I have vaginismus, and though I’ve undergone physical therapy for it, pap smears are still unbearably painful — it basically feels like I’m being stabbed. Is there any way to tell my doctor that an Ativan and a Tylenol won’t cut it? Or am I doomed to never get a pelvic exam ever again?
— Molly from N.Y.C.
Pap smears should not be painful ,and they are most definitely not something to endure. In fact, each painful pelvic exam or Pap smear can further increase your pain, which worsens your underlying condition, never mind causing stress and trauma. There are definitely options to reduce your pain.
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Pap smears and pelvic exams should not be painful, and I am sorry for your experience. As an OB/GYN and pain medicine physician I cannot say this enough: A painful pelvic exam should be stopped.
For someone who historically has suffered with pain during pelvic exams or who has underlying pelvic pain and is understandably apprehensive about an exam there are several options:
Find someone with expertise in doing pelvic exams for women who have pelvic pain. As a pelvic pain specialist, I see women every day who tell me that my exam was their first pain-free Pap smear. I am so happy to help them, but it also makes me want to cry because it shouldn’t be that way. An experienced provider should allow enough time (feeling rushed helps no one relax) and may be able to coach you in other ways to help you relax your pelvic floor muscles. Some other options that can help reduce pain are applying topical numbing medication to the vaginal opening and using a narrow vaginal speculum that is about the size of a finger. Sometimes, I even have my patient insert the speculum herself.
A vaginal sample for H.P.V. (human papilloma virus) testing instead of a Pap smear. For women who are 30 years or older, H.P.V. testing can be used for cervical cancer screening. Technically H.P.V. testing as currently recommended is a swab from the cervix (so a speculum is needed), but there is data showing self-collected vaginal samples may be as accurate. Your provider could collect the swab this way without a speculum or you could collect it yourself. Inserting a vaginal swab on your own without need for a speculum or a provider to touch you may be a far less painful and fear-inducing option.
Intravenous anesthesia. For women for whom the first two options are not going to work (for example there is too much fear or pain, or memories of past trauma to take a vaginal swab, or there is a need to collect a Pap smear and look at the cervix because the H.P.V. test is positive), there is the option of an anesthetic. It is not any sign of failure to need anesthesia for a pelvic exam — we have modern anesthesia for a reason! This type of anesthesia is typically called monitored anesthesia care and an anesthesia provider (a doctor or nurse anesthetist) administers intravenous anesthesia in an operating room or a surgical center to control pain and anxiety. It is more expensive and typically requires several hours out of the day, although with modern anesthesia techniques and a short procedure the recovery is typically very fast. In some cases, this measure is worth it to be able to screen for potentially serious diseases like cervical cancer.
Dr. Jen Gunter, Twitter’s resident gynecologist, is teaming up with our editors to answer your questions about all things women’s health. From what’s normal for your anatomy, to healthy sex, to clearing up the truth behind strange wellness claims, Dr. Gunter, who also writes a column called, The Cycle, promises to handle your questions with respect, forthrightness and honesty.
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