Painful Vaginal Exam

Tips to navigate painful vaginal exams and uncomfortable PAP smears

The American College of Obstetricians and Gynecologists advice is – most women need to see their gynecologist yearly for a wellness check. Often patients are offered a vaginal exam or a or pelvis exam for checking the vaginal tissue. While it sounds routine it is perhaps the most stressful part for women experiencing pain. This dreaded painful vaginal exam can often be traumatic enough to stop women from going to the doctor. Sometimes women feel dismissed by their provider about concerns related to pain during vaginal exams or speculum use in general. Let’s face it, no one likes a pelvic exam ! So when you tell your doctor – I am afraid it will hurt ..it is possible that they think it is normal to be scared. If you have had previous painful vaginal exams chances are you are already feeling anxious. You might have to go the extra mile to advocate for yourself during these exams and request a few considerations to address the pain during vaginal exam.

If the fear of the smear is real for you try these tips to help navigate pelvic exams.

Write a letter explaining your severe vaginal pain and fear of speculum and hand it to your medical team ( doctor / assistant / nurse) prior to your appointment
Before any exams can begin, ask them if they have read your letter. Just to ensure your request was actually received by your provider.
Request your provider to give you a play-by-play for the exam you are about to receive and only proceed after your consent.
Request the smallest speculum

Pro-tip-holding the speculum under running warm water helps prevent the pain caused by cold metal touch.

Put your hand on the lower belly and take some deep belly breaths. Make your belly rise up like a balloon as the speculum is being slowly inserted.
It can be helpful for some people to hold the examiner’s wrist and gently guide it inside your body. You are not the driver here but it helps your brain control the anticipated fear.
While the speculum is being opened focus on keeping your bottom on the table and as if you were glued to the treatment table. Notice if you are unintentionally pulling yourself away from the speculum..if you are.. focusing on the glue..very sticky glue..can be a helpful visual. Sometimes visualizing that your buttocks are separating from each other can help keep muscles relaxed and decrease pain.
Some women find comfort in placing their own hands on the vulva as if they were separating their labia apart can provide comforting counter pressure.
Pretending that you are gently passing wind out of your butthole can help you relax your bottom and decrease pain.
For some, imagining as if you were slowly trying to poop a lemon out of your bottom can do the trick of relaxing pelvic muscles.
Last but not the least- relax your jaw and face. When we clench the jaw ..we tighten the pelvis. Avoid breath holding and instead open jaw low loud grunting sounds is the way to go!