Questions for after pelvic exam

[reese678]

I faced a pretty big fear yesterday and had my first gynecologist appointment! Overall I think it went well, and my doctor and nurse were super super nice to me, which made things easier. I didn't cry, they listened to my concerns, and gave me full control over what happened, when, and for how long (something I was incredibly nervous about going in). Besides this, I have some questions about what happened and what was discovered during the appointment, because I can't find much information online.

1. I could not complete the speculum or bimanual exams. I was okay with and consented to doing them both, and because my doctor and nurse were so nice, I didn't feel horrifically nervous or tense. I was decently relaxed, but the second she tried to insert the speculum, it literally felt like she was trying to shove a hot knife or blade into me. I knew I wouldn't feel super comfortable during this process, but I was NOT expecting it to be painful, especially to that degree. She couldn't really get it inside even though she was using a pediatric speculum and she saw that I was in a lot of pain, so she asked if I wanted her to stop. I said yes. She told me it was okay and that we could skip the pap test and speculum exam. Then she said she was going to do the bimanual exam with just one finger. I said okay and thought maybe the speculum was the reason it hurt. She started, and again, it hurt horrifically bad. She asked if I wanted her to stop and I said yes. Again, my doctor told me it was totally okay and did not shame me or belittle me for not being able to do it. Despite her reassurance, I feel like I failed and wasted everyone's time. Is this common?

2. My doctor told me that I have a tight hymenal ring, and that she could not reach my cervix when she was doing the bimanual exam. Has anyone heard of this before? She told me that I could do something called dilating if I ever wanted to have sex in the future or use tampons (I've never been able to insert one even though I tried what feels like a million times) but there's no pressure. Despite not wanting to have sex, I feel like I should probably try doing something so I can have exams in the future. Has anyone tried this before? I know it is used for people with vaginismus, but I can't find anything online about my diagnosis or how to properly use dilators for it. I did see online that people say to use a lidocaine cream/gel when doing it, but how do I find a lidocaine cream/gel that's safe for use in that area? Are there any ingredients I should look out for/avoid? I don't want to give myself an infection.

3. Everything still hurts really bad down there despite it being over 24 hours since my appointment. I tried taking advil, but it hasn't helped at all. Is this normal? I also had a lot of thick blood come out of me this morning when I went to the bathroom. I thought my period came early, but it stopped. It was maybe like a teaspoon of blood. Is that normal? I'm just worried something is wrong, especially because I didn't actually have a pap (which I know can cause a small amount of bleeding).

4. Because I could not do the exams, my doctor gave me a prescription thingy to have a pelvic ultrasound done so she could try to see what is causing my symptoms. She said it will be a transabdominal ultrasound given my situation, but I noticed it doesn't say this on my ultrasound order (I checked all the codes, too). Are they going to try and do a transvaginal ultrasound on me? I'm worried the office I go to won't believe me if I tell them I can't do that and they will pressure me into doing one anyways. I don't want to be in this kind of pain again. How can I tell them I can only do the transabdominal one in a way they will believe me?

Sorry if these are stupid questions. I know I should have asked my doctor some of them, but I was sorta out of it towards the end of my appointment. Everything is kind of hazy after the exams started. I didn't think to ask her anything : (

[Heather]

Good on you for taking that step, reese! I'm so glad that it went well for you emotionally, though I'm so sorry it was painful and still scary in some ways. None of these are stupid questions, and it can also be really hard to remember everything we want to ask our doctor. (In the future, I find it really helps to write down my questions ahead of time, but that obviously is only helpful with questions you actually have ahead of time!)

1. I don't think I would say that's generally common, no, but you did already know you were going in with a lot of anxiety about this, and if that was the case, then it *is* common when scared for the muscles of the vagina to clamp so hard as to be nearly impenetrable, and then yes, when that's going on, attempting to slide anything inside can feel really painful. But #2 also may give us some extra information.

2. If your hymen hasn't worn away as much as we'd expect yet, so there's still that tight ring, which it appears there is, that's another reason that could have felt like it did. The hymen itself doesn't have nerve endings, but it is attached to the inside of the vaginal opening, which very much does.

If you want to try dilation, this isn't something you have to -- or even should -- DIY. That's something that your healthcare provider should give you clear directions for, as well as prescribing all of what you need (dilators and lube) to do that with so you can potentially have insurance cover those costs. I agree that dilation is probably a good idea to at least try. Did you like these providers enough to circle back to them and tell them you'd like to try it so they can give you patient directions as well as prescribe what you need to do it?

3. I would call the office about the bleeding you experienced and the pain you are having. It is totally possible this is because you got an abrasion from the speculum, because you experienced pain that caused your muscles to tighten or both, but I'd just let them know about it and see what they say first. That said, I doubt this is anything for you to worry about.

4. While you're on the phone with them, I would also ask them to reiterate that they gave an order for an abdominal ultrasound. Mind you, no office should pressure anyone into anything, and if that happens, you should leave and not go back. I also can't imagine that given a bimanual exam wasn't possible for you yet, anyone would suggest or order a transvaginal ultrasound.

Just a reminder that you can always call a provider's office with questions anytime: before or after an appointment.

[reese678]

Thank you! And yeah I did write down a bunch of stuff to take with me to the appointment! I typed up a whole sheet with answers to common questions I might be asked, the symptoms I wanted to make sure I asked about, and even instructions for one of the breathing exercises I learned. Sometimes I have trouble speaking when I get really nervous or overwhelmed, so I find it helpful to write everything down before going into a stressful situation (especially since I can just hand the doctor the paper if I have a verbal shutdown!). And yeah like you mentioned the questions I have are mainly related to stuff that came up at the end of the appointment. I think I was too out of it by then to really process what she was telling me until I got home and read the appointment summary on the patient portal : (

2. Yes, I do think I will be going back to this doctor. I'm not 100% sure if I'm supposed to go back after I have the ultrasound/how that works, but I will definitely ask her about the dilator stuff. I know she mentioned something about buying them on amazon, but I wasn't sure if she was telling me to do it on my own or what. I just didn't want to try anything without asking someone first since all the stuff I can find about it online is related to vaginismus, which isn't my specific problem. I don't want to mess anything up/make things worse since my issue is a purely physical one.

3. Okay, good. I was really worried when the pain wasn't going away and I saw all the blood, but that makes me feel better. The hours at this doctor's office are weird (they're only open monday-wednesday), so I'll try leaving a message on the patient portal about it.

4. And I will! I know pelvic ultrasounds can be done either way, but not seeing which one it's supposed to be on the order had me feeling nervous. I'm going to check with her in my message and also confirm with the other office I'm going to just to make sure. And yeah me either. That's kinda why I felt nervous because I've seen how big the wands are (I'm a nursing student) and I was like "if my doctor couldn't even fit one of her fingers up there, how is an ultrasound wand going to fit!?" I'm pretty sure I'm working myself up over nothing (again), but I guess I was just looking for reassurance lol

Thank you so much for responding!

[Latha]

Hi there, Reese!

Has the pain and bleeding gotten better?

I think I was too out of it by then to really process what she was telling me until I got home and read the appointment summary on the patient portal : (

Oh, this happens to lots of people, and isn’t that strange - medical exams can be taxing in the best of circumstances. It’s one of the reasons why being able to call after an appointment is so useful.

I know pelvic ultrasounds can be done either way, but not seeing which one it's supposed to be on the order had me feeling nervous.

Well, there is no harm in making sure that the details of what your doctor wants are written down properly. It’s a good practice, and it will prevent miscommunication. If you’re not sure whether you’ll have to go back after the ultrasound, that is a good question to ask them in your message/call. They do need to explain the results to you, so there should be some kind of meeting.

Your doctor should explain everything you need to dilate, but as an additional reference, we have a series on the subject: Debunking Dilators.

[Heather]

Latha! I was just coming in to add that link. I literally woke up with a start realizing I'd forgotten to add it. Thanks.

Also, I wouldn't be so certain this isn't vaginismus to some degree. I know you don't have that as a diagnosis, but the kind of response you had with the speculum and exam does sound like what I know to be a vaginismus kind of response. Regardless, though, if a healthcare provider is suggesting dilation, and you say yes, that should come with a full set of instructions/direction meant for you as well as prescriptions for anything your insurance might cover. A lot of the time, healthcare providers seem to have no idea what managing the costs of things involves, nor that some things can be covered by insurance they might not consider (especially if they have never had to pay for them themselves) so long as the patient has a prescription for it. <3

[reese678]

Oh wow you guys have articles for everything! Thank you, this very helpful!

And yes I'm doing much better with the pain and bleeding and stuff today. It still hurts and there's still spotting going on, but it's nowhere near as bad as it was on Wednesday and Thursday.

And yeah they haven't responded on the portal thing so I'm going to try calling the office directly Tuesday morning instead! I'll probably just ask about the ultrasound and the follow up appointment stuff, and then next time I see her I'll ask about the dilators.

And that is also true. I know one of my friends has vaginismus, and when I told her yesterday about what happened she said it sounded simillar to what happens to her. I might ask my doctor about when I ask about the dilators.

Thank you guys so much for helping me, I really appreciate it!

[KierC]

Hi Reese!

I’m so glad this is helpful for you, and it’s also good to hear you’re having at least a bit less pain and bleeding today. Calling the office on Tuesday sounds like a great idea, and good on you for advocating for yourself and asking questions.

If you have any follow up questions, or would like more support with this or another topic, we’re here for you.