Cervical screening care for women living with the impact of sexual violence and abuse: a systematic review

Background: Cervical cancer is one of the most preventable cancers. Screening uptake may be lower among women affected by sexual violence and abuse (SV&A), although evidence remains mixed. These women face unique barriers to accessing intimate healthcare, reflecting deep-rooted inequities. This systematic review examined how experiences of SV&A influence engagement with cervical screening and identified approaches that improve access to, and experiences of, screening care for this population.
Methods: MEDLINE, EMBASE, ASSIA, CINAHL, PsycINFO and the Cochrane Library were searched. English-language studies and grey literature published from 2000 onwards exploring barriers and prevalence of cervical screening among women living with the impact of SV&A across OECD countries were included. PRISMA guidelines were used by two independent reviewers to search, screen, data extract, critically appraise and narratively synthesise included studies.
Results: Thirty studies met the inclusion criteria. Three overarching themes were identified: (1) engagement with cervical screening care, (2) influential factors, and (3) compassionate care. Practical, emotional and structural barriers influenced attendance, with experiences of SV&A often leading to avoidance of intimate examinations. Compassionate and trauma-informed approaches emphasising trust, communication, choice and control were linked to improved engagement and more positive screening experiences.
Conclusions: Understanding barriers to accessing cervical screening care for women who have experienced SV&A can enhance access to intimate screening care. Enhancing care at each stage of the screening process may better respond to women’s individual experiences. Further research is needed to explore models of compassionate care and their longer-term impact on quality of life and health outcomes.
Keywords: Cervical cancer, cervical screening; sexual violence and abuse; childhood sexual abuse; screening uptake; compassionate care.