Preparing for a pain-free Pap smear.

Why do Pap smears seem to become more painful as we get older? 

If you're in your 40s, 50s, or early 60s and Pap smears have started to feel more uncomfortable than they used to, you’re not imagining things. Hormonal changes during perimenopause and menopause can make your vagina drier and less elastic, which can turn a routine test into a not-so-pleasant experience. Not that they were on the top of my bucket list even when I did have collagen and elasticity!

 What’s going on and how you can make things a lot more comfortable?

Midlife Changes Down There

As estrogen drops, vaginal tissues can get thinner, drier, and more sensitive. This is super common and goes by the name Genitourinary Syndrome of Menopause (GSM). Don't you love the meno-lingo? It can make sex and exams like Pap smears uncomfortable or even painful. Painful sex and Paps? Give a girl a break!  On top of that, your pelvic muscles can weaken, which might cause organs like your bladder or uterus to shift. Fun, right?

Why It Hurts More Now

Things feel more painful for many of us these days. Thinner tissues, dryness, and changes in pelvic anatomy mean that the speculum used in a Pap smear can feel scratchy, pinchy, or cause cramping. If you've got prolapse, it can add pressure and make the exam trickier.

What You Can Do to Make It Better

Use a Vaginal Moisturizer

Apply one a few times the week before your appointment to hydrate tissues.

Ask for Extra Lube

More lubrication on the speculum = less friction. Less friction means less sweary under your breath.

Request a Smaller Speculum

Yes, they exist! Smaller speculums can make a big difference. I don’t know who invented the ‘standard size’ I always seem to get but I have thoughts on that!

Try Coconut Oil

Use it on the outside (the vulva) daily to keep skin soft. I also recommend using labia moisturizers. They should be part of your weekly routine.

Consider Vaginal Estrogen

Super safe and really effective. Don't take my word for it though. Ask your doctor.

Take Ibuprofen Beforehand

Popping one 30–60 mins before can help ease discomfort. I’m a chicken so I always have one handy!

Relax and Communicate

Tell your provider if you’ve had painful exams. You’re in control. 

Dr. Andrea Walsh Weighs In

Dr. Andrea Walsh, MD, a board-certified OBGYN, shares:

"You can use vaginal moisturizer for several days leading up to the appointment or just use vaginal estrogen. It is very safe to use. Coconut oil can be used on the vulva to help with that area. Also ask for a smaller speculum."

She adds:

"I almost automatically use the smaller speculums with postmenopausal patients unless they are complaining of prolapse because that tells me that they have a lot of laxity."

The bottom Line

Menopause changes things, but you don’t have to suffer through Pap smears. Prep a little ahead of time, speak up about your needs, and make sure your comfort comes first. You’ve got options—and support. You deserve to be pain-free and healthy!