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Having Pain with Well-Woman, Annual, or Pelvic Exams? Read This!

Pelvic medical exams, whether performed by a gynecologist or pelvic pain specialist, can be scary. Especially when these exams are physically or emotionally painful.

I see this a lot in my clinic. Women share with me that a pelvic exam was too much, but they didn’t know how or what to say to interrupt the process, or what other options they had. So, instead, they suffer silently.

Healthcare can be difficult to navigate, as there is often an imbalance of power between the healthcare provider and the patient. My intention in writing this article is to empower you, the reader, with words and tools to use before, during, and after these exams for less physical and emotional pain.

If you would rather watch than read about this topic, check out this video from my youtube channel!

First and foremost, let me remind you that your body is yours. I recognize that pelvic medical exams are a form of self-care. Your intention is likely to better yourself or prevent future health issues, and for that I champion you. That being said, you are allowed to ask for different options both before and during these exams to prevent unnecessary suffering. Let’s break down these appointments, and highlight different tools that you can use for more autonomy and less pain throughout the process.

Before Your Appointment

First, let’s discuss tools that you can use before the appointment begins. There are medications that may be helpful for you to use prior to the exam.

Prescription bottle with generic pills

Muscle Relaxants

One option is a muscle relaxant. Often, someone with a history of painful pelvic exams will unknowingly guard before the insertion of a finger or a speculum. A speculum is the instrument that inserts into and opens the vaginal canal. Think about how your abdominal muscles respond if you get punched in the gut. They would reflexively tighten, or guard, or spasm, in order to protect you and the contents inside of your abdomen.

In the same vein, your pelvic floor muscles, which surround your vaginal opening and vaginal canal, can reflexively tighten and guard in order to protect you and your vagina from a threat. In this case, the threat is in the form of a finger or speculum. Muscle relaxants can help your pelvic floor to relax before the exam, which can mean less physical or emotional pain for you.

Over the counter lidocaine cream

Topical Lidocaine 

Another option, pending on the type of pain you have with pelvic exams, could be topical lidocaine. Lidocaine is a numbing agent that you can get over the counter or your doctor could prescribe for you. If the pain you experience with pelvic exams feels closer to the opening of your vagina, instead of deeper in the canal, lidocaine may be a good option for you. Numbing your vaginal opening might allow better relaxation, and less physical or emotional pain surrounding the exam.

Prescribing medication is outside of my scope of practice as a physical therapist. Please discuss these options with and get clearance from your doctor before trying muscle relaxants or topical lidocaine.

During Your Appointment

Moving into the exam itself, another topic you can discuss with your doctor is the speculum. Again, a speculum is the instrument that inserts into and opens the vaginal canal. There are speculums made for adults, and speculums made for children. The speculums for children are smaller, and tend to be less traumatic for someone who has a history of pain with pelvic exams. Don’t hesitate to ask your doctor to use the child’s, or “pediatric,” speculum during your appointment.

Furthermore, you can discuss how often certain tests need to be performed during your annual or well-woman visit. There are some tests that you may not need annually. Decreasing the frequency of those tests can decrease the amount of time your doctor is spending assessing internally. Annual exams usually consist of three parts:

The External Exam

Here your doctor is examining the skin and tissue surrounding your vagina to make sure that everything is happy, healthy, and normal.

The Internal Exam Using a Speculum 

Here your doctor is examining your cervix. There are two tests specifically that you may not need annually: the pap-smear and STD testing. A pap-smear is a test where your doctor uses a brush to scrape and collect your cervix cells to see if anything precancerous or cancerous is growing there. You may not need a pap-smear every year, as some doctors will allow for one every three years if your previous tests were negative. Furthermore, if you know that you are not at risk for STDs, you can ask your doctor not to test for them. This test also occurs with the speculum inserted, where your doctor takes a swab of your cervical fluid (or discharge) for testing. Eliminating these tests can decrease the amount of time your doctor uses a speculum your examination.

The “Bi-Manual” Exam

A “bi-manual” exam is another way of saying a “two-handed” exam. Usually this portion of the exam consists of your doctor using one hand externally and one hand internally to assess your reproductive organs, pelvic floor muscles, or both. You can request that your doctor use only one internal finger instead of two for this portion of the exam.

After Your Appointment

to do list: get groceries, annual exam, self care day!

Finally, following the exam, if you know that this will be a tougher experience for you, take care of yourself. Consider scheduling the appointment for later in the day so that you can go home afterwards instead of returning to work. Think about bringing a heat pack to the appointment, so that you can apply heat to your pelvic muscles during the car ride home and help yourself relax. Conversely, some women find ice to be more therapeutic than heat. Perhaps you can bring a small cooler with an ice pack or bag of frozen peas for the car ride home. If you are someone who tolerates anti-inflammatory medication well, consider taking ibuprofen (Motrin or Advil) following the appointment for pain relief. When you get home, maybe you could take a hot bath, or rest on the couch with your favorite movie.

Regardless of what works best for pain management for you body, you are allowed to take care of yourself. You are allowed to acknowledge that this is a difficult experience for you. You are allowed to care for and love yourself afterwards.

In Summary:

  1. You are in charge of your body.
  2. There are medications, like muscle relaxants and topical lidocaine, that may decrease pain with these exams. Talk to your doctor about whether or not they would be appropriate for you to use before your appointment.
  3. A smaller speculum exists, called a child’s or “pediatric” speculum. You can ask your doctor to use it instead of the adult speculum.
  4. You can ask your doctor which tests are necessary for you annually, and which tests can be done less often. Ask specifically about pap-smears and STD-testing to decrease the amount of time your doctor uses a speculum. Don’t forget, you can also ask your doctor to use one finger instead of two for the manual exam.
  5. After your exam, take care of yourself!

Last but not least, if you are having painful pelvic exams and you aren’t seeing a pelvic physical therapist… Check us out! Often a painful pelvic exam does not occur in isolation. Perhaps you also experience pain with periods, or tampon use, or penetrative sex, or tight clothing, or pelvic pain in general. Pelvic physical therapy can be a wonderful option for women with any of these symptoms. Find a pelvic provider near you, here!

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