I think I have vaginismus. Can I start dilating before I see an OBGYN?

[Jay27]

I’ve talked on here before about how I had several failed internal exams, and the one time I could actually get a Pap smear I was in excruciating pain during it and for the rest of the day. In the past few months I can’t insert a tampon and I can’t even get 1 finger in with a lot of lube. The only thing I can get in my vagina was a cotton swab but that hurt too. I’m worried for my future. I’ve never been interested in penetrative sex, I’m just worried about medical procedures. I’m seeing a doctor for it in a month. There’s no earlier appointment. I’m scared she’ll want to put a finger or a speculum inside me when that’s not possible. I read your website’s article on dilators and I want to start ASAP. Should I use the dilators for a month before the appointment?

[KierC]

Hey there Jay27,

I’m sorry to hear you’ve been going through this, especially with all the pain you’re experiencing as well — I am glad, though, that you’re here, and that you’ve made an appointment to discuss this with a doctor as well.

You can certainly try using dilators before your appointment, especially since you’ve read up on it quite a bit and it sounds like you’re aware of what it involves (too, if you have any more questions during the process, we’re always here). I would advise, since it sounds like one finger is quite painful for you currently, to start with the smallest size you’d like, and go s l o w l y … with lube! Too, if it begins to feel like too much at once, or painful, it’s okay to stop. I would also tell your doctor when you have your appointment, that you’ve been training with a dilator, what size, how often, and how that’s been feeling.

I know you read our article on dilators — did you get a chance to look at part 2 of that article as well? It goes through next steps once you’ve chosen a good size to start with, and it goes through some important safety instructions for doing this at home.

On a separate note, I hear you that this can add a lot of worry and anxiety around doctor’s appointments — would it help to have some readings that go through strategies for what to expect at the doctor, and how to advocate for yourself, your boundaries, and your pain management?

[Jay27]

I read part 2 of the article and I’ve looked at recommendations on Reddit. I’m thinking of buying the small set on Intimate Rose. I’d like to learn about advocating for myself at the doctor. Am I allowed to turn down a pelvic exam? I don’t think it’ll be physically possible for her to insert anything. I have a lot of anxiety that she might not be able to help me at all, and I have shame for having vaginismus in the first place. I’ve already been to a gynecologist before but she said she doesn’t know how to help me. That’s why I’m finding a new one.

[KierC]

Hi Jay27,

I’m glad you read part 2 and sought out more recommendations — that all sounds great, and I agree that the small set sounds like a safe place to start.

You are absolutely allowed to turn down a pelvic exam — it is your right to refuse any sort of treatment and discuss alternative options with your doctor, and while your doctor can make recommendations based on your presenting symptoms, ultimately the decision-making should be a decision between you and your doctor — it’s your body and your choice.

Pelvic exams are indicated for patients with symptoms like vulvar or vaginal pain or sores. Still, though, if you ever feel like you don’t need a pelvic exam or don’t want one, you can absolutely tell your doctor and discuss other options. Here’s an article, too, that goes through when pelvic exams are and are not indicated, and how to refuse one or ask more questions. Do You Need A Pelvic Exam? Maybe, Or Maybe Not

So, usually a doctor will test for Vaginismus by briefly inserting one finger either inside the vagina or around the vaginal opening, and watching for an involuntary muscle contraction. So, if you’re presenting symptoms of Vaginismus and nothing else that would warrant a pelvic exam, there should be no need to go any further. Too, if you’re experiencing a lot of pain with one finger, your doctor may be able to visualize an involuntary contraction without inserting a finger, by just touching the outside of your vaginal opening — definitely tell your doctor this, and that you’d like to be touched on the outside only, if that is what you want.

With trauma-informed approaches in pelvic exams, a doctor sometimes can do a technique where they touch your leg first before even touching your vulva or vagina, asking consent before each step, to ease you into the process. You may even be able to ask the doctor if you can insert a finger yourself and have them see if there’s a contraction. All this to say, there’s options for accessing care that isn’t anxiety-inducing or scary.

Also, if it would help or if you feel like you want to, you have the right to have a medical advocate either with you in the room or in the waiting room (this can be a friend, loved one, or someone you trust to advocate for you). Sometimes it can help if you feel like it’s intimidating being alone with a doctor or hard to say no to an exam you don’t want or need. Does that sound like something that might help?

[Jay27]

Thank you, I think that would help. The idea of her inserting a finger stresses me out because it’ll hurt a lot. I’ve tried it and there’s burning pain for up to 20 minutes after. I definitely feel traumatized from previous failed/painful pelvic exams. The thought of it makes me want to cry. Maybe I can bring my girlfriend if she has the day off.

[Andy]

I’m glad what Kier said was helpful!

And I’m sorry you had a painful and uncomfortable experiences with medical exams, that can really make the future ones seem scary. On top of all the excellent advice Kier gave you you can try reading through this article to see if you find something else helpful: Dealing With Doctors: Taking Control of Your Health Care Destiny

You can also try getting in contact with the doctor’s office in advance, tell them about your worries and ask if they can provide some accommodations for anxious patients so you will know what to expect and decide according to that. No good doctor should ever want their patient to feel pain or discomfort unless it’s necessary so fingers crossed it will be the case!

[Jay27]

What would possible accommodations be? I have an ativan prescription and that’s all I can think of,

[Willa]

Hi Jay27,

One option can be to set up a consultation appointment before an appointment with any physical exam. This may help you ease some of that anxiety and begin a conversation with your doctor about your anxieties around intense pain during pelvic exams. This is a time in which you and your provider can make a plan to move forward and map in some of those accommodations.

Accommodations can look like explaining what the next visit will look like in the consultation, bringing someone into the appointment with you, doctors moving slowly and explaining each step of the process before they proceed, asking for consent before touching areas of your body, and other things you may personally need. If your doctor is not able to provide these accommodations then they are not the right fit for you!

[Jay27]

Thanks for all the advice! I think I’ll use the first appointment to talk to the doctor and deny a pelvic exam until a future appointment. But maybe it would hurt less because I’ll have been training for a few weeks. I’m anxious about starting to use the dilators.

[Willa]

Hi Jay27,

That sounds like a really good plan for your first appointment with your doctor to make sure you are safe and comfortable. Would you like to talk more about the anxiety you're feeling surrounding dilators?

[Jay27]

Yes, I’d like to talk about it. I’m anxious that the smallest one won’t go in because I can’t insert my own finger. I’m also anxious that it will hurt a lot.

[Latha]

Hi Jay27,

Given how you've described it, it makes so much sense that you're worried about being in pain. I wish I could tell you that there is something you can do to prevent this pain from occuring at all. But let's say you start with the smallest one, and it doesn't go in. Perhaps even though you've used lube and you're going slowly, it starts to hurt. What happens then?

You can just take a break. Don't push further if it starts to hurt. You can decide to try again later, or you could wait until your visit to the doctor.

(On that note: before you even try to insert the dialator, you could try to see how you feel if you hold it on the outside of your vaginal opening, as Kier suggested for the doctor.)

[Jay27]

Thanks for the advice. I could see myself getting upset if I can’t get the smallest dilator in because I’m still insecure about having vaginismus but I know it doesn’t mean there’s something wrong with me as a person.