Cervical screening is too painful!

Cervical screening (used to be known as smear tests) can be uncomfortable, but some of you find it so painful you’d do anything to put it off. In the perimenopause and menopause, your vagina loses some of its stretchiness and combined with dryness, this can mean having a vaginal examination becomes unbearable. It doesn’t have to be this way.

During the perimenopause and menopause, low levels of estrogen (and testosterone) can lead to thinning of the tissues in and around the vagina, it loses its elasticity and also can become drier and more fragile.

Around 70% of you will experience symptoms such as soreness, itchiness, urinary symptoms such as needing to pee a lot, or having some accidents, and any kind of vaginal penetration can be uncomfortable whether that be tampons, sex, or examinations using a speculum. The bad news is without treatment these symptoms tend to get worse over time. But the good news is that there’s very effective hormones available to reverse this process.

What can I do about it?

1. Speak to your doctor or nurse before your next examination is due and ask for vaginal estrogen or vaginal hormones. It comes in a pessary, cream or gel that you insert directly into your vagina, usually at night time. Or you can ask about an Estring which is a silicon ring that sits inside the vagina for 90 days releasing a steady dose of estrogen. Estrogen helps restore your tissues back so they are lubricated, plumper, stretchier and more healthy. It is safe to use these products long term and they have no associated risks.
2. You can also take HRT alongside using vaginal hormones, which will help boost hormones all over your body, and improve other menopausal symptoms at the same time.
3. Try keeping the area moist with daily use of specialist moisturisers and when there are times that you need extra help, such as for sex, there are lubricants that can really help make things more comfortable.
4. When you go for cervical screening, make sure you’ve been using a vaginal hormone treatment for a few weeks already. Tell your nurse or doctor that you have soreness and dryness and ask them to explain everything as they go and ensure they use plenty of lubricant. Remember, you can ask them to stop at any point.
5. Look at the speculum that will be used and you may be able to choose a smaller size if you’re worried about the insertion.
6. If you find it more comfortable lying slightly on your side, ask if that’s possible.
7. If you have a particular anxiety about cervical screening, tell them when you’re booking the appointment. Also let them know in advance if you’re a survivor of sexual violence, have experienced FGM, or are trans or non-binary.

None of us look forward to cervical screening, but it shouldn’t be a traumatic experience for anyone. Regular health checks like screening for cervical cancers are too important to put off.