Painful smear after menopause

I just had a reminder for a smear test - I ignored the first call as the last test 5 years ago was so painful. I’m 64, and my vagina has tightened a lot - I wasn’t sexually active for a number of years, and now penetration is impossibly painful. I am taking hormone pessaries for vaginal atrophy/dryness. I don’t know whether to try again with vaginal dilators prior to any test, or to refuse to go…I have had clear smears for 30 years or so. Any advice? Should add I have had problems with smears in the past as my cervix is high up and pointing in the “wrong” direction - and the one doctor at my practice who succeeded has retired!

Hi KayJayDee:

I had a nose around to see if there are any statistics on this and found a recent study reported in various papers. Apparently, 25% of 60+ aged women in the UK don't go for their smears and one third of all new cases of cervical cancer (3000ish per year) are in women over 50.

I'm sure that many of these women haven't been as diligent as you in keeping up with your smear tests. I read an article in the Daily Telegraph where they discussed the physical difficulty that some older women face in having a smear test. They are doing trials for a self-administered HPV test, but it's not available in the UK yet on the NHS. Don't know if it's available privately.

Have you ever be tested for HPV? It's so corelated to cervical cancer that the gist of the article seemed to be that if you were negative for HPV you could safely skip the smear - assuming you hadn't been sexually active since the test. If you haven't been tested then you're not necessarily negative as it can lay dormant for years and years.

So what to do? If you don't know for sure you are HPV negative I would have the smear, but I would go to a gynocologist. If Miss Cervix is a bit of a free spirit  and doing her own thing, she may need someone who is used to dealing with ladies like her!You could definitely mention your issues first and any doctor, NHS or private, should be a) pleased that you are taking such good care of your health and b)able to give you some help to make the test easier. Maybe even a tiny local anesthetic?

I hope this helps. FYI, I am in my mid-fifties (although I don't know how that happened!)and after 20 years of annual clear smears and no symptoms I was diagnosed with cervical cancer in April. It was caught super early, I had a hysterectomy and am on 6 monthly checks, with no further treatment required. Had I not gone for that smear my outcome would not have been so rosy.

Hi TeresaF,  Thanks for your advice. Have never been HPV tested, so I probably ought to try the smear. So far I'm trying the dilators again - having looked up sizes of speculums, I think I should be able to cope if I can get up to the 3cm size! So, a way to go yet. I'll get on to the surgery and enquire which is the doctor who does most smears, and mabe enquire about a gynaecologist instead. Hope your results keep coming back clear - sounds like you caught it in time.


Sounds like a plan!

Someone on another board mentioned a self-test for HPV but that's all she mentioned. Didn't know whether you were interested in that so I thought I'd mention it.

Good luck

t x 

Just to update....the vaginal dilators really do work......I've been using them for a few months, just had my smear, no pain, no problem finding the cervix - mighty relieved!