Hormone OptimizaitonOur Gyno HealthOur Sex Life

Testing to See Why Sex is Painful

It’s a little known, and probably less used fact that a type of Pap test can be used to judge your sexual health, more accurately the health of the lining tissue of the vagina. The least invasive, and fastest growing therapies involve vaginal treatments to treat the issues once they are detected. For therapy of vaginal atrophy, come for consultation regarding MonaLisa Touch or ThermiVa, come to Women’s Health Practice.

Traditional pap tests can detect infections such as yeast and bacterial vaginosis, as well as cancer. But they can look for atrophy as well.

This test can be useful for vaginal health, but is not going to be as revealing for vulvar health.

On the same test swab that checks for cervical cancer, STDs can be tested for but there is a lesser known pap test. This is the test called a Maturation Index: this is not a cancer test, but it is a type of pap smear. It is done with the same collection technique of getting cells from the cervix with a swab and placing them in fluid or on a slide.

The swab can be taken from any part of the vagina, but it is recommended as analysis of the vaginal wall cells from the upper third of the vagina.

When women have hormonal deficiencies, hormonal transition, perimenopause, and menopause the lining tissue tends to thin and dry. This condition is called vaginal atrophy, or VVA. Atrophy makes you not ready for sex as you may experience pain or bleeding when you try to have sex and have VVA.

After your gyno collects the pap 100 cells are evaluated and the proportion of the parabasal cells (the lower most layer that sits on the top of what is called the basement membrane), the intermediate and the superficial cells. Prior to menopause, if you have a normal healthy vaginal wall you will have somewhere between 40-70/100 intermediate cells and about 40-60/100 superficial cells, and no parabasal cells. If you have early menopause, and a bit of estrogen, you may start having some parabasal cells when your maturation index is taken. Once women are fully in menopause, and the vaginal walls become atrophic, then they may have as many as 65/100 cells as parapaasal cells, and only 5/100 superficial cells.

Nonhormonal lubricants can help with pain at the time of sex, but cannot heal the tissues like treatments or hormones, and we don’t have a good test for lubricant allergies.

Hormone blood testing can help figure out why sex is painful, and may be indicated in some cases.

Women who are responding well to estrogen therapy for vaginal problems in menopause should have the healthy maturation index of a young women. If your maturation index has not improved, then the estrogen therapy that has been designed for your is not working well and may have to be redesigned for maximum effectiveness. New vaginal therapies using energy based treatments such as CO2 non-ablative fractional lasers or radiofrequency RF treatments can help heal the tissues.

To read more about this in our Kindle book Menopause, Make Peace With Change


Suzanne Trupin, MD, Board Certified Obstetrician and Gynecologist and owner of Women's Health Practice, Hada Cosmetic Medicine, and Hatha Yoga and Fitness

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