How to get over fear of speculums?

[LBS1515]

I had a painful and somewhat traumatic first pelvic exam in an emergency room. Since then I get extreme anxiety and almost a little panicked when I’ve seen the speculums at my OBGYN office or when she’s brought up doing a Pap smear or pelvic exam. Right now I’m in physical therapy which has helped a little with my anxiety but the exam that she does is a lot less intimidating than what they do at the obgyn. Any tips for getting over this fear?

[kirsten]

I’ve been reading along here on the forum for a while and I finally had the courage to create an account and write something down.

Sorry for asking, but how old were you when you had your first pelvic exam, LBS1515?

I have the impression my story is pretty similar.

I’ve had heavy periods when I was a teen, so heavy my mom decided to take me with her to her gyn to see what was going on. At that moment I was 17 and I had ZERO sexual experience. I never masturbated, never used tampons, never put a finger inside… I even never kissed a guy! So when I was asked to lie down on the table and got my first internal exam, I was TERRIFIED. Why would a gyn do this without asking if I was okay with this? Why couldn’t she just LOOK or prescribe me some pills or whatever? I was TOTALLY unprepared for this, I had to go nude in front of someone I didn’t know, I didn’t even know how to lie down on the exam table. The whole experience turned out to be super painful and traumatic and I while I was having tears in my eyes, I could see on the face of the gyn she thought I was exaggerating. When I came home and went to the toilet, I found blood in my underwear, which upset me even more.

One year later, I went to Amsterdam as an exchange student, and one of my periods was so heavy my “second” mom (that’s how I called her) drove me to a Dutch gyn. I’ll never forget what happened there. The gyn asked me if I was sexually active, and when I said no, she said they don’t do internal exams on those girls unless it is really, really necessary! This gyn was SUUUPER friendly, and when I told her what happened in the States she said in Holland the reason they don’t do that is because they are causing too much trauma. FINALLY someone who knew what I went through! And I remember I kept on thinking: WHY WHY WHY do they keep on doing this in the States?

I don’t know if Maze has any data on this, but I’m following different sites on vaginismus and in a LOT of cases the condition seems to be triggered by a traumatic first internal exam. So I think the medical world has a giant responsibility to take here. Change the rules and make sure those first exams are less traumatic for teens!

As for me, I should make an appointment to get my first PAP smear, but I want to finish my therapy first. So I’m reading along here, hoping to find some tips and tricks as well.

[rabbit]

Some very good points are made here by kirsten.

Where I live, gyns never do internal exams on virgins cause they are most of the time too traumatic. When they have to, for instance when you’re over 25 and need a PAP smear, they usually give you some kind of sedation and a nurse will be there to help you and tell you what’s going to happen.

[LBS1515]

So I was actually on the older side. I was 25 when I had my first pelvic exam but I had never been able to use tampons and avoided getting a Pap smear for years so nothing had ever been inside me. The doctor knew all of that but she still didn’t tell me what she was doing or what to expect. She also made me bleed and I felt so violated afterwards. I’m sorry you had a similar experience!

[rabbit]

You were a virgin as well? She probably tore your hymen during the exam… sorry you had to go through this. Some doctors really have no clue how to treat their patients with respect.

[recessivegenequeen]

It’s so frustrating to hear stories like these (especially as a resident of the US as well) – I think we have a really unfortunate culture around early visits to the gynecologist. There’s a big emphasis on it being necessary for your health and “enduring” the pain of an examination without thinking about the kind of trauma THAT can do. There’s an interesting thread on the forum (see below) where we’ve talked a bit about the differences in how the US vs. Europe handle early sexual experiences:
http://mazewomenshealth.com/forums/topic/treating-vaginismus-before-the-first-sexual-experience/

The medical realm definitely deserves to take a large share of the blame for why vaginismus goes so long without being diagnosed and probably many cases where it begins. Girls who have to be examined for things like heavy periods should be better prepared by gynecologists and it should be prioritized NOT to do an internal exam without trying other methods first, in my opinion. The US’s for-profit medical system in many disciplines encourages an assembly-line treatment of patients where doctors must see as many people as possible to make more money without taking time and care to understand them or put them at ease.

LBS1515, as to your question about addressing your fear of speculums, something I’ve seen recommended by the Maze clinic’s doctors are to see if your gyno can insert a smaller speculum or one made of plastic, or possibly better yet, to let YOU insert the speculum yourself (you may even be able to get one to practice with). Inserting it yourself could give you back some control of the situation, which can help anxiety.

[Heather]

Hi LBS1515!
I’m sorry you had a scary experience like that. And I looooooove what everyone above had to say! Females don’t get the proper preparation for penetrative anything. But one great tip that helped with my vaginismus was connecting my mind and body. I did this in the safety of my bed, and I just inserted my finger up to the first knuckle, and going clock wise… gently press the inner wall entrance of the vagina and massage it. Tell yourself out loud(this gives you more reassurance) that you are safe, that you are in control, and that pain doesn’t have to be a factor. This really helped with my “wall” situation by desensitizing the entrance of the vagina. Along with your PT, this should help a lot! I hope this works for you! 🙂 And for future exams, you can ask for Valium! I always ask my Gyn and it helps sooooo much. Best of luck!

[SexlessInSeattle]

I had a very similar experience. I suggest the following:
– Tell your doctor that clear communication is very important to you during a pelvic exam. It’s okay to tell them you are scared or nervous.
– Practice the use of dilators ahead of a pelvic exam. Even possibly try to block out the time before the visit and dilate an hour or so beforehand.
– Tell the doctor you want to try inserting the speculum yourself. Be firm about this. My best experiences have been when I could do the initial insertion myself and then the doctor guides it after that.
– Give yourself permission to leave an appointment if you don’t feel like your needs for communication are being met. It’s okay to go to an appointment, discuss your concerns, and refuse a physical exam.
– Plan something nice for yourself after the visit. If there’s any chance you could take the day off, I think that’s great self-care. Doesn’t have to be anything big, maybe just tell yourself you get to watch a movie in bed or something else kind and gentle.

[feedtaleone]

Ask how the patient is feeling. It’s crucial to begin the consultation by asking your patient how she is feeling. Explain the exam. Let the patient see the speculum. Give the patient control. Consider single-use tools. mobdro