Woman in A Same-sex Relationship Who Missed Her Smear Invite, Requesting Sti Screening — Free SCA Practice Case

Character Overview: You are Robyn, a 26-year-old graphic designer. You are in a relationship with a woman and have only ever had female sexual partners. About three months ago, while you and your partner were briefly separated, you had a one-off sexual encounter with a woman you did not know well, and you want STI testing. You have no symptoms. You ignored your cervical screening invitation last year because you understood — from things you had read and been told — that women who only sleep with women do not need smear tests, and you also felt awkward about the examination. You are open and articulate but will be embarrassed if the clinician is clumsy or makes assumptions about your relationships. You are keen to do the right thing once it is explained.

Opening Sentence: "Hi Doctor. I wanted to arrange an STI screen, please. About three months ago there was a one-off thing with someone I didn't know well — I've got no symptoms, but I'd like to be tested to be sure."

History if Asked (Data Gathering Phase)

• ●The reason for testing: "A one-off encounter about three months ago, with a woman I didn't know well. My partner and I were on a break at the time."
• ●Symptoms: "No symptoms at all — no discharge, no pain, nothing."
• ●Sexual history (if asked appropriately): "I've only ever had female partners. I'm with my partner now; we've been back together about two months."
• ●Cervical screening (only if raised): "I got a letter last year but I didn't book. I'd read that women who only sleep with women don't need smears. And honestly, the idea of the examination put me off."
• ●What she wants: "The STI tests. That's what I came for."

ICE — Ideas, Concerns, Expectations

The patient does not volunteer this information unprompted. These responses surface only when the candidate directly explores her perspective.

• ●Ideas: Robyn believes — incorrectly — that cervical screening is not necessary for women who only have sex with women, and is also put off by the examination. "I genuinely thought smears weren't relevant for me. And the examination worries me."
• ●Concerns: Her stated concern is whether she has picked up an infection; if explored, she is also anxious about what a positive result would mean for her relationship. "I want to know if I've caught something. And I'm anxious about what it would mean for us if I have."
• ●Expectations: She expects STI testing to be arranged. "I want the tests done."

If Asked — Sexual Health and Screening Assessment

The patient answers these only when directly asked, and more openly if the candidate signposts and avoids assumptions.

• ●If asked about the nature of the sexual contact (practices, and whether barriers/toys were shared): "It was oral and manual, and we shared a toy. We didn't use any barriers or clean it between us." (Establishes a genuine transmission route.)
• ●If asked about timing of the exposure (three months ago): "Three months ago, roughly."
• ●If asked about any male partners, ever, or the possibility of pregnancy: "No, I've never had a male partner, so pregnancy isn't a concern."
• ●If asked about symptoms (discharge, odour, pain, dysuria, bleeding, ulcers, rash): "None of those — no discharge, no odour, no pain, no bleeding, no sores or rashes."
• ●If asked about her current partner's sexual history/testing: "As far as I know she's only been with women too. She hasn't been tested recently."
• ●If asked about previous STI testing or infections: "I've never had an STI test before. No previous infections."
• ●If asked about injecting drug use, tattoos/piercings abroad, or blood-borne-virus risk: "None of that."
• ●If asked about HPV vaccination: "I don't think I had it at school — I moved around a lot."
• ●If asked about cervical screening history: "Never had one. I ignored the letter."
• ●If asked about smoking, alcohol, and general health: "I smoke socially, drink moderately, otherwise well."
• ●If asked about safeguarding/coercion (whether the encounter was consensual): "Yes, it was completely consensual."
• ●If asked about mental health/mood: "I'm fine — just a bit anxious about the tests."

Responses to Management (The Negotiation Phase)

• ●If the Doctor corrects the cervical-screening misconception — key: "Wait — so I do need smears? Even though I've only ever been with women? I had no idea. I thought HPV was something you got from men." (The tested point is correcting the misconception clearly: HPV is transmitted between women, and cervical screening applies to everyone with a cervix aged 25–64.)
• ●If the Doctor addresses her anxiety about the examination: "It's partly the examination that put me off. Can you tell me what actually happens?" (The tested point is addressing the practical barrier so she attends.)
• ●If the Doctor explains the STI tests and window periods: "So swabs, and blood tests for HIV and syphilis? And three months is long enough for those to show up?" (The tested point is explaining appropriate tests and window periods.)
• ●If the Doctor discusses her practices and risk reduction: "I hadn't thought about the toy being a route for infection, or using barriers between partners." (The tested point is practice-specific, non-judgemental risk-reduction advice.)
• ●If the Doctor offers sexual-health-clinic options and HPV vaccination advice: "I could go to the sexual health clinic instead? And I should check whether I can still have the HPV jab?"
• ●If the Doctor raises telling her partner: "If something comes back positive, I'd have to tell my partner, wouldn't I? That's the bit I'm dreading."