Pregnant Women:
Cervical screening is not routinely performed during pregnancy in Ireland.
- Women with a negative screening history or those who have never been screened may defer their cervical screening test until three months after the birth of the baby.
- If a screening test is abnormal and the woman becomes aware that she is pregnant, she should still be referred for colposcopy if advised. She should be encouraged to attend her appointment and reassured that colposcopy is safe during pregnancy.
- Note that HPV infection does not impact pregnancy outcomes.
Post-Natal Women:
A woman does not require a screening test routinely after childbirth unless it is due.
If a woman is due for a screening test according to her call or recall recommendations, wait until three calendar months after she gives birth.
Breastfeeding Women:
Women who are breastfeeding should wait until three months after the birth of their baby before having their screening test. Breastfeeding is not a contra-indication to cervical screening.
During lactation, low oestrogen levels can cause vaginal dryness. Lubricants are recommended for comfort during the screening if required. Click here to read our information sheet about lubricants.
Post-Miscarriage or termination of pregnancy:
If a woman has had a miscarriage or termination of pregnancy (TOP), and is due for a screening test, it is advised to wait until three calendar months after the miscarriage/TOP before taking the test.
Women with renal failure requiring dialysis, pre/post renal transplant, or are undergoing pre-solid organ transplant workup, should attend for annual screening. Please refer to the CervicalCheck Eligibility Framework. Women in this group are referred to colposcopy following their first positive HPV result. These women are eligible from the time of diagnosis, even if aged under 25 years, but will exit the programme at age 65.
It is important that you complete the screening form highlighting this information in the Clinical Details section by ticking the appropriate box/boxes. By ticking the appropriate box/boxes, you are ensuring that the laboratory has the required information to apply the correct recall for the women with these special circumstances.
The following link is to the Cervical Screening Form
Cervical Screening Form.
The following is a link to information on how to complete the Cervical Screening Form
How to complete the cervical screening form - GP practices
All women with a diagnosis of HIV should have annual cervical screening tests when appropriate i.e. after first sexual contact. Please refer to the CervicalCheck Eligibility Framework. The sample taker is responsible for ticking the box “HIV Positive” on the cervical screening form to identify that the woman has a HIV infection and is eligible for annual screening tests. This information is not stored on the woman’s cervical screening record, so needs to be entered for every test.
These women are eligible from the time of diagnosis even if aged under 25 years but will exit the programme at age 65 years unless there are extenuating circumstances. See below:
WHO recommendations on managing cervical screening in women living with HIV.
It is important that you complete the screening form highlighting this information in the clinical details section by ticking the “HIV positive” box. If you do not tick the box, the laboratory will not be aware of the woman’s medical history and may assign an incorrect recall.
Link to Cervical Screening Form
Cervical Screening Form.
Link to how to complete the Cervical Screening Form
How to complete the Cervical Screening Form - GP practices.
Women with autoimmune conditions or those taking immunosuppressant medication are managed as per the normal eligibility criteria. There is little evidence to support more intensive screening for women on routine immunosuppression therapy once they have a HPV ‘not detected’ result.
The current Standards for Quality Assurance in Primary Care and Other Cervical Screening Settings recommend that only women who are pre or post organ transplantation, those on renal dialysis, and women living with HIV have annual screening. Therefore, increased screening is not advised for women with autoimmune conditions or those on immunosuppressant medication.
Link to standards - Quality Assurance in Primary Care and other settings
The human papillomavirus (HPV) is responsible for >90% of cervical cancer. Family history of cervical cancer is not a major risk factor for developing cervical cancer. This means it is not passed down genetically, like some breast or ovarian cancers can be. A person can develop cervical cancer even if no one else in their family has had it. Similarly, they might not develop cervical cancer, even if someone else in their family has had it. There is limited research suggesting that if someone with a close family relationship had cervical cancer, their risk of developing it may be slightly increased. This could be their mother, sister or grandmother. We don’t know the exact reason for this. We know that smoking and not attending cervical screening are the two biggest risk factors for developing cervical cancer. Scientists are also researching whether it could be related to genetic differences in a person’s immune system, which could make them less able to clear HPV infection.
This indicates that more frequent cervical screening is not necessary if a close family member has had cervical cancer. The primary risk factor for cervical cancer is a persistent HPV infection, not family history.
Cervical screening is based on eligibility. A woman does not require an additional test as part of her fertility treatment/investigations. See CervicalCheck Eligibility Framework. Women who are embarking on fertility investigations or treatment should be advised to ensure that they are up to date with their screening by checking their eligibility online.
Women who have undergone pelvic radiotherapy for cancers of the genital tract, bowel, or bladder should not continue with cervical screening. Radiotherapy alters cervical cell structure, making cytology unreliable. While HPV screening may have a role in the future, current practice focuses on vigilant symptom monitoring due to increased cancer risks. Please see the guidance note on when cervical screening is not advised for further information.
In situations where cervical screening is not advised, please complete the Cervical Screening Not Advised form and email it to info@cervicalcheck.ie.
Eligibility depends on the type of hysterectomy:
- Sub-total hysterectomy: cervix or cervical remnants remain
- Total hysterectomy: entire cervix removed
Click here to read more about different types of hysterectomies.
If a woman has a hysterectomy but her cervix is still intact, she should be screened as per the general population. This is documented on the screening form as a sub-total hysterectomy and the sample site is marked as cervix.
If the total hysterectomy is for non-CIN or non-cancer pathologies, no further cervical screening is needed. The treating clinician or the GP should complete the Hysterectomy Data Collection Form and advise the woman she requires no further screening. Click here to access the Hysterectomy Data Collection Form.
If a total hysterectomy is performed for treatment of CIN, or unexpected CIN is noted on histology, the woman should be referred to colposcopy by the Gynaecologist who performed the hysterectomy for follow-up. The treating colposcopist will determine the follow up and discharge instructions.
Finally, if a woman reports having a total hysterectomy but her histology is unknown, such as in cases where there is no available documentation detailing her procedure and outcome, she should undergo one further screening test. If this HPV test is negative, she can be discharged from screening, provided her doctor signs and returns the Hysterectomy Data Collection Form to CervicalCheck to confirm that the woman requires no further screening.
Click here to read the full Guidance Note on screening after hysterectomy.
CervicalCheck does not have access to a woman’s medical history or records. She can only be removed from the register by herself, or by her GP completing the Hysterectomy Data Collection Form. CervicalCheck does not automatically remove women from the Cervical Screening Register after hysterectomy, as the Programme does not have the relevant information. A woman will no longer receive invitation letters once the doctor returns the Hysterectomy Data Collection Form, confirming a total hysterectomy and no further need for screening (provided there is no history of CIN treatment or unexpected CIN on histology). Click here to read the full Guidance Note on screening after hysterectomy. Once the form is processed and actioned on the register, the woman will be notified by post that she will no longer be invited for screening.
CervicalCheck invites women between the ages of 25 and 65 for cervical screening. Cervical cancer is rare in women who have never been sexually active (Winer et al, 2003). While we cannot say that there is no risk, we know the risk is very low. The risk of developing cervical cancer is minimal if a woman has never had any sexual contact with a man or woman. Sexual contact includes vaginal, oral or anal sex, as well as any skin-to-skin contacts with the genital area, and the sharing of sex toys.
Low-risk individuals: Some individuals have an extremely low risk of HPV infection and may not benefit from participating in the cervical screening programme. HPV is transmitted through any form of sexual contact, including skin-to-skin contact of the genital area. If an individual has never had sexual contact involving their genital area, their risk of HPV infection is low. However, it is essential to thoroughly counsel patients to ensure that they fully understand all the possible circumstances in which they could have been exposed to HPV before deciding to opt out of screening.
Importantly, the presence or absence of hymenal tissue should not automatically influence the decision to exclude someone from screening without careful discussion of their individual risk of HPV infection.
In situations where cervical screening is not advised and the patient is in agreement, please complete the Cervical Screening Not Advised form and email it to info@cervicalcheck.ie.
Personal choice: It is ultimately the woman’s decision to participate in cervical screening. If they choose not to proceed and no longer wish to receive invitations, they have the option to opt out. This means they will not be invited for cervical screening in the future.
If at any point the person wishes to return to cervical screening (up to the age of 65) or if they become sexually active, they can contact the programme and an invitation will be issued.
In all cases, it is crucial to provide comprehensive and easily understandable information to support an informed decision. It is important to communicate that opting out may result in early signs of cervical cancer going undetected.
Ensuring an informed decision
Women who are advised that screening is not needed and those who choose to opt-out will be made inactive on the Cervical Screening Register (CSR) and will no longer receive letters from CervicalCheck inviting them for cervical screening tests. This ensures that the individual’s decision is documented appropriately and that they are removed from the screening programme when indicated.
Participation in cervical screening can be deferred, and the woman informed that if/when she becomes sexually active, she should have a cervical screening test.
If the woman does not want to have a screening test and does not want to participate in the screening programme, an opt off form can be completed and sent to CervicalCheck. This will mean the woman will not get any further invitations from CervicalCheck. She can however opt back in at any stage in the future by booking a cervical screening test.
In line with the principles of the Assisted Decision-Making (Capacity) Act, patients can be supported to decide if cervical screening is right for them.
Cervical Check have developed a set of resources to assist women with intellectual disabilities or cognitive impairment to use the Cervical Screening Programme available at Accessible cervical screening information.
There are five different decision support arrangements available. These arrangements are based on the different levels of support that a person requires to make a specific decision at a specific time.
- Decision-making assistance agreement (the person makes their own decision with support from their decision-making assistant. Their decision-making assistant helps them to access and to understand information and to communicate their decision).
- Co-decision-making agreement (the person makes specified decisions jointly with a co-decision-maker).
- Decision-making representation order (the court appoints a decision-making representative to make certain decisions on the person’s behalf).
- Enduring Power of Attorney.
- Advanced Healthcare Directive.
CervicalCheck’s Access Officer is available to help women with additional needs with any queries or assistance required in relation to cervical screening, please email access@cervicalcheck.ie.
Diethylstilboestrol was prescribed to pregnant women between 1941 and 1975, before it was withdrawn due to safety concerns. Women exposed to DES in utero (referred to as DES-Daughters) are at increased risk of clear cell cancer of the lower genital tract. These women should have a colposcopy assessment in a specialist setting to determine if they require additional screening. The DES clinic at the National Maternity Hospital is recognised as the national centre of excellence and manages all known cases of DES exposure in Ireland.
Women who do not have a history of DES exposure, or who have not been assessed as having signs suggestive of exposure such as vaginal adenosis or T-shaped uterus, should have routine screening.
Daughters of women exposed to DES in utero (DES-granddaughters) are not at increased risk and should have routine screening.
Yes, transgender men who have a cervix are eligible for cervical screening and should follow the same guidelines as cisgender women. If their gender is documented as “female” they will be imported from the Department of Social Protection database. Trans-men will need to self-register with CervicalCheck if they are registered as male with the Department of Social Protection. We don’t ask for gender when registering online.
Some women may have had cervical screening tests taken outside the Republic of Ireland or may have elected to have a private screening test performed. CervicalCheck does not have access to any reports on these screenings as they are not part of the national cervical screening programme.However, if the result and recommendation from a private screening test fulfils CervicalCheck criteria for colposcopy referral, the GP can refer the person to a CervicalCheck colposcopy service, i.e. HPV detected and abnormal cytology or persistent HPV infection (two consecutive positive HPV tests). It is important the result of the private screening test is included with the colposcopy referral.