Pelvic Exam Pain?

Last year I went for a pelvic exam and when the doctor was inserting the speculum, it hurt so much that I wasn't able to continue with the exam. I was fairly relaxed and the doctor was very nice about it and stopped the exam.

I am going for another doctor visit soon and I just want to get the pelvic exam done to make sure that there are no abnormal cells. I was wondering why I would have pain with this, and is there anything I can do to reduce the pain. I know that the more relaxed I stay and deep breathing will help, but is there anything else that I can do to make it less painful?

Thanks in advance.

First of all, congratulations. In spite of last year's bad experience, you have a very good attitude.

As one other poster mentioned, having your doctor or nurse practitioner "lubricate" the speculum with warm water may help a bit. Unfortunately, it's not indicated to actually lubricate the speculum with an exam lubricant, such as KY jelly, as this can interfere with the pap smear collection. But, read on....

THE most important thing you can do is to talk to/communicate with your doctor from the start. The nurse too. Tell them about last year, even if it's the same doctor and he/she probably noted your difficulty in your chart. And, I want you to specifically request "a small or pediatric speculum". And, if you were in my office and we were dealing with this issue, the first thing I would do is to gently examine you with one or two gloved fingers, lubricated with warm water. I would want to check for anything specific that could be causing this pain you felt. For a new and especially for a first time patient, this is something that I do almost routinely. If there is something inside that's sensitive, sore or an issue, I'd rather come across it first gently with a finger, than to have a speculum "trip the land mine", so to speak. And, if you're feeling bold enough, go ahead and suggest such an action. Tell the doc that your friend had a similar problem and that "her wonderful doctor" did a preliminary exam with just his finger(s). (You'll be leading him like a show horse, too... no doctor wants to feel that some OTHER doctor was more caring or sensitive. :)

One other thing... if you again have issues with speculum insertion, even with a small spec and even perhaps with the "finger exam first" plan, I would suggest that you ask the doctor to go ahead and lubricate both the speculum and the edges of your vagina with KY. That will scuttle an accurate pap for this exam, but if you successfully tolerate the speculum, we'd know that it's just a question of lubrication and perhaps relaxation. And psychologically, you'll know that you're basically all right, after which next year's exam would probably go fine with the warm water.

Oh, one more thing... perhaps an adjustment in your positioning and/or the stirrups would help as well. This is another reason for the doctor to consider a "finger first" check, maybe he/she'll discover that your vaginal vault needs to be positioned slightly differently for a more clean and comfortable speculum placement.

Let me know how it goes, email is fine. One other thing, how old are you? Was last year your first pelvic exam attempt?

John Jones, M.D.

Same thing with me. Your vagina is very different when it is not lubricated. My doctor runs the speculum under warm water and then uses a lubricant which helps. It still hurts but your right, the key is to be relaxed. Its very hard to do though i know!

Take two ibuprofen tablets an hour before your pelvic. These are anti-inflammatory drugs and should help somewhat. It might be just extreme pressure, as you will feel...or a pinch. If the pain is sever enough to cause extreme discomfort then you should ask your doctor to check for a cyst or for vaginitis.