How can I minimize pain during a gynecological exam?
August 17, 2011 9:37 AM Subscribe
Help me survive my upcoming gynecological exam. Special, nsfw snowflake details after the jump.
My GP recently referred me to a gynecologist since her own pap smear efforts failed. Unfortunately, anything longer than 2 centimeters causes pain in my ladybits. It's as if my vaginal walls have been knit together by little genital elves, and the resistance caused by any intruding object causes a stinging pain. The GP assured me that the gynecologist would have a smaller, "pediatric" speculum, but I'm still concerned. I haven't been able to insert a tampon in about ten years due to the discomfort and I've never had penetrative sex of any kind. My GP suggested that the discomfort and resistance was psychological, but I haven't ruled out the possibility of physical condition. For what it's worth, this isn't my first pelvic exam -- the first one was about four years ago and was "successful," but painful. I don't think any hymen is extant, but I suppose it's possible.
My question is: how can I get through my upcoming exam with minimal pain and discomfort? How do I avoid clenching up my legs/loins, which doesn't help matters? Any advice is much appreciated!
Throwaway e-mail: sockpuppet765@yahoo.com
My GP recently referred me to a gynecologist since her own pap smear efforts failed. Unfortunately, anything longer than 2 centimeters causes pain in my ladybits. It's as if my vaginal walls have been knit together by little genital elves, and the resistance caused by any intruding object causes a stinging pain. The GP assured me that the gynecologist would have a smaller, "pediatric" speculum, but I'm still concerned. I haven't been able to insert a tampon in about ten years due to the discomfort and I've never had penetrative sex of any kind. My GP suggested that the discomfort and resistance was psychological, but I haven't ruled out the possibility of physical condition. For what it's worth, this isn't my first pelvic exam -- the first one was about four years ago and was "successful," but painful. I don't think any hymen is extant, but I suppose it's possible.
My question is: how can I get through my upcoming exam with minimal pain and discomfort? How do I avoid clenching up my legs/loins, which doesn't help matters? Any advice is much appreciated!
Throwaway e-mail: sockpuppet765@yahoo.com
I'm a rape survivor and exams are usually pretty traumatic for me. If your issue is indeed psychological, and I'm not saying it is, I've been pretty successful with some self-hypnosis techniques including deep breathing and visualization crap. I don't usually go for that sort of thing, but it's been surprisingly helpful for me. If you have a therapist, perhaps he/she can teach you some of these techniques to see if they might work, at least to find out if what you have is a physical complication.
Feel free to PM me if you have any questions.
posted by Sophie1 at 9:43 AM on August 17, 2011 [1 favorite]
Feel free to PM me if you have any questions.
posted by Sophie1 at 9:43 AM on August 17, 2011 [1 favorite]
This sounds like Vaginismus. Treatment options are listed in the link, but there don't seem to be any clear-cut, easy answers. Maybe have a xanax/valium before you go in?
posted by litnerd at 9:48 AM on August 17, 2011 [10 favorites]
posted by litnerd at 9:48 AM on August 17, 2011 [10 favorites]
If you don't have access to the various meds others are mentioning try just taking a couple of tablets of ibuprofen (Advil) an hour or two before. I was advised to do this by my dentist and it really does help.
Are you seeing a female GYN? You will likely be more comfortable with a woman doc. Ask if the office nurse (if she's female) or other medical assistant can hold your hand during the exam. If you have a close female friend and feel comfortable enough with her to bring her along ask if she can be in the room with you.
Bring an Ipod or other music device.
Write down your history and all of your concerns and bring it with you so that you remember all of the questions you want to ask and aren't nervous about forgetting something.
Good luck, I hope it all goes well.
posted by mareli at 9:59 AM on August 17, 2011
Are you seeing a female GYN? You will likely be more comfortable with a woman doc. Ask if the office nurse (if she's female) or other medical assistant can hold your hand during the exam. If you have a close female friend and feel comfortable enough with her to bring her along ask if she can be in the room with you.
Bring an Ipod or other music device.
Write down your history and all of your concerns and bring it with you so that you remember all of the questions you want to ask and aren't nervous about forgetting something.
Good luck, I hope it all goes well.
posted by mareli at 9:59 AM on August 17, 2011
2nding vaginismus. You should talk to the gyno about this. And perhaps meds would help too, either pain or anti-anxiety.
posted by catatethebird at 10:02 AM on August 17, 2011
posted by catatethebird at 10:02 AM on August 17, 2011
It doesn't matter if it's psychological or physical, it's real. Maybe this is a good time to address this medical problem, and find a gyn who can really help? Bringing music is a great idea. The doc needs to take plenty of time, talk to you, and be verrry patient. Ask them to prescribe somehting to help you relax. I don't know if a muscle relaxer would help. This must be quite difficult for you, and I just wanted to say that you deserve to have great treatment and all the time it takes.
posted by theora55 at 10:03 AM on August 17, 2011
posted by theora55 at 10:03 AM on August 17, 2011
Like others have said, you should read up on vulvodynia, particularly vulvar vestibulitis (also known as vestibulodynia) and vaginismus. Only a doctor (preferably a gynecologist) can diagnose it for sure, but you do seem to have a lot of the common symptoms. Surprisingly not even some ob/gyns know much about this, so if you get a blank look when you ask your doctor about it, switch and find a ob/gyn who does know.
I have ongoing problems with vestibulitis, which in my case appears to be a weird glitch in my nerve wiring present since birth. I grit my teeth and can get through a pelvic exam, although it isn't pleasant. I take ibuprofen beforehand and I also have a prescription for lidocaine gel, which numbs the area and can help, if applied 10 minutes before the exam itself. I also try to "wiggle my toes" to avoid clenching up, and deep breaths help too. My previous doctor also said I could do an outpatient hospital procedure where they do a pelvic exam while I'm under anesthetic, but I haven't had to do that.
Vaginismus, if you have it, is often successfully treated through pelvic floor physical therapy. I've had pretty good results from that, myself. Your ob/gyn can get you a referral if he or she confirms that diagnosis. I'd also recommend picking up The V Book as it's a great resource.
posted by castlebravo at 10:11 AM on August 17, 2011 [1 favorite]
I have ongoing problems with vestibulitis, which in my case appears to be a weird glitch in my nerve wiring present since birth. I grit my teeth and can get through a pelvic exam, although it isn't pleasant. I take ibuprofen beforehand and I also have a prescription for lidocaine gel, which numbs the area and can help, if applied 10 minutes before the exam itself. I also try to "wiggle my toes" to avoid clenching up, and deep breaths help too. My previous doctor also said I could do an outpatient hospital procedure where they do a pelvic exam while I'm under anesthetic, but I haven't had to do that.
Vaginismus, if you have it, is often successfully treated through pelvic floor physical therapy. I've had pretty good results from that, myself. Your ob/gyn can get you a referral if he or she confirms that diagnosis. I'd also recommend picking up The V Book as it's a great resource.
posted by castlebravo at 10:11 AM on August 17, 2011 [1 favorite]
Vaginismus is a real, not uncommon problem. Do not let a gynecologist say it's just you being crazy or stubborn. Most will not just dismiss your concerns like your GP has, since they actually deal with this body part most often, but it is true that some will. DO NOT LET THEM. If the doctor doesn't help with the pain and instead is dismissive or implies you're being difficult or something like that, it is 100% fully within your right to say you're not comfortable, you want to stop the exam, could they please leave so you can get dressed, and GO TO A DIFFERENT DOCTOR. This is not you being whiny or crazy or annoying, this is you taking your health into your own hands.
That said, most GPs understand that Vaginismus is a thing, and will be able and willing to help. Before you start, have this discussion, don't expect the doctor to just magically figure everything out when they're poking all about. Bring it up, ask what can be done. Because you are not having penetrative sex and presumably you have no other symptoms, you are not a super high-risk group that needs a pap right this second, and you and your gyno can take your time to figure out the problem together before there is lots of pain.
posted by brainmouse at 10:11 AM on August 17, 2011 [3 favorites]
That said, most GPs understand that Vaginismus is a thing, and will be able and willing to help. Before you start, have this discussion, don't expect the doctor to just magically figure everything out when they're poking all about. Bring it up, ask what can be done. Because you are not having penetrative sex and presumably you have no other symptoms, you are not a super high-risk group that needs a pap right this second, and you and your gyno can take your time to figure out the problem together before there is lots of pain.
posted by brainmouse at 10:11 AM on August 17, 2011 [3 favorites]
Yeah, this stuff sucks, my sympathies.
I would recommend you try to approach this and frame it with the gynecologist as an appointment designed to identify and address your pain, not as the gynecologist taking another crack at doing the standard pelvic exam because your GP couldn't do it. (By the way, my understanding is that if you haven't had penetrative sex, Pap smears aren't actually particularly necessary.)
My understanding is that there's the psychological/tensing up issues of vaginismus, but then there are other possibilities of physical problems too, one of which is vulvar vestibulitis. And then these things can get mixed up together too, i.e. you can develop vaginismus after bad/painful experiences which result from the physical problems.
I've had some really bad experiences, some mediocre ones, and one very good one. Things that made the difference for the latter one and helped me relax:
-- A good conversation beforehand while still clothed, discussing my symptoms and past experiences and the gyn's thoughts about how to proceed
-- Getting the gyn to promise he would stop as soon as I asked (I have unfortunately had ones who insisted on continuing even when I was literally begging them to stop-- it was really helpful to get an explicit promise in advance)
-- He started out by using a Q-tip and asking me to tell him if/how much it hurt. I was still freaked out and tensed up at the beginning, but he went really slowly, starting on the thighs and moving inward, touching very lightly and quickly... so I knew that any pain would be quick, and it helped me realize that there were only limited spots where it was excruciatingly painful and many where it didn't hurt at all, and I was able to relax my body more. And then I was able to trust that the speculum wasn't going to inevitably hurt terribly, just depending on where it was, and that if it did, he would stop. (My understanding is that the Q-tip thing is also important in the diagnostic process.)
-- I was also kind of able to detach a little and feel more curious about what was going on and want to relax and do my best to let him find out-- basically rather than feeling like the pain was being forced on me, out of my control, it became "I'm choosing to feel this pain, which I can stop at any time, because I want to understand more about my problem and how to fix it." (I was able to do that because I trusted him to stop, and also because this visit was framed as "let's figure out what's going on with this pain" rather than "let's make sure you get a Pap smear you don't really need," which is a much less motivating reason to welcome and accept the pain.)
Feel free to message me about any of this! Good luck!
(This may also be helpful: Guide to smooth gynecological visits, as well as other good stuff on the Vaginismus Awarenses Network website.)
posted by EmilyClimbs at 10:26 AM on August 17, 2011 [1 favorite]
I would recommend you try to approach this and frame it with the gynecologist as an appointment designed to identify and address your pain, not as the gynecologist taking another crack at doing the standard pelvic exam because your GP couldn't do it. (By the way, my understanding is that if you haven't had penetrative sex, Pap smears aren't actually particularly necessary.)
My understanding is that there's the psychological/tensing up issues of vaginismus, but then there are other possibilities of physical problems too, one of which is vulvar vestibulitis. And then these things can get mixed up together too, i.e. you can develop vaginismus after bad/painful experiences which result from the physical problems.
I've had some really bad experiences, some mediocre ones, and one very good one. Things that made the difference for the latter one and helped me relax:
-- A good conversation beforehand while still clothed, discussing my symptoms and past experiences and the gyn's thoughts about how to proceed
-- Getting the gyn to promise he would stop as soon as I asked (I have unfortunately had ones who insisted on continuing even when I was literally begging them to stop-- it was really helpful to get an explicit promise in advance)
-- He started out by using a Q-tip and asking me to tell him if/how much it hurt. I was still freaked out and tensed up at the beginning, but he went really slowly, starting on the thighs and moving inward, touching very lightly and quickly... so I knew that any pain would be quick, and it helped me realize that there were only limited spots where it was excruciatingly painful and many where it didn't hurt at all, and I was able to relax my body more. And then I was able to trust that the speculum wasn't going to inevitably hurt terribly, just depending on where it was, and that if it did, he would stop. (My understanding is that the Q-tip thing is also important in the diagnostic process.)
-- I was also kind of able to detach a little and feel more curious about what was going on and want to relax and do my best to let him find out-- basically rather than feeling like the pain was being forced on me, out of my control, it became "I'm choosing to feel this pain, which I can stop at any time, because I want to understand more about my problem and how to fix it." (I was able to do that because I trusted him to stop, and also because this visit was framed as "let's figure out what's going on with this pain" rather than "let's make sure you get a Pap smear you don't really need," which is a much less motivating reason to welcome and accept the pain.)
Feel free to message me about any of this! Good luck!
(This may also be helpful: Guide to smooth gynecological visits, as well as other good stuff on the Vaginismus Awarenses Network website.)
posted by EmilyClimbs at 10:26 AM on August 17, 2011 [1 favorite]
There are gynecologists who specialize in problems like vaginismus, vulvodynia, and lichen sclerosus (a dermatological condition that can occur in the pelvic area). Asking around, if you feel comfortable doing so, might lead you to a GYN in your area who has special knowledge in this area. Barring that, if you do see a new GYN, you could ask them if they are aware of anyone in your area who has a special interest in these conditions.
posted by SweetTeaAndABiscuit at 10:27 AM on August 17, 2011
posted by SweetTeaAndABiscuit at 10:27 AM on August 17, 2011
The Wikipedia listing for vaginismus is good, but I'm not sure it's clear from their description that the desensitization/dilation tactics they detail for treatment can be undertaken by yourself, at home. They make it sound a little like something that has to be done by medical personnel in a laboratory. But if you don't mind going to a sex shop, you can easily buy the necessary materials (i.e. smaller to larger size dildos, basically) to do this at home. If I were having trouble with vaginismus, this is what I would do.
If you've never had sex and you're not having any specific complaint that needs investigation, a Pap smear/pelvic exam may not be of as much (or any) utility, but I still think this is a good thing for you to be seeing the OB/GYN about and addressing yourself, because there are a lot of reasons why you might want to take care of this problem for future benefit to yourself - even if you never want to have penetrative sex, if a medical issue did come up, since the treatment process is not a quick one, it would be really helpful to be able to undergo any needed testing and treatment with the greatest amount of ease and comfort to you.
posted by treehorn+bunny at 11:13 AM on August 17, 2011
If you've never had sex and you're not having any specific complaint that needs investigation, a Pap smear/pelvic exam may not be of as much (or any) utility, but I still think this is a good thing for you to be seeing the OB/GYN about and addressing yourself, because there are a lot of reasons why you might want to take care of this problem for future benefit to yourself - even if you never want to have penetrative sex, if a medical issue did come up, since the treatment process is not a quick one, it would be really helpful to be able to undergo any needed testing and treatment with the greatest amount of ease and comfort to you.
posted by treehorn+bunny at 11:13 AM on August 17, 2011
To add to treehorn+bunny's advice: many health insurance plans will also cover the dilators and other materials that will help you to overcome this, if you indeed have vaginismus/vulvodynia/other pain conditions. It is a very, very common problem that can often be overcome or, at least, improved with time and patience. Don't be afraid to ask your OB/GYN any questions you may have, either. It's not that you're crazy, it's that you have a medical problem that needs to be addressed.
For this exam, try to relax as much as possible. That might include listening to music, asking the doc to go really slowly, taking a Xanax, etc. All good advice given by the folks above. One thing that has helped me is asking the doctor to warm up all the instruments, use plenty of lube, and have them tell me what they are doing as they are doing it. Good luck! You are brave to tackle this and not to put it off.
posted by zoetrope at 11:30 AM on August 17, 2011
For this exam, try to relax as much as possible. That might include listening to music, asking the doc to go really slowly, taking a Xanax, etc. All good advice given by the folks above. One thing that has helped me is asking the doctor to warm up all the instruments, use plenty of lube, and have them tell me what they are doing as they are doing it. Good luck! You are brave to tackle this and not to put it off.
posted by zoetrope at 11:30 AM on August 17, 2011
When you are at the exam, whatever else happens, ask about pelvic floor physical therapy and have them refer to you to a PT specialized in this area.
The PT could make a world of difference for you.
If you are in the Boston area, I know several good PTs who work specifically with pelvic floor issues of this sort and would be happy to pass along their contact information.
posted by zizzle at 12:46 PM on August 17, 2011
The PT could make a world of difference for you.
If you are in the Boston area, I know several good PTs who work specifically with pelvic floor issues of this sort and would be happy to pass along their contact information.
posted by zizzle at 12:46 PM on August 17, 2011
Nthing vaginismus. I hope you can find an ob/gyn who knows how to handle this. Physical therapy can help quite a bit. What you want is to find someone who specializes in pelvic pain and then ask them if they know how to handle vaginismus. On preview, what zizzle said. Also, I know a great person in the sfbay area if that is where you are.
As for the exam that is coming up in the not too distant future, my best tips are to do a lot of deep breathing -- like yoga if you have ever done that, and then try to visualize yourself pulling the back wall of your vagina back towards your butt. You can also try to move your muscles in a way that is called "bearing down", but I find that harder to explain. It's like you are trying to push something out. That can open things up quite a bit. (IANAPT)
Finally, I highly recommend The V Book as a resource for you.
posted by freezer cake at 4:04 PM on August 17, 2011
As for the exam that is coming up in the not too distant future, my best tips are to do a lot of deep breathing -- like yoga if you have ever done that, and then try to visualize yourself pulling the back wall of your vagina back towards your butt. You can also try to move your muscles in a way that is called "bearing down", but I find that harder to explain. It's like you are trying to push something out. That can open things up quite a bit. (IANAPT)
Finally, I highly recommend The V Book as a resource for you.
posted by freezer cake at 4:04 PM on August 17, 2011
Wait -- is this just a routine pap-smear that doctors usually give as a regular part of well-woman care, not something that you need for a reason specific to you?
If you've never had any form of penetrative sex, are you sure you need this pap-smear? As far as I am aware, the purpose of a routine pap-smear is to detect cancerous and pre-cancerous cervical cells... and something like 98+% of cervical cancer is caused by HPV. As a complete virgin vaginally, if I were you, I'd make sure I actually needed this before going through what seems like a completely pointless hassle.
posted by Ashley801 at 6:44 PM on August 17, 2011
If you've never had any form of penetrative sex, are you sure you need this pap-smear? As far as I am aware, the purpose of a routine pap-smear is to detect cancerous and pre-cancerous cervical cells... and something like 98+% of cervical cancer is caused by HPV. As a complete virgin vaginally, if I were you, I'd make sure I actually needed this before going through what seems like a completely pointless hassle.
posted by Ashley801 at 6:44 PM on August 17, 2011
This thread is closed to new comments.
Heck, maybe a Tramadol or Codeine pill or two would help.
posted by amtho at 9:42 AM on August 17, 2011 [1 favorite]