In South Africa problems with current cervical screening uptake, including low coverage and loss of screened women to follow-up, have been identified. This paper presents the findings of an anthropological study of rural Black women's perceptions and understandings of cervical symptomatology, screening and cancer conducted among three different language groups in South Africa. The data collected indicate that women were screened when presenting with symptoms of reproductive tract infection, with the result that for many the smear came to be associated with the diagnosis and treatment of sexually transmitted diseases (STDs). In some cases the smear was said itself to "clean" the womb. The results were often interpreted by women as signifying womb "dirtiness" and confirming the presence of symptomatic reproductive disease for which they had initially presented to the biomedical facility. Several barriers to screening were identified including fear of vaginal exposure, expectation of pain, being asymptomatic, and gender of the practitioner. In addition women perceived womb cancer to be invariably terminal, knowledge which was constructed from personal and community experience of the illness. The illness was closely associated with (usually female) "promiscuity". The authors discuss the implications of the data for healthworkers and health promotion specialists, in particular the association of the smear with STDs, the way in which women are recruited for screening, the perceived terminality of womb cancer, and the processes by which local knowledge about illness is constructed. The findings demonstrate the importance of medical anthropology in contributing towards the provision of effective and locally appropriate healthcare.