Cervical cancer is one of those conditions that can develop quietly. You may feel completely healthy, have regular periods, experience no pain and notice nothing unusual about your vaginal discharge. Yet, changes may already be developing in the cells of your cervix.
This is why cervical cancer screening matters. You do not have to experience symptoms to need screening, and you should not wait for pain or bleeding before speaking to a healthcare professional.
The good news is that cervical cancer is largely preventable. Vaccination against human papillomavirus (HPV), appropriate screening and timely treatment of precancerous changes can significantly reduce the risk of developing the disease.
So, what should every woman know about HPV, cervical cancer and protecting her reproductive health?
1. What is cervical cancer?
The cervix is the lower, narrow part of the uterus that opens into the vagina. Cervical cancer occurs when abnormal cells in the cervix grow uncontrollably and may invade surrounding tissues.
Most cases develop following a persistent infection with certain high-risk types of HPV. However, developing HPV does not automatically mean you will develop cervical cancer.
In many women, the immune system clears or suppresses the infection naturally. In some cases, a high-risk HPV infection persists and causes changes in cervical cells. These changes can take years to progress to cancer, creating an important opportunity for screening and early treatment.
According to South Africa’s Department of Health, cervical cancer remains a significant public health concern, despite the availability of effective prevention measures. The country is working towards eliminating cervical cancer as a public health problem by 2030.
2. What is HPV, and how is it connected to cervical cancer?
HPV stands for human papillomavirus. It is a very common group of viruses that can affect the genital area, mouth and throat, and other parts of the body.
HPV is primarily transmitted through intimate skin-to-skin contact, including sexual contact. Penetrative intercourse is not necessary for transmission.
There are many HPV types. Some cause genital warts, while others are classified as high-risk because persistent infection can cause cancers, including cervical cancer.
High-risk HPV types 16 and 18 are responsible for a substantial proportion of cervical cancer cases.
Important facts about HPV
- HPV is common. A person can acquire it without knowing because the infection often causes no symptoms.
- HPV can affect anyone who is sexually active. It is not exclusive to people with multiple partners.
- A positive HPV test does not mean you have cancer. It means the virus has been detected and that appropriate follow-up may be needed.
- HPV can remain undetected for years. A positive result cannot reliably establish when the infection was acquired or who transmitted it.
- Vaccination helps prevent important HPV infections. It does not treat an infection that is already present, and it does not replace cervical screening.
An HPV diagnosis should not automatically be interpreted as evidence of recent infidelity. The virus can remain undetected for a long time, and testing generally cannot identify when transmission occurred.
3. Why can cervical cancer develop without obvious symptoms?
In its early stages, cervical cancer and the precancerous changes that can lead to it may cause no noticeable symptoms.
This is one of the most important reasons to attend screening even when you feel healthy.
Screening looks for HPV infection or abnormal cervical cells before symptoms necessarily appear. It is different from diagnostic testing, which investigates symptoms or an abnormal examination.
For example, a woman might have no pelvic pain, no unusual bleeding and no change in discharge, but a screening test may detect high-risk HPV. Further assessment can determine whether cervical cell changes are present and whether treatment is needed.
Feeling well is reassuring, but it cannot confirm that your cervix is healthy.
4. Symptoms of cervical cancer women should not ignore
Although early disease may be silent, certain symptoms require medical assessment.
| Symptom | What you should know |
|---|---|
| Bleeding after sex | May result from several conditions, but persistent or unexplained bleeding needs assessment. |
| Bleeding between periods | Hormonal changes, contraception and other conditions can cause this, but cervical disease must sometimes be excluded. |
| Bleeding after menopause | Any vaginal bleeding after menopause should be assessed promptly. |
| Unusual vaginal discharge | A persistent watery, blood-stained or foul-smelling discharge deserves medical attention. |
| Pain during sex | Can have many causes, including infection, endometriosis and cervical conditions. |
| Persistent pelvic or lower abdominal pain | Requires assessment, especially when accompanied by unusual bleeding or discharge. |
| Persistent back or leg pain, or leg swelling | These symptoms have many possible causes but can occur in more advanced cervical cancer and should not be ignored. |
These symptoms do not automatically mean you have cervical cancer. Many are caused by less serious and treatable conditions. However, symptoms that are new, persistent, recurrent or unexplained should not be self-diagnosed.
Seek urgent medical care for severe bleeding, fainting, severe pelvic pain or significant weakness.
5. Who is at risk of developing cervical cancer?
Persistent infection with a high-risk HPV type is the main cause of cervical cancer. Several factors can increase the likelihood of persistent infection or progression to disease.
These include:
- Not receiving HPV vaccination.
- Missing recommended cervical screening.
- Living with HIV or another condition that weakens the immune system.
- Smoking, which is associated with a higher risk of cervical precancer and cancer.
- Having a history of abnormal cervical screening results without completing the recommended follow-up.
- Barriers to accessing screening, diagnostic services or treatment.
Women living with HIV have a higher risk of persistent HPV infection and cervical disease. They may need to start screening earlier and attend more frequently than women who are HIV-negative.
Having one or more risk factors does not mean you will develop cancer. Equally, you can develop cervical cancer without recognising any particular risk factor, so screening remains important.
6. What is cervical cancer screening?
Cervical screening looks for signs of high-risk HPV infection or abnormal cells that could develop into cancer.
Depending on the healthcare service and your circumstances, screening may involve an HPV test, a Pap test or another approved screening approach.
HPV test versus Pap test
| Test | What it checks | Why it matters |
|---|---|---|
| HPV test | Detects high-risk HPV types associated with cervical cancer. | Identifies infection that may require further assessment. |
| Pap test (Pap smear) | Examines cervical cells for abnormal changes. | Can identify precancerous or other abnormal cells. |
| Colposcopy | Allows a clinician to examine the cervix more closely, often using magnification. | May be recommended after an abnormal screening result or when symptoms require investigation. |
| Cervical biopsy | Removes a small tissue sample for laboratory examination. | Helps establish whether significant precancerous changes or cancer are present. |
South Africa is transitioning towards HPV-DNA-based screening, although the exact test and pathway available can vary by service and individual circumstances.
A positive HPV test does not automatically mean you need cancer treatment. Your clinician will consider the HPV type, other test results, age, immune status and relevant medical history to decide on the next step.
7. When should you start screening in South Africa?
The appropriate starting age and screening interval depend on the guideline being followed, your HIV status, previous results and personal risk factors.
South Africa’s established public-sector policy provides screening for eligible women who are HIV-negative from age 30, with three screening opportunities at approximately 10-year intervals. Women living with HIV are eligible for earlier and more frequent screening.
More recent professional guidance recommends HPV-based screening from a younger age in some circumstances. National services are also moving towards updated HPV-testing pathways.
This means there is no single screening schedule that is appropriate for every woman.
If you are unsure whether you are due, ask your clinic or gynaecologist:
- Which screening test is currently available to me?
- At what age should I start, considering my HIV status and history?
- When should I repeat the test?
- What follow-up is needed if my result is abnormal?
Do not wait until the next routine screening date if you have symptoms. A woman with unexplained bleeding or persistent concerning symptoms needs a diagnostic assessment, even if she recently had a normal screening result.
8. What happens during a cervical screening appointment?
Many women delay screening because they are anxious about discomfort, embarrassment or not knowing what to expect.
A typical appointment may involve the following:
- A conversation: The healthcare professional asks about your medical history, previous screening, symptoms and relevant risk factors.
- Consent and explanation: The clinician explains the examination and obtains your consent. You can ask questions or discuss concerns.
- A speculum examination, when required: A small instrument is gently inserted into the vagina so the cervix can be seen.
- Sample collection: A small brush or sampling device collects cells or a sample for HPV testing.
- Follow-up arrangements: You should be told how results will be communicated and what to do if further testing is required.
You may experience pressure or brief discomfort, but the procedure should not cause severe pain. Tell the clinician if you feel uncomfortable, have experienced trauma, or need additional time or support.
Ask about self-collection for HPV testing if it is available through your healthcare service and appropriate for you.
Most importantly, do not let embarrassment prevent you from accessing care.
9. How can you reduce your risk?
There is no guaranteed way to prevent every case, but several measures substantially reduce risk.
Get vaccinated against HPV. Vaccination is most effective before exposure to HPV. South Africa provides HPV vaccination through its school-based programme for eligible girls, with availability and eligibility determined by current programme guidance. Adults should ask a healthcare professional whether vaccination is appropriate for them.
Attend recommended cervical screening. Vaccination does not protect against every cancer-causing HPV type, so eligible women still need screening.
Complete follow-up after an abnormal result. An abnormal screening result is not necessarily cancer, but ignoring it can allow important changes to go untreated.
Avoid smoking. If you smoke, seek support to stop.
Use condoms. Condoms reduce the risk of HPV transmission but do not eliminate it because HPV can affect skin not covered by a condom.
Know your results. Keep a record of screening dates, results and recommendations, and ask for clarification if you are unsure what a result means.
10. Normal changes versus signs that need medical attention
| Usually not a reason to panic on its own | Needs assessment |
|---|---|
| No symptoms and feeling well | Being overdue for screening |
| A single abnormal screening result that is being appropriately followed up | An abnormal result with no follow-up plan |
| A positive HPV result without a diagnosis of cancer | Persistent HPV or abnormal cervical cells requiring further investigation |
| Temporary light spotting after a cervical sample, if explained by the clinician | Repeated bleeding after sex or unexplained vaginal bleeding |
| Ordinary vaginal discharge without other concerning changes | Persistent watery, blood-stained or foul-smelling discharge |
The key distinction is that symptoms and screening results need to be interpreted in context. A normal-looking discharge cannot rule out cervical disease, and an abnormal screening result does not automatically mean cancer.
11. Frequently asked questions
Can I have HPV if I have only had one sexual partner?
Yes. HPV can be transmitted by a single partner, and it may remain undetected for years. Having HPV does not establish that someone has had multiple partners or been unfaithful.
Can I have cervical cancer if my periods are regular?
Yes. Regular periods do not rule out HPV infection, cervical precancer or cervical cancer. Screening is important even when your menstrual cycle seems normal.
If I have received the HPV vaccine, do I still need screening?
Yes. The vaccine protects against important cancer-causing HPV types but does not cover every type associated with cervical cancer.
Does a positive HPV test mean I have cancer?
No. It means HPV has been detected. Further testing or follow-up may be recommended, depending on your results and individual risk.
Can cervical cancer be treated?
Yes. Precancerous cervical changes can often be treated before they become cancer. Cervical cancer is also more likely to be successfully treated when detected early. Treatment depends on the stage and may include surgery, radiotherapy, chemotherapy or a combination.
Can I go for screening if I have no symptoms?
Absolutely. That is the purpose of screening: to identify risk or early changes before symptoms develop.
Your cervical health checklist
Use this checklist to take practical steps towards protecting your health.
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I know when I last had cervical screening.
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I know when my next screening test is due.
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I have followed up on any abnormal results.
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I know my HIV status or have considered testing if appropriate.
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I have asked about HPV vaccination for myself or eligible children in my care.
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I will seek medical assessment for unexplained bleeding, persistent unusual discharge or ongoing pelvic pain.
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I know how to access my screening results and where to seek further care.
The bottom line
Cervical cancer can develop without obvious symptoms, which is why waiting until you feel unwell is not a safe screening strategy.
HPV is common, but persistent infection with high-risk types can lead to cervical cancer over time. Vaccination, appropriate screening and timely follow-up give women important opportunities to prevent disease or identify it early.
Whether you are in your twenties, raising children, planning a pregnancy or approaching menopause, make cervical health part of your routine healthcare. Speak to your clinic or gynaecologist about the screening schedule that applies to you, and never ignore unexplained symptoms simply because you feel otherwise healthy.
Your health deserves attention before something feels wrong.