's experience they quickly begin to see its potential for reducing the burden of pelvic examinations and expanding screening coverage.

Client- and provider-perceived benefits of vaginal sampling and self-sampling

  • Vaginal sampling is rapid and convenient, both for women and for providers.
  • Vaginal sampling avoids the discomfort associated with pelvic exams.
  • Many women report that self-sampling was less embarrassing than exposing themselves during a pelvic exam. However, some patients reported that they did not like touching their genital area.
  • The sensitivity of vaginal samples is acceptable, though it is slightly lower than for cervical samples. It is higher than for Pap or VIA.
  • In general patients felt that self-sampling was easy to do once it had been explained to them clearly. Most said it was not painful.
  • Client- and provider-perceived drawbacks of self-sampling
  • Some women had concerns about not sampling correctly. They were afraid that the sample might become contaminated or otherwise unsuitable. They worried that they "could not see down there" and they felt that a trained provider could collect a sample more reliably.
  • Some—a minority—said that self-sampling was painful or uncomfortable or they were concerned about hurting themselves. Some worried about pushing the sample collection brush in too far, or they thought that the brush might be stiff or coarse. (In reality it is very soft.)
  • Obese women may have trouble reaching their genital regions and may need the provider to obtain a sample.

Strategies appropriate for vaginal sampling and self-sampling.

  • Consider offering vaginal sampling by nurses or other staff, or if the woman prefers, guide her to collect the sample herself.
  • Vaginal sampling, without the need for a pelvic examination, has the potential to dramatically increase access to screening for many women around the world. For example, in campaign-style situations, outreach teams could give self-sampling kits to women when visiting villages, and ask them to return the samples to the clinic later (or the team could collect them at the end of the outreach visit or pick them up in a return visit). Even in a clinical setting, women could be trained to sample correctly and given a private place to do so, speeding sample collection.
  • If a woman did not feel comfortable collecting the sample herself, a nurse, nurse’s assistant, or female "health helper" could be trained to collect a vaginal sample from the woman, freeing up higher-level clinic staff’s time and increasing screening rates. Such strategies could have a major impact on screening coverage in low-resource settings.
  • Some women may assume that the sample collection brush is coarse or stiff like a toothbrush or hairbrush. To reduce concerns about hurting themselves during self-sampling, when talking to women, show them the demonstration brush and how soft it is. Let them feel the brush on their arms.

Messaging specific for vaginal sampling and self-sampling

  • A vaginal sample is nearly as good as a cervical sample.
  • Pelvic exams are not necessary for collecting vaginal samples.
  • It is very easy to take a vaginal self-sample; many women in many countries have done it with no problem.
  • Don’t worry about doing it incorrectly or contaminating the brush; just follow the simple directions, step by step.
  • Self-sampling can be done in private, even in your home if you wish.
  • The brush used for sampling is very soft, like a feather (not like a hair brush) and it is very small. [Consider showing women the brush when explaining the procedure.]
  • Insert the brush until you feel resistance. This should be 5 to 8 centimeters (2 to 3 inches), or half the length of the brush.
Photo: PATH/Jose Jeronimo

Additional resources

Print version: Cervical cancer screening and treatment in low-resource settings (PDF, RHO Cervical Cancer website)

Watch videoScreening and Treatment of Precancerous Lesions video and transcript

Screening and treatment (RHO Cervical Cancer website)

World Health Organization: Comprehensive Cervical Cancer Control: A guide to essential practice (PDF)

Planning and Implementing Cervical Cancer Prevention and Control Programs: A Manual for Managers (PDF)

Evidence-Based, Alternative Cervical Cancer Screening Approaches in Low-Resource Settings

Strategic Plan for Cervical Cancer Prevention and Control in Uganda (PDF)

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