Less painful Pap smears?

Dear Desperately Seeking Speculum,

Pelvic examinations and Pap smears can certainly invoke a deep sense of vulnerability for many people — and in your case the added discomfort of vaginal penetration presents a particular challenge. Fortunately, you seem to be on the right track by looking for your own speculum. Practicing with a speculum at home may help increase your own level of comfort and control and familiarize your body with the sensations involved in an annual pelvic exam. Speculums, either metal or plastic, are sold at some medical supply stores and online medical retailers. You can find guides to performing a self-exam in Our Bodies, Ourselves for the New Century by Our Bodies Ourselves, but it’s not a replacement for seeing a health care provider for pelvic exams. A mix of do-it-yourself prep work and communicating with your health care provider can hopefully make this process more comfortable for you. If you don't feel comfortable talking about this with your health care provider or the changes they make aren't easing your discomfort, you may want to try switching health care providers to find one that best fits you. Read on for more information to help you prep for your Pap.

You might consider the following strategies to help you get ready to prep before and during the exam:

• Before you use a speculum on your own, you may want to practice putting a finger or a smaller-sized tampon in your vagina to familiarize yourself with the sensation. Adding a water-based lubricant (also used during exams) can help make penetration more comfortable. It could also help to try this lying down and comfortably supported.
• Even though you've had a Pap smear already, it may help you become more familiar with what to expect during the exam. This may bring you some peace of mind and help ease your nerves before even meeting with the health care provider.
• During the exam in a medical office, breathe or use relaxation exercises as the speculum slides into your vagina. If you feel discomfort or pain, tell your provider.
• Some scratching or scraping sensations, along with feeling vaginal pressure, are common during a Pap smear because your provider is collecting cell samples to evaluate the health of your cervix. However, if you are very uncomfortable or have severe pain, point this out to your provider, this may be discomfort with the exam or a symptom of something else. As such, it’s wise to mention this to your health care provider so they have make adjustments to make you more comfortable, and if they deem necessary, check for symptoms of your pain and discomfort.

The provider doing your exam can have a huge impact on your overall level of comfort for the exam. If you feel your current provider just isn't taking enough measures to put you at ease, you might try a new one. You could talk with friends and family to see about recommendations based on their experiences with providers. Having a provider with whom you are comfortable and who listens to you can create an environment of familiarity and trust, which may help you to relax during exams. Prior to the exam, being proactive and talking with your health care provider can also go a long way toward making the experience more tolerable. Consider the following talking points:

• Before the exam gets underway, tell them about your past experiences, fears, or anxieties about penetration and the exam.
• For the manual examination portion, ask your provider if it's possible for them to perform the exam with one finger instead of two.
• Don't hesitate to ask about types and sizes of speculums — they may have a smaller speculum that could be more comfortable or less invasive for you. 
• Request that the area be numbed either with an ice pack on the vulva or with a local anesthetic. 
• Ask if they could warm up the speculum and the lubricant used with it and to place the lubricant on the speculum prior to insertion. This may ease the introduction of the speculum into your body and cause less pain.
• Ask if the speculum blades could be applied in a different direction (i.e., side to side versus front and back). This may help put less pressure on the bladder and may make it more comfortable.

As an additional option you may want to check out health care providers that specialize in lesbian, gay, bisexual, and transgender (LGBT) health. The Centers for Disease Control and Prevention (CDC) has information about LGBT clinics across the country. Such a place may be a good fit to meet your Pap smear needs, as well as being a great resource for your overall health and well-being.

More power to you for recognizing the value of this annual routine, and for addressing your discomfort with such a proactive attitude. Although health care providers may be the medical experts, taking an active role in your health by being versed in preventative measures (such as Pap smears), being able to communicate your concerns, and ask questions can better prepare for you for being an advocate of your own health and well-being.