Experiencing Pain During Your Gynecology Exam? Here's What You Can Do

We may love our care team, but no one really looks forward to their annual gynecology visit. We get it: It can be stressful, uncomfortable and even embarrassing. But what does it mean when your pelvic exam hurts? Often the pain experienced during a gynecology checkup occurs when your doctor inserts the speculum. A speculum is the medical tool that helps your doctor gently open the vaginal canal and see inside (you may know it by the tell-tale clicking sound). These exams are often done at gynecology and urogynecology appointments so that doctors can check internal pelvic organs, such as the vagina, cervix, fallopian tubes, ovaries and uterus. Your doctor may also use a speculum when collecting a sample for a pap smear or STI test.

While most women feel pressure and some slight discomfort, intense pain during speculum exams isn’t normal and can indicate another issue with your pelvic floor. Pain can be a signal of tension in the pelvic floor muscles themselves, hormonal thinning of vaginal tissues, chronic infections (like UTIs, bacterial vaginosis or yeast infections) or even a history of medical or physical trauma. Rest assured, if you experience pain at the gynecologist, there are ways to make the checkup more comfortable. 

First, talking to your doctor can help.

At the start of your appointment, while you are still dressed, let your provider know that you have had pain with speculum exams in the past or that you are worried about having pain with the exam. You can ask them to go slower during the exam and let them know you have some strategies you would like to try.

Ask them to use the smallest speculum size available in the clinic. Speculums are not one-size-fits-all, and they come in a variety of shapes, sizes, and materials. The most common type of speculum used for gynecological exams is a bivalve speculum, which can be made of either plastic or metal. There are multiple sizes of bivalve speculum that can be used as well. Although smaller speculums are typically used on younger people, adults can always request that their provider use a smaller speculum to make the exam more comfortable.

The type of lubricant can make a difference for some women, too. If you have sensitive skin or are prone to infections, you can bring your own favorite lubricant (we recommend a water-based one without glycerin or parabens).

Some women also find it more comfortable to insert the speculum themselves. If you would prefer this, let your provider know. If you would rather have the provider insert the speculum, you can always ask them to give you a few moments to relax first.

Another option is to ask your doctor to let you know when they are going to insert it so you can try some pelvic floor muscle relaxation techniques while they complete the exam.

Next, try these exercises to relax your pelvic floor.

The pelvic floor muscles are a group of muscles at the base of the pelvis surrounding the vaginal opening. If these muscles are tight or tense, they can narrow the vaginal opening and cause pain with insertion of the speculum. Relaxing the pelvic floor muscles can help decrease pain during pelvic exams. Try these steps to help loosen up.

• Diaphragmatic breathing: Inhale with a long, slow and deep breath. Think about your ribs opening out to the sides. The lower abdominals and low back should gently bulge out. The inhalation and exhalation should be a little longer than your normal breathing pattern. This method of breathing mechanically relaxes the pelvic floor muscles, which can help make the exam less painful. Breathing in this way is also used for relaxing, so it may help manage anxiety about the exam. This can be a great exercise to do before and during the exam. You can start breathing like this as soon as you get on the table.
• Belly bulges & pelvic drops: Gently bulge out your lower abdominals like you are making a beer belly. When we do this action, our pelvic floor muscles also bulge down and relax. This can be a great technique to use as your provider is inserting the speculum.

While these are simple exercises, they can take some time to get used to. It may be good to practice these ahead of time, so they come more easily when you’re in stirrups.

Finally, recover after your appointment.

If you have pain that persists after the exam, there are some things you can do at home to help you recover. Using a heating pad over your lower belly or taking a warm sitz bath can help relax those tense muscles. Continuing with breathing exercises can also help your pelvic floor recover from the speculum insertion. Finally, practicing some light yoga or stretching can help center your mind and relax your muscles. Yoga is widely recommended for relieving aching muscles. In fact, a recent study found that it is particularly helpful for women who experience chronic pelvic pain. A couple of simple poses - along with deep breathing - can help you toward a speedy recovery.

Child’s Pose

This classic resting pose is well-known for a reason: It’s easy to do and offers lots of benefits. From stretching out tight joints to promoting deep breathing and stimulating circulation, it’s a staple for most yogis. It only takes a few minutes of child’s post to help you loosen up and relax your mind, body and pelvic floor. 

1. Begin by kneeling on the floor with your feet together and slowly come to a sitting position on your heels.
2. Bend forward so that your belly meets your thighs.
3. Stretch your arms out in front of you and bring your forehead toward the floor.
4. Breathe deeply and relax.

Happy Baby

This pose can help stretch your pelvic muscles and groin to soothe the aftermath of a speculum exam. Added benefits include a light stretch of your thighs, hips and lower back that can help reduce stress, stretch the spine and ease back pain. Like most yoga poses, it can also improve general flexibility and mobility.

1. Lie flat on your back, bending your knees back toward your chest with the soles of your feet facing the ceiling.
2. Grab your feet with your hands to open your knees outward toward your underarms.
3. Gently rock from side to side while focusing on deep breathing.

These simple tips may be all you need for pain-free speculum exams. However, some women who report painful pelvic exams also suffer from pain with sex and even tampon insertion. If you also have discomfort with these activities or still have pain during checkups after trying these strategies, you may want to talk to your doctor.