Preventing pain during pelvic exams

Gynecologic exams are done for cervical cancer and STD screening, and are an important part of evaluation for pain, bleeding and discharge. They are an important part of women’s health maintenance.

However, some women find these exams to be especially distressing and painful. Fear of pain is a common reason women avoid getting examined, especially among adolescents, women with a history of negative experiences, trauma or abuse, disabilities and sexual minority groups.

This is a common problem, and yet, we don’t talk about it much, as health care providers or patients. Fortunately, there are a few things women can do to help counteract that pain.

So, what can I do to prepare for my exam?

One way to prepare is to routinely practice gently placing your thumb at the opening of your vagina. This can be done while showering, and can progress to gentle vaginal insertion, using a water or silicone-based lubricant.

It’s also important to take note of any fear or anxiety ahead of your exam, and remind yourself to breathe. If the fear or anxiety feels too big to handle, then learning relaxation techniques, such as mindfulness or a consultation with a mental health specialist to specifically address these feelings can be very helpful.

I’m postmenopausal and have vaginal dryness. What can I do to prepare?

When women become post-menopausal, their estrogen levels drop and, as a result, their vaginal lining can become thin and fragile. The medical term for this problem is vulvovaginal atrophy. Many women experience this as dryness, irritation, or pain with vaginal penetration. Although vulvovaginal atrophy does not usually improve with time, it is very treatable.

One way to lessen the discomfort with gynecologic exams following menopause is to begin a daily routine of using oil at the opening of the vagina. Different oils have different properties, but unfortunately, these aren’t well studied for vulvovaginal atrophy. Nevertheless, commonly recommended oils are vitamin E, mineral oil, and coconut oil. I tend to recommend organic sunflower oil, for its skin healing properties.

Women should start this daily routine ideally at least one month prior to the exam: place two to three drops of oil onto the pad of their thumb, then insert their thumb about one to two centimeters into their vagina, focusing on the outer, bottom half of the vagina and gently massage the oil into the skin for 10–15 seconds.

This technique is called a perineal massage, and targets the most problematic area for most women with vulvovaginal atrophy. Oils should not be used in conjunction with latex condoms, as these oils can degrade latex, and lead to condom breakage.

What can I do during the office visit to lessen the fear and pain?

If you commonly experience pain during gynecologic exams, it’s okay to tell your provider about this issue. In fact, you should tell your provider if you feel uncomfortable, and you can both collaborate on ways to help you feel more comfortable, such as:

• Bringing a friend or loved one for support
• Adjusting your body positioning for optimal comfort
• Asking your provider to explain what they’re doing, as they’re doing the exam
• Using a lubricant to reduce pain

It’s human reflex to tighten up when we’re anticipating that something—like a pelvic exam—will hurt. But when our pelvic floor muscles contract and tighten, it can lead to more pain during the exam. A way to prevent this pain is to ‘bear down’ during the early part of the internal exam. ‘Bearing down’ is a technique that involves pushing by using the same muscles that are used in a bowel movement.

All tips, tricks and techniques aside, what’s most important to remember is that it’s acceptable to tell your provider to slow down or stop. You should always feel safe and in control during your gynecologic exam.

While these techniques can lessen the fear and pain with exams, they are sometimes not enough, and may not solve pain with sexual activity. Consult your health care provider for further treatment options or questions.

Dr. Lynn Wang is a gynecologist and female sexual medicine specialist at Main Line Gynecologic Oncology, and has office hours at Lankenau Medical Center and Paoli Hospital.