Undergoing gynaecological exams (such as cervical screening or fertility related procedures) is commonly somewhat uncomfortable.
It’s normal to feel some awkwardness or nervousness before and/or during these intimate exams. Fair enough – these are necessary but invasive procedures. And sometimes with a complete stranger.
It is also common to feel some physical discomfort – the equipment may be cold and hard, you may be feeling tense and find it hard to relax your pelvic muscles, a swab may poke in a sensitive spot.
For some people though, gynaecological procedures are very uncomfortable, painful and distressing. Pelvic pain can impact in a variety of ways and may be caused by a variety of factors. These include:
- Vulva and vaginal skin conditions (dermatological issues);
- Vulvodynia and provoked vestibulodynia (nerve pain conditions of the vulva);
- Pelvic floor dysfunction and vaginismus (muscular issues);
- Gastrointestinal conditions (bowel conditions that inflame the pelvis);
- Infection (such as genital herpes and thrush);
- Interstitial cystitis (painful bladder syndrome);
- Endometriosis (related to pain deeper in the vagina); and
- Pudendal neuralgia (pelvic nerve damage/entrapment).
People who experience pain during gynaecological exams may also experience pain or discomfort during genital touching and sex, when using tampons, and/or when sitting or wearing tight pants.
What can you do?
While it is common to feel some physical discomfort during gynaecological examinations, vulva and vaginal pain are not normal and there are treatments available.
If you’ve tried to address pelvic pain in the past, you may have been told that this kind of pain is “all in your head” or that you just need to relax. Whilst relaxation strategies can form part of a comprehensive treatment plan for pelvic pain, this is often only one component of the treatment. And relaxation may not be relevant to everyone with pelvic pain, such as people experiencing an acute infection.
Here are some options to consider:
Get an assessment and diagnosis from a specialist – Depending on the condition, assessment, diagnosis and treatment may involve:
- A gynaecologist or sexual health physician.
- A pelvic physiotherapist.
- A psychologist or counsellor.
Read here for more information about seeing a specialist for assessment.
Tell your clinician – You don’t have to just sit and suffer pelvic pain. Tell your clinician about the pain and/or distress you experience and they can:
- Tell you if there are any less invasive options or strategies to minimise discomfort;
- Tell you the details of a procedure before it occurs to help you mentally and physical prepare;
- Talk you through the procedure as they go (ie. tell you what they are about to do before they do it) to help you mentally and physical cope.
Learn about pelvic pain – The book When Sex Hurts by Andrew Goldstein, Caroline Pukall and Irwin Goldstein has helpful information about the management of different kinds of pelvic pain, and how to best prepare for doctor’s appointments. Read more about their suggestions here.
Other helpful, general pain resources include:
- Explain Pain by David S. Butler and G. Lorimer Moseley.
- Painful Yarns: Metaphors & Stories to Help Understand the Biology of Pain by G. Lorimer Moseley.
Practice relaxation strategies – For some pelvic pain conditions, learning relaxation strategies in your day-to-day life, as well as prior to and during a gynaecological procedure, can be helpful. This could include:
- Breathing exercises;
- Mindfulness exercises;
- Progressive muscle relaxation; and
Further information about some of these startegies can be found at The Centre for Clinical Interventions website.
Bring a support person – You can bring a partner or other support person with you to any procedures.
When Sex Hurts by Andrew Goldstein, Caroline Pukall and Irwin Goldstein
Explain Pain by David S. Butler and G. Lorimer Moseley.
Painful Yarns: Metaphors & Stories to Help Understand the Biology of Pain by G. Lorimer Moseley.
National Vulvodynia Association: www.nva.org/learnpatient/
Online vaginismus resources: https://www.vaginismus.com/
Dr. Alice Hucker