Gynecological exams. Speculums. Stirrups. Depending on who you are, and what your experiences have been, these images may conjure up feelings of inconceivable dread and intense worry. While routine pelvic exams are incredibly important for our health and well-being, especially when it comes to cancer detection, they can be quite uncomfortable. Maybe even awkward. Does the thought of a pelvic exam cause tense feelings, uncertainty, or hopelessness?

Pelvic exams can be challenging for most people, these feelings of anxiety, stress, and apprehension, can be amplified if you have chronic pelvic pain or experience pain during penetration, whether that is during tampon insertion, fingering, intercourse, or any other type of vaginal penetration.

pelvic exam | vaginismus | kiss and tell

Pelvic exams for individuals who have vulvodynia, vaginismus, or any other similar condition have the potential to awaken a whole spectrum of mixed emotions, such as fear, resentment, shame, sadness, anger, and despair. There are many who worry that an upcoming pelvic exam is just another opportunity to feel belittled, misunderstood, and maybe even harshly dismissed by a medical provider who may not know a whole lot about pelvic conditions, or who simply is not comfortable enough to explore these realities with a patient.

Others may worry that the exam will only compound any previous trauma they have already experienced. Meanwhile, there are other individuals whose concern is that a negative experience with a gynecologist serves as a confirmation that their medical concerns will never improve and that they may never be able to achieve the personal goals they have set for themselves. Even without a formal diagnosis of vaginismus, endometriosis, or vulvodynia,  a gynecological exam can be exceedingly intimidating. Just a single negative pelvic experience or trauma to the pelvic region can make the idea of approaching a gynecological exam difficult. 

It takes an immense amount of bravery to advocate for one’s self and decide to undergo a pelvic exam, despite what one’s previous experiences have been, along with the bundle of emotions and cognitions one may have about the procedure. Whether you have or have not been formally diagnosed with vaginismus or a related condition, this article is solely devoted to sharing suggestions and recommendations that can help patients feel more comfortable and confident about their upcoming pap smear. 

Find the right provider

The first step to consider when it comes to making the pap smear environment more welcoming and less riddled with anxiety is to find a compassionate, knowledgeable provider. Admittedly, this may take longer than wanted and prove to be rather frustrating, but it will all be worth it once you have discovered the right provider for you and your unique needs.

pelvic exam | kiss and tell

Make some time in your schedule to sit down in front of your phone or your laptop and window shop. Read each provider’s profile or call clinics and ask for more information about a particular clinician. Ask the provider if they have ever treated a patient with (insert your particular medical concern), and if they have not, follow up and ask them what they might do if a patient of theirs had that concern. 

It is crucial that the provider in charge of the procedure is someone you feel a connection to. A person you can trust. A person who listens and makes you feel heard, valued. Connection is paramount. 

Relevant questions that you may consider asking your provider include the following:

  • What can I do to manage my pain/anxiety in regards to the exam?
  • What tools are out there that can make this experience more positive?
  • Have you ever conducted a pelvic exam with a patient who has pelvic pain/penetration anxiety?
  • Would you recommend I take Ibuprofen before the exam?

Identify Your Resources

Individuals who have high levels of anxiety associated with undergoing pelvic exams can request anti-anxiety medication to take beforehand. If you feel this could be right for you, do not feel afraid to ask your medical provider about this. Make sure to find transportation services for your gynecological exam. Taking an anti-anxiety medication can impair your driving ability. Clinics may offer free or reduced transportation services for patients. 

Additionally, gynecological offices usually offer lidocaine numbing cream to patients who experience pain/discomfort in the vaginal canal. If the clinician is not aware of this option, request a lidocaine prescription and explain why you believe this is important for you and the care you need. A helpful provider will listen to your concerns and do their best to accommodate their clients. The gynecologist may offer to assist in the lidocaine cream application for patients who feel uncomfortable about using the product by themselves. 

pelvic exam | vaginismus | kiss and tell

 Generally speaking, clients can request to use pediatric speculums. There are times when clinics do not have these tools on hand or believe that a larger tool may better assist them with the pelvic exam. Talk to your provider about what your options are. Some individuals find that plastic speculums are more comfortable and less fear-inducing. I highly encourage you to speak to your provider and ask any questions you have. This exam is for you and your health needs. 

Bringing a trusted chaperone to the appointment can make the experience more positive and easier to undergo. Invite a family member or a friend whom you trust and feel safe with. 

Meditation music can be a very powerful tool. Weeks before the appointment, search around on Spotify or Youtube for playlists that allow you to feel grounded, centered. Music can inform our nervous system and facilitate relaxation. The music does not have to be a meditation playlist, but just anything that feels calming.

You may wish to practice dilating at home with the playlist and seeing what effects if any, the music has on that experience. If the music makes you feel scattered and distracted, that may be an indication that this is not the right playlist for you. Practicing dilation at home with a playlist and then using that calming playlist at the pelvic exam is another creative way for clients to feel more familiar with the situation and also feel more in control of what is happening. 

Bring a stress ball or a good luck charm. Having a small good luck charm like a favorite ring or bracelet, or a squishy stress ball that you can hold, may give you more confidence. A great pairing is to have a mantra associated with the charm. A green crystal bracelet may, for instance, remind you to have belief in yourself. Therefore every time you need added reassurance, you may look at the bracelet and speak aloud, “I believe in myself.” Verbally speaking your mantra can send relaxation signals to your body and your mind. 

The Day Before the Pelvic Exam 

pelvic exam | vaginismus | kiss and tell

The day before the pelvic exam is important. Allowing yourself that time to properly decompress and gear up for the big day can make a big difference. If you can schedule the appointment for a day where you are not too busy and can look after yourself following the exam. Understandably so, not everyone can schedule the exam during a day off, but if you can rearrange your schedule to accommodate the exam, I highly suggest doing so, that way you can focus more on your comfort and any positive coping mechanisms you have established which will aid you during the pelvic exam. 

Getting enough to eat and drink and sleeping well before the exam are important considerations. You want to feel as comfortable and as reassured as you can. Before going to bed the day before your exam, try to carve out some time just for yourself where you can relax and process.

Maybe you would like to spend this time watching your favorite lighthearted show, or reading an uplifting book. Maybe talking on the phone for forty-five minutes with a best friend is the way you would like to cap the night. Drink some refreshing tea and eat your favorite snack. Take a long bubble bath. Dance in your living room. Do something that makes you happy. Reward yourself for being at this stage in your health journey. 

The Day of the Exam

Right before the pelvic exam, you may begin to feel nervous and that is completely okay. It is normal to feel nervous before embarking on a new adventure, before going to places you have never been. Remind yourself of this and of how far you have come. Recall past obstacles and what you did to overcome these challenges.

Then recall how proud you felt after surmounting these difficulties. Rely on your support network to see you through this. Doing some basic stretching while focusing on your breath can help your body recenter itself and send relaxation signals to your brain. Movement is a really great way to shake out any nervousness or tension being stored in the muscles. 

If at all possible, plan a little treat for yourself following the exam. No matter what ended up happening in the exam room, celebrate that you showed up and took this huge step for yourself. Pelvic exams can be intimidating and not every method or every tool will work for you. It is about finding what you need.

Finding what works for you. If you take the time to explore, if you listen to your body and your mind together, if you give yourself grace, you can and will successfully identify the tools that you need.

Medical Disclaimer: This article was written using original ideas and insight as well as recommendations based on personal experience. These suggestions may or may not work for you. It is always best to speak to a medical professional about your health needs.


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