How to make intimate examinations more comfortable

Most women accept that intimate examinations are a necessary part of being female.  Examinations are needed for cervical screening (smear tests), during pregnancy and childbirth, to investigate certain medical problems and during fertility tests and treatments.

Often the thought of going for an examination is worse than the reality

Don’t worry if you feel anxious, this is normal and many women feel the same. Whilst many of us find such examinations embarrassing or unpleasant and perhaps a little uncomfortable, some women unfortunately find them very painful and very distressing.

Before we start…

Why do some women react differently to others? There are a number of reasons from high levels of anxiety to previous negative or painful experiences during tampon use, intimate examinations or sexual intercourse. A woman may also have a medical condition that makes the vulva or the vagina sore. All of these can cause a woman to anticipate pain.

When we anticipate pain we tend to hold our breath and tense our body which includes the pelvic floor muscles around the vaginal entrance. The tighter the pelvic floor muscles are the more discomfort a woman experiences.

The aim of this guide is to help minimise discomfort or distress by planning ahead.

Vaginal examination Day!

A vaginal examination will be carried out by either a doctor or a nurse.  You can request for a female health care professional if one is available, but a man can be just as helpful.  

If, for example, you are going for cervical screening at your local GP practice and you are feeling really anxious about it, give them a ring and ask for a longer appointment slot which will give you and the doctor/nurse more time.

Wait a second…

When we are anxious we often feel the need to go to the loo either for a wee or for one last check that everything below deck is looking ship-shape. But before you do, check whether they need a urine sample.

Who will be in the room with me?

You should always be offered a chaperone.  But you can take a friend or partner with you and they can act as your chaperone and at the same time, hold your hand, chat to you or explain things on your behalf. Make sure you tell them what you think they can do to help you.

You may prefer to talk to the doctor alone. This is especially important if you need to disclose any sexual assault or abuse. You should be fully dressed when discussing this, unless you need to show the doctor something.

Students sometimes attend consultations as part of their training. Whilst this may be helpful for their learning you may not feel comfortable. So if you really don’t want them there, say so. It’s ok, no one minds.

Can I explain something?

If you have problems with pain and discomfort it is important for the doctor or nurse to know about it. A mirror may help you to show them exactly where it hurts.  

You can take a note with you of your symptoms and medical history to help the doctor understand your situation better. This can save time and avoid repeating unhelpful treatment.

If they use medical terminology that you don’t understand, ask them to explain what they are saying in a different way. Again, no one should mind, it’s important that you leave the room understanding what’s happened and what might happen next.

What will they do?

Before you undress, be sure to know what to expect. The door, screen or curtain should be closed for your privacy. You should also be offered a paper sheet to cover your tummy which can help you feel less exposed. Consider wearing a skirt which you can pull up rather than taking it off completely.

• Ask to look at any instruments the doctor will use. There are different sized speculums and they will often use the smallest one if this is your first examination or if you have experienced difficult examinations before or problems with painful sex. However, sometimes they may decide to use a larger one if they think it will be easier to see your cervix (entrance to the womb).

• Ask the doctor or nurse to tell you step by step what they are going to do and to go slowly. Remember, you can stop the procedure at any time.

• If you feel pain or distress, tell them. Otherwise, how will they know?

What position will I be in?

There may be stirrups at the end of the examination couch, they help tilt your hips and make it easier for them to see your cervix. Your cervix can be tilted forward (anteverted) or backwards (retroverted).  Anteverted is more common but both are ‘normal’.

If there aren’t any stirrups, a cushion or pillow may be placed under your hips to tilt your pelvis which helps them get a better angle. Place your feet shoulder width apart and then slide your heels up close to your hips and let your knees fall open wide.

If the examination couch is next to a wall you can rest your knee against it and rest the other one on person doing the procedure. Practice getting in this position at home, before your examination so you feel more comfortable on the day.

What will help me relax?

There a basically two ways, one is to physically relax your body by using diaphragm breathing (using your tummy) exercises and pelvic floor relaxation. My suggestions for doing these are below.  

The other is to distract yourself, by taking your mind off somewhere nice whilst having the procedure.

Both of these will be more effective if you practice them for a few weeks before your examination is due.

Relaxation

Rest both hands on your tummy, one just below your ribs and the other above your pubic bone. Keeping your tummy soft, breathe in slowly through your nose so that your hands rise and fall and then breathe out slowly through your mouth.

It is easier to insert a speculum or probe on a long slow outbreath.

Squeeze and then relax your pelvic floor muscles making sure the muscle is relaxed when the speculum goes in.

Distraction

Chatting to the person who is examining you or to your chaperone can help can help you focus less on the procedure, thereby making you less tense psychologically and physically.

Put your headphones on and listen to music or a meditation app.  

Breathing Exercises

Practice at least 10 times every day.

When we are anxious that something will hurt or cause discomfort we tend to hold our breath which can cause more discomfort.  It is therefore really important that you use your breathing to help relax your pelvic floor muscles.

Breathe in slowly through your nose for the count of seven, your tummy should move out as though you are blowing it up like a balloon and your shoulders should be relaxed. Breathe out slowly through your mouth for the count of 11, your tummy should go down like you are letting the air out of the balloon.

Pelvic Floor Exercises

Practice 10 times every day

These exercises are generally advised for women after a hysterectomy (removal of the womb) or childbirth to help to strengthen the muscles but in this situation they are used to help a woman gain more conscious control over relaxing her muscles.

Squeeze the muscle between your legs (it is the muscle that you use to stop yourself passing wind or the one that you hold when you really want to go for a wee).

Do not hold your breath and try not to squeeze your bottom, leg or tummy muscles at the same time.  

Squeeze the pelvic floor muscles for the count of three, next release/relax the muscle for the count of six.  It might be easier to do this when you are lying down.

Will they use a lubricant?

If you are going for cervical screening sometimes the speculum is moistened with water or a water-based lubricant is used. As lubricant makes it easier for the speculum to slide in, ask them to use a small amount.  

This needs to be used very carefully so it will not spoil the sample that they need to take from you cervix.  

Remember: if the sample is spoiled you will need to have the procedure done again so weigh up the pros and cons.

For all other procedures a lubricant will generally be used, but ask them to reassure you, if this helps you to relax. If you regularly use one at home for sexual intercourse, take it with you and ask them to use it.

Phew, the vaginal exam is over, what next?

First things first, get those knickers on! The doctor or nurse will then discuss things with you, tell you what happens next and you will have an opportunity to ask them any questions that you have.

If you need a follow-up appointment, ask to book it before you leave, this will give you more choice of dates and the option of seeing the same doctor or nurse.  

If you feel very anxious about having the same person ring just before the date to check that they will be there. Some women experience spotting (very light bleeding) for a day or so after the procedure, this is normal and nothing to worry about.

Finally…

• If it is your first time or you are feeling nervous, tell them so they can reassure you and help you relax. The more relaxed you are the less discomfort you will feel.
• The best time (if possible) for cervical screening is in the middle of your menstrual cycle, halfway between one period and the next. Most GP practices will ask you to book the test yourself, so remember to take you menstrual cycle into account before you book an appointment.
• If you have been prescribed vaginal pessaries to treat an infection then postpone your smear test for at least a week after treatment has finished
• Do not have sexual intercourse 24 hours before your smear.
• If you are using vaginal oestrogen cream for menopausal symptoms do not apply it on the day of your test.

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This article was written by Angela Gregory – BA (Hons), PST Dip, CH Dip,COSRT acc.

Angela is the Lead for Psychosexual Therapy at the Chandos Clinic, a sexual dysfunction service for men and women with a wide range of sexual difficulties based at Nottingham University Hospital Trust. She works as a full-time Sexual and Relationship Psychotherapist and provides in-house training for both medical and nursing staff and regularly lectures at a national level.

She is currently the secretary of the British Society of Sexual Medicine. In 2013 she had work published in the International Journal of Gynaecology on ‘Sexual Problems in Older Women’ and a further two articles were published in 2014, one in the International Journal of Urological Nursing on ‘The Impact of Trauma on Sexual Functioning’ and the other entitled ‘Tales of the Un-erected’ in the Endocrinologist.

In 2015 she was involved in primary research looking at ‘Women’s experience of using vaginal trainers (dilators) to treat vaginal penetration difficulties diagnosed as vaginismus’ published online here.