Trauma & Your Pelvic Exam
Let’s talk about it. I typically tell patients, “It’s me and the dentist that no one wants to see.” Or, “no one’s banging down our door each morning for a pap smear.” (Yes, my sense of humor is top notch). But for a lot of patients, pelvic exams and inserting a speculum is beyond uncomfortable. It can actually be traumatic and sometimes impossible.
Why would someone struggle so much to complete a basic screening exam?
Getting into stirrups puts you in a very vulnerable position, so being jumpy to the slightest touch is normal.
Someone you barely know is touching you with a hand, and then a hard object that is not sexual in nature. Yes, lubricant is applied to the speculum, but your body is not “ready” for insertion of anything like you were going to have sex after plenty of foreplay.
Your body remembers trauma. Even if you try your best to relax, distract yourself with your phone or music, there are involuntary responses that your body has to touch, sound, smell, etc. It just happens.
What do we do about it? I advise patients if they know they typically struggle with exams to think about the following:
Would a support person help? Would bringing a friend, a significant other, or just having a medical assistant or nurse hold your hand be helpful? Often the answer is yes.
Would medication help? I have had many patients put off a necessary pap smear or diagnostic test due to fear of the exam. I personally have no problem prescribing a one time dose of a muscle relaxer or anti-anxiety medication if it means you can complete your cervical cancer screening. You’ll need to ask your provider about this one, but it is a reasonable request.
Might there be a musculoskeletal problem as well? After trauma, childbirth, injury, or for no reason at all, you can develop muscular imbalances in the pelvic floor. This can make some muscles spasm or become very painful with the slightest touch. If your provider discussed pelvic floor physical therapy with you, it doesn’t mean anything is “wrong” with you. It means they have identified a problem with a possible solution. (I will provide much more in depth info on this topic in later posts).
Talk to someone. If there is unresolved trauma from childhood or adulthood, it does not resolve on its own, and it will continue to permeate into other areas of your life. And please don’t diminish what has happened to you. Even living in a very religious household where you were told sex was bad, or dirty, or wrong can be hard to get over. You don’t flip a switch one day and go from “my genitals are a dirty and shameful thing,” to “yes, I’m very comfortable with a cold metal speculum.”
Long story short. It’s okay if you don’t love your pelvic exam. But pain, fear, and anxiety around the exam should be addressed, and your provider should be ready to help you.
**I live in Illinois where marijuana is legal. I have had many patients tell me they smoked or ate edible marijuana before their pap or IUD insertion to make it more tolerable. While legal, ask your provider first if this is something they are okay with. Most will probably say yes. . . as long as it is only marijuana and you are not mixing it with other things. Gracias.
