Cervix Visual Assessment Guide

The Cervix Visual Assessment Guide (CVAG) is designed to assist health professionals with the assessment and evaluation of the cervix. The CVAG is a visual educational tool developed by health professionals specialising in colposcopy and gynaecology. In response to audit and colposcopy data suggesting some primary health workers’ have little experience of recognising the signs and symptoms of invasive cancer of the cervix, a significant number of women are referred to oncology/colposcopy clinics with suspected cervical cancer in the absence of disease. The guide aims are to raise awareness of signs, symptoms and appearance of cervical cancer; demonstrate the wide range of normal cervical appearances; provide advice and referral guidance for the clinical management of women attending surgery with irregular vaginal bleeding; increase the accuracy of referral for women with suspected invasive cervical lesions and improve the quality of care for women.

Contact Details

Project Dates

Project Start 12/01/2015
Project End Ongoing


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“This is an excellent tool to supplement learning and to support nurses and doctors working in all areas where cervical screening takes place.”
North East Cervical Screening Service
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Cervical screening is a method of preventing cancer by detecting and treating abnormalities of the cervix. The NHS cervical screening programme is available to women aged 25 to 64 in England. Women aged 25 to 49 receive invitations every 3 years.Women aged 50 to 64 receive invitations every 5 years. Early detection and treatment can prevent 75% of cancers developing.

The success of the NHS Cervical Screening program in reducing the incidence of cervical cancers means many primary care clinicians never see a cervical cancer and local trust audit results and regional colposcopy data they suggests some primary health workers’ have little experience of recognising the signs and symptoms of invasive cancer of the cervix.  Subsequently, a significant number of women are referred to oncology and colposcopy clinics with suspected cancer of the cervix in the absence of disease. Additionally, inappropriate referral often results in patients suffering unnecessary distress and anxiety. General Practitioner and Nurse Screener Trainees do not frequently have the opportunity within local colposcopy clinics to practice skills relating to assessing the cervix and distinguishing normal from abnormal appearances.  A Local audit of Trust gynaecology services in 2012 indicated that some primary care professionals face challenges in distinguishing normal and benign cervical conditions from cancer of the cervix.

The inspiration for the Cervix Visual Assessment Guide (CVAG) began in 2012 as a practice development initiative through the undertaking of a Master of Arts Advancing Practice Degree at Teesside University. It was designed with the purpose of helping primary care health professionals to understand the difference between normal and benign cervical appearances and cancers.

The guide was developed by Alison Roberts, Specialist Nurse Colposcopist and colleagues at South Tees Hospitals NHS Foundation Trust and is designed to assist primary healthcare professionals with the assessment and evaluation of the cervix.  The guide comes in a handy spiral bound stand up A5 desktop format and can also be used as a support to explain some detail to patients

The CVAG is comprised of multiple visual images of the cervix, ideally not too magnified, but what could be expected to be seen if visualising and assessing the cervix in a primary care environment. Clinical management and referral criteria based on current evidence-based national guidelines were also included in each section. An A5 size working document, complete with introductory pamphlet which explains learning outcomes and how to use the CVAG, was produced in 2013.

A small scale evaluation study raised awareness of the need for an educational tool to improve the quality of care for women. Initial findings suggested the CVAG had great potential to achieve this aim. In 2015 the business plan for development of the CVAG was entered into a competition providing funding for the Trust’s Innovation Hub to support further development of the project.

A mutually agreed working relationship with DYSIS helped to supply photographic images eligible for publication in support of the project. Version 2 of the CVAG was published and marketed for purchase in 2017.

South Tees Hospitals NHS Foundation Trust launched the guide on 1st May 2017 from their Innovation Hub and Alison Roberts, Specialist Nurse Colposcopist, presented a poster about the guide at the British Society for Colposcopy and Cervical Pathology (BSCCP) conference at Cardiff in May 2017. The guide was reviewed and updated in 2021.

The Cervix Visual Assessment Guide (CVAG) is available to order from South Tees at https://www.southtees.nhs.uk/about/strive/innovation-team/commercial-products/cervix-visual-assessment-guide/.

From May 2017 to April 2023 the Trust has sold over 2,500 guides throughout the UK and ROI, and also had interest from overseas with sales in Canada. The guide has been purchased by North East Cervical Screening and Northumbria University and is supplied to their students as part of their training offer. In 2023, the Greater Manchester Cancer Alliance purchased the guide to distribute throughout their primary care services.  A number of training facilities in the North East also provide their students with copies of the guide as part of their training.

The guide is a visual educational tool for recognising the signs and symptoms of invasive cancer of the cervix.


The Academic Health Science Network for the North East and North Cumbria, supported South Tees with:

  • primary market research
  • market evaluation
  • IP advice regarding copyright

Through the AHSN NENC, South Tees won funding in order to take the guide from an idea to its first print run, as the Cervical Screening Service in Newcastle was keen to purchase the guide. The rest of this funding was used towards the marketing of the guide.

When you work in general practice you work alone very often, there’s pressure not to drag colleagues… to come and have a look at a cervix… so in fact you look and you hope that you are making the right assessment … in a sense this (CVAG) acts as… a safety net.
Primary Care Health Professional