Sex is painless, so why did my pelvic exam hurt so bad?

[Jay27]

Penetration with fingers during masturbation or sex has never been painful for me. It usually feels very pleasurable if I’m turned on, or a bit uncomfortable if I’m not in the mood, but it never hurts. I’ve also been using tampons since I was in high school and I’ve never had pain inserting them, even the larger sizes.

But I tried to get a pelvic exam and Pap smear for the first time recently and they couldn’t put anything inside me. I had taken some Ativan and was feeling chill, but I guess my body was still very tense. My vaginal muscles were literally pushing the doctor’s finger out. The only speculum they had was kinda big, and even with lube it hurt a lot. Once they tried to open it I was in some of the worst pain I’ve ever felt so they couldn’t do the pap smear. She tried to just put the swab in me without a speculum but not even the swab on its own would go in. And I’d been able to swab myself during a chlamydia screening a couple weeks before that, but I think by that time of the appointment I couldn’t put the swab inside because my body had been through too much that day.

Since then I’ve been nervous whenever I try penetration during solo or partnered sex or put in a tampon, but it’s felt completely painless just like before. Fingering in a sexual context is still very pleasurable to me. My doctor thinks the pain and tightness in my vagina is limited to medical settings because I’ve already had many years of traumatic experiences with different doctors, some of which I’d describe as emotional abuse. I’ve never experienced trauma related to sex though. All of my experiences have been consensual and really enjoyable. It was my first time seeing this doctor and that might have also made things harder.

I don’t know what to do because I’m sexually active and also have really bad period symptoms lately so it’s really important that I can get these medical tests. I have another gyno appointment in early August and I’m terrified. I’m just so confused about why this is happening and what I can do. I don’t want to neglect my health. I have some friends with vaginismus but any kind of penetration, even the smallest tampon, hurts them so I don’t think that’s what I have.

[Latha]

Hi there, Jay27

I'm sorry that the examination went so poorly- pelvic exams definitely shouldn't hurt like that! I think you're right that your past experiences in a medical setting combined with the fact that you were with a new doctor could have caused it. Fortunately, there are several things you can try that may make these exams more comfortable.

1. It may not solve everything, but a smaller speculum could be helpful. Perhaps you could call ahead to make sure that they'll have one before your next appointment?

2. You could also try to lie in a different position- here are a few: (Source: Pelvic Exams: A Modern Guide)

The “letter M”: knees bent and feet on the end of the exam table, thighs apart.
The “letter V”: on your back with legs straight out on the table, separated in a V shape.
The “diamond”: knees bent, soles of feet together with legs open in a diamond shape.
Sidelying: lying on one side with hips and knees bent up towards your torso.

(All of these avoid using stirrups, which makes some people feel more comfortable as well.)

3. You could ask for a topical numbing cream or an anti-spasm medication

4. You could practice pelvic floor muscle relaxation techniques, and try to use them as the speculum or swab is inserted

5. You could try putting the swab or speculum inside yourself on your own

Let your doctor know that you have experienced pain during pelvic exams before, and ask to take it a bit slowly. They should be sensitive to your request.

I hope this helps!

P.S. Vaginismus can be situational- it is possible for someone to have no problems using tampons while having pain during sex, for example.

[Jay27]

Thank you for the response. My psychologist also recommended taking a much larger dose of Ativan (it’s prescribed and I would ask my doctor first). I’ve heard of people getting exams under sedation but I don’t like the idea of someone touching my vagina while I’m asleep and anesthesia has made me throw up before. I’ve looked up pictures of the pediatric speculum and it’s looks like it’s only the size of a regular tampon so way smaller than the one they used on me. Should I call ahead and ask if they having numbing gel in the office? Also would it be possible for me to ask to swab myself in a different room where the doctor isn’t there? When I swabbed myself in the bathroom on my own during a STI test it was a lot easier. It sucks but I’ve had panic attacks just from stepping into a hospital and I almost cried recently from the smell of an alcohol wipe I used to sterilize a new nose ring. I’m working on it with my therapist but this isn’t something that will be fixed in the next month.

[Carly]

Hey Jay -- It sounds like you have a good sense of what you're comfortable and not comfortable with in this situation. I think it would be ok to give them a call and speak to someone about the options you have for numbing gel and/or self-collection for a pap smear. How do you feel about reaching out? Have you ever had to advocate for yourself like this? If you want to practice with us here we're happy to help.

[Jay27]

I have a lot of trouble making phone calls because of my anxiety disorder. I don’t know if I’d be able to do it.

[Nicole]

Hi Jay27,

I completely understand. I'm sure there are other ways to contact them and ask questions, such as through email. I'm sure the clinic's office has an email address listed on their website. That might be a better option for you. You could email the office and ask for your doctor's email. Then, you can discuss privately with your doctor how to improve your future visits. What do you think?

[Jay27]

That sounds good. The gyno I’m seeing this time is different from the one who did my first pelvic exam. I’ve never met her before. The reason I’m using different doctors is because the one I went to a couple months ago is in my college town, and the one I’m seeing in August is in my home state.

[Latha]

Hi there, Jay

Fingers crossed for you to get the accommodations you need easily! Would you feel more comfortable getting a pelvic exam if you were familiar with the doctor?

[Jay27]

I think so. I’ve never been comfortable with a doctor before, besides maybe my primary care doctor and my plastic surgeons who did my breast reduction/lift. I feel like there’s a bit of a time crunch because I might only have time to see her once or twice before I go back to college 3 hours away.

[Sam W]

Oof, yeah, the weird space you can end up while trying to get healthcare during college while also going home for the summer can make forming a connection and trust with a doctor much trickier. Although if you end up liking this one and she's good about accommodations, one option might be to ask her if she has anyone she'd specifically refer you to in the area where you go to school; sometimes healthcare providers are able to connect us to other providers who approach care with a similar philosophy.

[Jay27]

That might help. I’m going to a doctor who uses medications and natural treatments which I think will help because my body reacts badly to almost all of the meds I take. Hopefully she’ll understand that because I’ve been gaslit so many times