Internal exam question (NSFW?)

[fireheart]

I have had a slight problem in the past. I am due for a pap smear sometime soon.
The problem is however, that in the past and recently, I tend to tense up automatically anytime an internal exam commences. This also does affect me in the bedroom to some degree (however, unlike a doctor's office, I CAN relax with the right moves). As a result, said internal examinations hurt like anything. A pap smear I KNOW is meant to be uncomfortable, however this is painful. I can handle one or two fingers (i.e. inserting tampons), but it's really becoming painful as of late.

Can anyone recommend ways to help me relax so I don't tense up everytime a speculum comes near me?

[Mora]

Have you tried lying with your ankles flush against your bum cheeks? This was suggested to me once and now everytime I have a smear i do it and it makes the whole thing painless and super quick! I think it narrows the vagina length to bring your cervix closer so the doc can get in and out easier.

Obviously deep breaths, ankles to bum cheeks and mentally singing Moves Like Jagger can only help so far.

Good luck! I hope it goes by easy for you.

[Sapphire Silk]

Try taking some Motrin before hand. If you think you are going to experience pain, then the anxiety makes it happen.

TELL your doctor before she does the exam! This could actually be a symptom of another problem that is easily treatable. Do you have pain with intercourse or on urination?

If your doc is using a metal speculum, ask her to warm it first. Also ask her to use a smaller speculum. Speculums don't have to be sterile; it's a clean procedure (they're sterilized AFTER the procedure).

It's actually possible to do a pap without a speculum. I had to have this done once due to some issues I was having at the time. I was lucky that my doc knew how to do it; not all may know how. The doc I had at that time had practiced in India for awhile and apparently, learned this technique due to some issue with doing speculum exams there (can't remember what exactly, it's been a long, long time since I've seen that doc).

If it turns out to be simple anxiety, ask your doc if taking Ativan or something similar to calm you would be appropriate. But rule out other problems first.

[Lyse]

It might be worth it to contact your doctor before hand and request that they have a smaller or child sized speculum available.

[RecoveringKinkoid]

I don't know what it's called, but going somewhere else in your head helps, if you can do it. I know it sounds kind of trite, but I've had some pretty damn painful things done to me, and this mental technique works for me. You just pick some really pleasant thing (for me, it's the time I got semi-lost in a canoe and hit some serious white water). I concentrate on maneuvering the canoe, imagine the icy water, remember the excitment and adrenaline. Basically, I concentrate so hard on the scene I feel it over what's happening in real life.

I'm not saying you won't feel anything, but it won't bother you so much, the pain will be less, and you'll be able to relax your body more.

[blas]

This probably sounds stupid and trite, but after over 5 years now of Paps every 6 months and several colposcopies (the horror, honestly, I hate them), I've figured a way that somewhat helps.

While you're undressed and waiting for the doc, practice some deep breathing and relaxation techniques.

When you get into position, close your eyes and look at the ceiling and keep with the breathing.

[ShadowBall]

Do what I do...don't get a pap smear at all.

You can try telling the doctor how you feel, but from what I have heard from other ladies, some of them will not listen at all and will tell you you're a big baby if you tell them you're nervous or to be gentle.

If it's all of a sudden painful, though, that could be a sign of some kind of reproductive issue. Do you drink at all? Normally I would not suggest this, but I suppose if you have someone to take you home, you could maybe have a small drink before the exam to relax you?

[Seshat]

I wouldn't recommend alcohol.
I would recommend a muscle relaxant, a prescription emotion-relaxant like Valium (it's possible for a doc to prescribe only one or two, at least here), meditation techniques, and developing conscious control of the pelvic floor muscles.

Well, any combination of the above.

Plus, of course, a doctor who is willing to be gentle, careful, and kind. And as Panacea said, it's possible that this is a symptom of something serious, so talk with the doctor about it and ask them to check for other potential symptoms while they're down there.

The muscle relaxant and/or Valium (or Ativan, or ...) will both almost certainly have to be prescribed by a doctor and dispensed by a pharmacist.

RK's 'going somewhere else in your head' is actually one of the possible meditation techniques - and one of the more fun sort. To practice it, get comfy on your couch or in your bed, settle down, and daydream. And really concentrate on the daydream in your mind, while letting your body drift and relax.

Ask, if you want more tips on meditation.

Conscious control of the pelvic floor: Kegel exercises, essentially. The physiotherapist who taught me had me imagine I was sitting on a silk scarf, and was trying to pick it up and put it down with either the vaginal or the butt area of the pelvic floor. Apparently, if you can get it with either of them, it's actually tensing or relaxing both.

Once you've found the conscious 'switch' for those muscles - or think you have - have your partner put a finger where he (or she) can actually feel the tension or relaxation. This would be just barely inside. Then they can tell you for sure that you're getting it right.

'picking up' is tensing, 'putting down' is conscious-relaxing. Doing neither consciously is a sort of 'neutral' state.

So during the exam, you would want to 'put down' the imaginary silk scarf during the insertion or removal or the speculum, or if you opt for a no-speculum exam, when the doctor most needs access. Don't try to hold it that way for the whole exam - it's tiring! Just when the doctor needs the most access. And do ask if it's helpful or not - if the doc prefers you to let it be neutral, go with that.

[Little Retail Rabbit]

Oh you certainly have my sympathies. I was mentioning in another topic that I suffer from anxiety and I've in fact just quit treatment as it wasn't getting me anywhere...and apart from dentists, the fact my first Smear is this year is terrifying me the most.

And I know the majority of you here are American or Canadian so I don't actually expect many of you to be particularly sympathetic...you won't believe what harsh reactions I've had from many people, especially outside of the UK. At least in the UK, unless you have an underlying health problem or have had children, you don't begin cervical smear tests until the age of 25 (I turn 25 this year) and then only every 5 years, whereas I know its far more frequent in the US. I've had some people be downright cruel about my anxieties, and it is one of the things that makes me nervous about emigrating to the US.

The only thing that makes me feel even the tiniest bit ok about UK procedure is that you can refuse a male doctor, the fact you don't have to undress if you're wearing a skirt...and the instruments are all plastic. Apparently one instrument is actually a bit like a little brush as well, so much gentler, and more importantly, not fucking cold! But other than that, I still don't see me being prepared for this, this year. No one takes tokophobia and related intimate anxieties seriously anywhere so I don't see how I'll get much help for this...

[Mishi]

It's every 2nd year after you become sexually active over here, and I've had nurse-midwives tell me off for not doing it. The only advice I can give is to relax as much as possible and talk to your doctor about how to make it easier for everyone.

I'm low-risk because we're monogamous and were both virgins with no family history of cervical cancer. I was nervous too, despite my first papsmear being after my second child and despite having vaginal births with both. I booked in with a sympathetic female doctor, wore comfy clothes, relaxed as much as possible and checked out mentally for the few minutes that it took. I'm so glad that the instruments are plastic here, it only took a moment and the doctor was very gentle and really sweet.

[Sapphire Silk]

And I know the majority of you here are American or Canadian so I don't actually expect many of you to be particularly sympathetic...you won't believe what harsh reactions I've had from many people, especially outside of the UK. At least in the UK, unless you have an underlying health problem or have had children, you don't begin cervical smear tests until the age of 25 (I turn 25 this year) and then only every 5 years, whereas I know its far more frequent in the US. I've had some people be downright cruel about my anxieties, and it is one of the things that makes me nervous about emigrating to the US.

Americans are the only people I know who are proud of their anxieties and neuroses. We wear 'em on our sleeves over here. You'll fit in fine

[dragon_wings]

Americans are the only people I know who are proud of their anxieties and neuroses. We wear 'em on our sleeves over here. You'll fit in fine

I'm gonna have to ditto this a thousand times.

Plus, you're a pretty British goth.

[Little Retail Rabbit]

I think, Mishi, being told off by a nurse would make me fly into a rage! I get a bit defensive about it ^^;; I have actually been told by some Americans before to "grow the fuck up" and just deal with it

IN the UK, you are only invited to start having it at age 25, and if you're a virgin you can still decline. In actual fact you can decline anyway, but I do realise that it has a purpose beside making women feel uncomfortable <.<

Panacea:...well that would explain the hypocondriac-like behaviour of my in-laws at least XD Seriously, if I so much as get a cold when i'm over there, they try forcing all sorts of pills on me...I only take anything for a cold if its affecting my ability to work, so while I'm on holiday, I veg and sleep :P I guess Brits have a more of a "get on with it" attitude to some of these things.

[SongsOfDragons]

I turn 25 in 20 days, and in seeing my doctor today I enquired as to whether a cervical smear was necessary for me, being a virgin. Her explanation was that, because the abnormalities they are looking for is mostly for cancer, and because the...HPV? virus as the major cause is sexually transmitted, it's not entirely necessary for me. It was a fair point, though I'm not sure yet whether I'd take it anyway just to check for the other things they might look for.

[Pagan]

If your doc is using a metal speculum, ask her to warm it first. Also ask her to use a smaller speculum. Speculums don't have to be sterile; it's a clean procedure (they're sterilized AFTER the procedure).

This is part of why I love the group I go to. They keep the instrments on heating pads.

It might be worth it to contact your doctor before hand and request that they have a smaller or child sized speculum available.

I've got that on my chart because I'm not a big person and it's a hell of a lot more comfortable.

Do what I do...don't get a pap smear at all.

Unless you've got someone like the NP I used to have and ties the renewal on your BC Rx to getting the exam. But, like some others, because of many factors, I only have to have it done every other year.

The only thing that makes me feel even the tiniest bit ok about UK procedure is that you can refuse a male doctor,

You don't have to have a male doctor here either. That's another thing I love about the group I go to. Of the 37 MDs, CNMs, CNPs, and a lone PA-C, only 4 are men.

I think, Mishi, being told off by a nurse would make me fly into a rage! I get a bit defensive about it ^^;; I have actually been told by some Americans before to "grow the fuck up" and just deal with it

Really? I think our country takes whining to a new level! On the other hand, though, we still haven't gotten rid of that insane Puritan work ethic. People are proud of how sick they are yet they still make it to work!

I only take anything for a cold if its affecting my ability to work, so while I'm on holiday, I veg and sleep :P I guess Brits have a more of a "get on with it" attitude to some of these things.

I've got the same attitude. Take an aspirin and get on with it.