I remember the anxiety I used to feel right before my annual appointment with my gynecologist. I attribute it to the traumatizing effect of my first pelvic exam when I was a teenager.
What happened was this: I arrived for a regular appointment with my pediatrician and was summarily informed that a pelvic exam would be required to renew my prescription for oral contraceptives (which my doctor had prescribed to regulate my erratic menstrual cycles and improve my severe acne). Those were the days of cold, steel speculums, too.
Later, during medical school, the stress I experienced learning to perform this extremely sensitive exam on others was even greater. Fortunately, we were able to train initially with a female volunteer so, instead of working on a lifeless mannequin, we got real-life training without having to worry about traumatizing our first patients.
Today, I no longer get stressed before my own exams or when I perform them on others, but I can definitely sense the anxiety that many of my patients are feeling.
Although I try to put them at ease, I also recognize that by the time they get to me, the stress of anticipation has probably grown exponentially. And, once a patient has become tense, her pelvic exam is more likely to lead to discomfort and take much longer than necessary, which creates a vicious cycle.
If you're someone who becomes anxious before your gynecological appointments, or if you would like to prepare your teenage daughter for her first pelvic exam, here are some tips that may help make the experience less stressful:
- Tell your doctor about your fears. Share any concerns, especially if you've had a bad previous experience.
- Realize that your doctor has seen it all before. From young to old, the anatomy is very consistent among women.
- Know what to expect. There should be no pain, although feelings of pressure or of needing to pee can certainly be present. Further, a proper pelvic should generally be performed annually and include a speculum exam to obtain cultures, a swab to collect cells for your Pap smear, and an exam to feel the size of the uterus and ovaries. Once you hit age 50, a rectal exam is usually included.
- Learn to relax. A pelvic exam isn't supposed to hurt and the more you relax, the less the possibility that you'll feel discomfort due to tightness. I instruct each patient to take a great deep breath as we start the exam, because the mechanics of exhalation incorporate muscle relaxation.
- Don't worry about pre-exam cleaning. There is no need to douche before your exam. Whether it's vaginal dryness, an unpleasant discharge, or some other abnormality, you want your doctor to see it so he or she can quickly determine a course of treatment.
- Schedule around your period. Ideally the Pap is obtained mid-cycle, but can still be done while you are menstruating as long as you are not bleeding heavily.
- Wax or shave according to your preference. Your doctor is not concerned with hair growth in the pubic area or on the legs; it will not obstruct the view of the vaginal vault or cervix.
Remember that by having regular pelvic exams, you are taking an important step in the prevention of cervical cancer and of complications from untreated vaginal infections. Next time around, relax about the exam and voice your concerns.
