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Guide to smooth gynaecological visits





The following is a list of some tried and true advice which can make a gynaecological visit or Pap smear test much less distressing for you. This advice is based on scientific papers as well as suggestions based on the experiences of many women who had vaginismus. If you are aware of what your rights are, then you will not feel as though you have to tolerate pain during an exam, or an obnoxious and insensitive doctor. You will be able to acknowledge your body’s fears, and have those fears validated and respected. This sense of empowerment alone can make many of your fears dissipate, which can reduce discomfort, trauma and pain during the exam.

Remember that it’s your body and it’s your vagina! Although the doctor is there to help you, you also have much to offer them in order to make a visit an empowering experience.



PART ONE


BEFORE THE APPOINTMENT



1. Find a gynaecologist who knows about vag.



Unfortunately, it is a fact that it is way too common for a woman to find incompetent gynaecologists who have no clue about vaginismus or how to handle a woman’s pain and fear during a visit. (See women's main complaints at gynecological exams).

A visit and/or internal exam with an incompetent doctor can be extremely traumatizing. This is especially true for virgins, women who have not yet tried any gradual insertions, or for those who have suffered from physical and sexual abuse in the past. To avoid this type of doctor’s visit, I was advised in my support group to call a few gynaecologists beforehand and ask them whether or not they treat vaginismus or know anything about vaginismus.
It may be hard to make that call if you never mentioned vaginismus out loud to anyone, so you may want to practice beforehand. It took me some time personally before feeling ok even just asking a total stranger (and a doctor) about this. Oh, and be ready for them to say "vaginis.. what?" !! Then you'll know it's time to hang up! :)
So try to call as many gynaecologists as you would like until you find one who is qualified. If you can't choose your own gynaecologist instead, for whatever reason, then there is a possibility that you will NOT have one who knows much about vag. In that case, you may want take him/her some material to read (See our article on Best Practices and be firm on having your rights respected (see part 2). This is your opportunity to teach your doctor about vaginismus.

2. Inform your doctor beforehand about your vaginismus



Another woman had gone a step forward. She told us that once you have found a gynaecologist with whom you feel confident enough discussing your vaginismus, you may even go an extra step and write, email or call that gynaecologists and let him/her know in more detail about what you are experiencing and what your special needs are during the exam (i.e. You could tell them that you may need extra time to talk before going through the Pap smear or that you would prefer a small size speculum, as explained below).
Then ask them if they can agree to these terms and only upon their agreement (which they will usually agree to), schedule your appointment.

3. Inform the doctor that you would like extra time with him/her during your visit



In some countries and in some private clinics, each appointment is allocated a certain amount of time. Often not much time..
If you would prefer extra time (which we suggest) you can call the doctor’s office and tell them that you will need extra/double time during your visit. They should be able to allocate you a double appointment so that you can discuss your vaginismus and get more comfortable with the doctor before going through with the actual examination.

4.Decide whether you would prefer a female or male practitioner



You have the choice to ask for a female gynaecologist, this is your right. Several polls and studies seem to suggest that at least half of women, and often more, prefer a female gynaecologist. Unfortunately, only a small percentage of all gynaecologists are female, so you may not be given that choice. But if a woman is not available, you should still be offered the option of having a female nurse or medical student, (called a chaperone), present during the exam. You may feel more comfortable with a woman in the room, but you may prefer to be alone with the doctor. I had to fight my inclination to be a people's pleaser more than once, and kindly reject the offer of a chaperone, cause I was not comfortable having more than one person hearing about my vaginismus stories. So try not to feel bad about them, they are fine, they can take rejection, it’s your choice and you have the right to be firm about whatever choice you make.

5.Know your rights regarding third parties present during the exam



As we just wrote, a chaperone should be made available to you if you require it, that's the policy, however, research shows that many women prefer to do without a chaperone so don't feel afraid to say that you'd rather not have another pair of eyes looking at you in such a private moment. Instead, having a third party of your choice (a friend, your mom or your partner) in the room with you is up to the discretion of the doctor, but it should be possible to take someone with you during your exam especially if the chaperone wasn’t available.

Sometimes, especially if you have a visit in a University hospital, they may ask you if you don’t mind having an undergraduate medical student present during the exam. Although it is true that these students need experience, you do NOT have to feel obligated to have them in the room during your exam. There is no reason that women with vaginismus should feel even more uncomfortable than they already do, so if you don’t feel comfortable, please just say a calm “I’d rather not.” Do not let anyone pressure you to accept.

6.Borrow or buy a speculum to practice with at home beforehand



If you already know and trust your gynaecologist, you could ask him/her if he/she could lend you (or sell you) a speculum to practice inserting. (This could be done weeks or months before the actual appointment). Please know that this has been done before; you might even want to mention to the doctor that other women have done this, and that it helped them A LOT to avoid pain and/or discomfort. I did that and he was a bit surprised 'cause he had never thought about doing that, but he thought it was a great idea so I walked home with a speculum that evening :)

Although each speculum should be perfectly sterile, you may feel safer buying a new one. You can buy it online (even on e-bay). If you decide to practice with a speculum beforehand, you can choose to only book an appointment when you're very comfortable inserting it, and maybe even opening up a little bit. br>

7. Empty your bladder!



Make sure you go to the toilet right before the exam :)




PART TWO: DURING THE EXAM



1. Ask for the smallest speculum available




There are some specula called ‘pediatric’ or ‘virgin’ specula which are used for children, and there are also small specula for adults called Pederson. Although it is a bit harder for doctors to see well with them, they can still be used to have a perfectly valid pap-smear. So ask for that one if they don’t think about offering.


2. He/She’s the doctor, but you’re the boss




Remember that only YOU own your body. Even when you are naked in front of the best doctor in the world, it's still YOUR body and YOUR vagina. You have very valid reasons for your fears and even more for the pain that you may have experienced or the fear that you may be re-experiencing. That means that a doctor shouldn’t patronize you, belittle you, or tell you how you should be feeling or behaving. Here are a few things that you have every right to do during an exam:

- Tell the gyno to stop at any time
- Ask the gyno to change positions
- Put the exam off to another day
- Change your mind half way through the exam and leave without feeling bad
- Ask for some more time
- Ask the gyno to explain what exactly they are about to do and what instruments they will use


3. You can self-insert the speculum or swab



You may ask the doctor if you can insert the speculum by yourself. Having control over the insertion can make an enormous difference, especially psychologically. Doctors should have NO objections to this if it makes you feel more comfortable.

Scientific research shows that there is no difference in the outcome of the exam if the woman does the insertion herself rather than the doctor doing the insertion. Research also shows that self-insertion can improve the experience for a woman. You may want to show your doctor these recent studies if he/she has reservations:

a) Wright D et al. (2005) Speculum 'self-insertion': a pilot study. Journal of clinical nursing 14 (9): 1098-1111

b) Chernesky, Max A PhD * (2005) Women Find It Easy and Prefer to Collect Their Own Vaginal Swabs to Diagnose Chlamydia trachomatis or Neisseria gonorrhoeae Infections. Sexually Transmitted Diseases. 32(12):729-733.


4. Lube it up!



We know that some doctors refuse to lube up a speculum thinking it will negatively affect the exam. Well, truth is: speculum CAN be lubricated, and you can suggest that he/she uses lube during the exam. The lubricant can be applied to the vaginal opening as well as the speculum (feel free to apply the lubricant to your vaginal opening rather than having the doctor do it if this makes you feel more comfortable, after all it is a sensitive area). Using lubricant can potentially make things a lot easier for you and scientific research shows that a lubricated speculum will not interfere with the pap-smear result.
See scientific evidence for this in the article on Evidence-based Best Practices for Pap tests and show those studies to your doctor if he/she is reluctant to do this..
(NOTE: If you are prone to vaginal infections you may want to ask for a glycerin-free lubricant. Glycerin is made up of sugars that can cause yeast overgrowth. Check the section on lubricants for the whole range of choice available).

5. Warm it up

If you prefer the lube not to be used (or for some odd reason the doctor prefers not to use lube), you can ask your doctor to at least warm the speculum up with warm water beforehand, it slides in better than if cold water or nothing at all is used.

6. Choose the position YOU are comfortable with

You may find that some gynaecologists use stirrups, whereas others don't. Some may have a small blanket to cover the area so you do not feel cold or too exposed; some even give you warm socks to wear! Whatever kind of bed you will find at the doctor’s, you have a right to choose a position that will make you feel the least vulnerable and the most comfortable (granted the position still allows your doctor to examine you).
For example: You can keep your knees together, not use the stirrups and/or ask for a blanket to cover your lower body, etc.

Scientific studies have found that NOT using stirrups reduce women’s sense of vulnerability. So if you feel better without resting your feet in the stirrups, you may want to show your doctor this British Medical Journal article, if they are sceptical.

7.Ask for a brochure or hand-out on vag.



In most cases they will NOT have information on vaginismus on–hand and may not even be able to refer you to a support group or any useful or objective websites. We still believe it would be a good idea for you to ask for it: information regarding vaginismus should be available in a professional’s office and by asking them for this information, you will make them realize that they really SHOULD provide information for vaginismus sufferers.

If they seem cooperative, you may even give them a brochure yourself and ask if you can leave a few in the waiting room (or suggest that they print out or create a free brochure like the one from this helpful Canadian website).
You can also give them the name of the support group in your language that you found helpful. Hopefully they’ll be humble enough to take the suggestions.

8. General suggestions and advice:


These are examples taken from our own experience and advice given to us from our gynaecologists (and we've seen plenty!) and things I learnt from the great book I'd recommend any woman, "THE V-BOOK" where a compassionate gynecologist (E.G. Stewart) gives really down-to-Earth practical advice on exams, for patients.

• You may feel more comfortable wearing a long skirt; you could simply hike it up a bit without having to fully undress.

• Try not to make an appointment when you have your period. It can get a bit messy for the examiner when menstrual blood is involved.

• Do not have intercourse or put creams, medications (except lube) in your vagina for the 24 hours before the exam. The PH in the vagina may change and it may affect results.

• If the exam is hurting at any point say “that hurts!” and if you would like them to stop say, “Please stop!” Don’t be afraid or intimidated to say it if your gyno is hurting you! Don’t hold back, you’re no martyr.

• Ask questions throughout the visit and during the actual exam. The doctor may be quiet while examining you, but that doesn’t mean you have to be.

• Shave if that will make you feel better, or remain as hairy as you are because it won’t matter. Doctors are used to seeing all kinds of hair-styles down there.

• If you are experiencing an odour in the area due to a vaginal infection, you may want to wash before your exam, but do not try to cover up the odour with fancy deodorants, etc. Make sure you tell the gyno about the odour before the exam begins. This information is useful to the gyno because they can often recognize the type of infection you may have based on the kind of odour.

• When you talk to your gyno, you can sit at the table, fully dressed, until you’re ready for the exam. After the exam, you don’t have to remain in the uncomfortable position that you were in during the exam. If you wish to talk further with your doctor you may dress and sit comfortably in a chair.



If you’re not comfortable speaking up or if you have a speech impairment, fill in a gynaecological chart and take it with you to the visit.
The following one is based on what I learnt personally with my gynaecologist, to whom I brought a list of questions, and from material I adapted for vaginismus from the really helpful advice that the gynaecologist Elizabeth Stewart gives in her "THE V-BOOK", where she describes the ideal exam. You may want to fill it mentally at home and only use a pen when you’re at the doctor, just in case you should lose it, so nobody will have your personal information! Hope it helps...



GYNAECOLOGICAL CHART



This is where I experience pain when I try to insert something:

- at the opening /entrance of the vagina
- deep in the vagina during insertion or thrusting
- at the end of the vagina/cervix




This is the kind of pain I feel when I insert or try to insert something:

- Burning
- Itching
- Pinching
- Feeling torn apart
- Bleeding
- Experiencing a brick wall




This pain began: _____________________________________
(ex. after I gave birth, after a sexual abuse, ever since I first tried inserting something etc..)



This is what I have tried so far and found painful
- inserting a tampon
- inserting a small dilator
- inserting a vibe
- attempt intercourse
- have a pap-smear (with another doctor ... years/months ago)



This is the lube I use: _____________________


My history of vaginal infections:
I (regularly/never/once) suffered from
- Yeast
- Vaginitis
- burning discharge
- bladder infections
- burning at urination
- urinary leakage
- bad odour
- ________________




Medications/products I am currently taking & How long I’ve taken them for

- _________________________________ ______________
- _________________________________ ______________




Contraception I’m using:
_________________________________________




I am allergic to these medications:

- ______________________
- ______________________
- ______________________



History of sexual abuse

Most doctors won't ask you if you were ever abused. They fear opening a can of worms that they may not be able to respond to so they prefer to avoid this question. This is terrible, because it is proven scientifically that when women are asked, they often tell, often for the first time. So doctors are advised to ask women about this and gynaecologists are in a great position to do this.
If they don't, you may feel like talking about this with your doctor, it may be very helpful. Just make sure he or she is a compassionate person. Don't just look at the titles/credentials on the wall...



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DISCLAIMER: This site is not designed to provide medical advice. All material is gathered from the experience of hundreds of women who experienced vaginismus but it is for information only and is not intended to be a substitute for professional or medical advice, diagnosis, and treatment. Please review the information contained on vaginismus-awareness-network.org carefully and confer with a health care professional specialized in vaginismus, as needed.