Q: I am 60, my last Pap smear was painful and my next one is due. I am nervous about having it done because even sex is uncomfortable these days. What can I do to make it easier?
A: After menopause, the loss of oestrogen (a hormone produced by the ovaries) can affect the health of a woman's vagina. The blood supply to the genital and pelvic region decreases and the vaginal walls can become thinner and dryer. There is a natural decline in vaginal lubrication and the vagina becomes more delicate and at times, irritated. This condition is referred to as vaginal atrophy (wasting), or atropic vaginitis. Women with this condition can experience vaginal dryness, soreness and associated pain during sexual intercourse.
Older women are often well aware of these vaginal changes and when they go to have their regular Pap smear, they may find the procedure uncomfortable or painful.
During a Pap smear a sample of cells is taken from what is called the transformation zone, in the cervix, to check for precancerous changes. The cervix is a neck of tissue that connects the vagina and the uterus. The transformation zone is in the upper cervix and is the area where the most common type of cervical cancer is likely to occur.
After menopause, it can become difficult to obtain a sample of cells from this area. This is because the transformation zone tends to move further up the cervical canal as oestrogen levels decline, which makes it more difficult to reach.
To prepare the vagina temporarily for a satisfactory Pap smear, or to alleviate the ongoing discomfort associated with vaginal atrophy, women can be prescribed vaginal oestrogen cream. Vaginal oestrogen cream is very effective in relieving vaginal atrophy and dryness. It does not appear to significantly increase the growth of uterine lining or have untoward systemic effects, as might other forms of hormone replacement therapy.
If required for ongoing symptom relief, vaginal oestrogen cream is typically applied nightly for three weeks, then twice weekly for ongoing therapy. Used with vaginal lubricants, this will enhance comfort during sexual intercourse for women with vaginal atrophy.
If required only prior to a Pap smear or for the re-evaluation of a Pap smear, women can use oestrogen cream for just a few weeks prior to the procedure, as prescribed by their doctor. This will provide only temporary relief from vaginal dryness and discomfort.
In the meantime, women can help maintain a healthy vagina as they age by remaining sexually active after menopause, either with or without a partner. Regular sexual activity improves pelvic blood flow, encourages vaginal elasticity and enhances lubrication. In addition, allowing women more time to become aroused before penetration, along with the use of vaginal lubricants, will help alleviate potential discomfort.
Last updated: April 2013
© Women’s Health Queensland Wide Inc. This article was written by Joanna Egan and reviewed by the Women’s Health Queensland Wide editorial committee. It was published in Health Journey 2013 Issue 1.