— Desperately Seeking Speculum

Dear Desperately Seeking Speculum,

Pelvic examinations and Pap smears certainly invoke a deep sense of vulnerability — and in your case the added discomfort of vaginal penetration presents a particular challenge. Fortunately, you seem to be on the right track in your search for a speculum to increase your own level of comfort and control during this needed procedure.

Getting your hands on your own speculum will help 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. The Feminist Women's Health Center in Washington State also sells plastic speculums and has a guide to performing a self-exam. Before you begin any kind of at-home examination or activities involving your speculum, you may also want to check out Our Bodies, Our Selves for the New Century by The Boston Women's Health Book Collective, which has a section on self-examination. At home you will be able to experiment with your comfort threshold; the body is capable of relaxing and adapting to many new sensations or experiences. The vagina is no exception.

Here are some more tips for a less painful pelvic exam:

• Read Gynecologist for the first time in the Alice Sexual Health Archive for details about the exam itself. Even though you have had a Pap smear already, it never hurts to review exactly what happens during one for your own peace of mind.
• Before you try working on yourself with a speculum, you may want to practice putting a finger, or even a junior-sized tampon, in your vagina to familiarize yourself with the sensation. Water-based lubricant (also used during exams) will make penetration more comfortable. It may also help to try this lying down and comfortably supported.
• During the exam, 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 during a Pap, are normal because your provider is collecting samples to evaluate the health of your cervix. However, if you are very uncomfortable or have severe pain, this needs to be pointed out to your provider, as it could be a symptom of something else.

Being proactive with your women's health care provider will also go a long way toward making the exam more tolerable. Here is some advice about talking with your gynecologist for a more comfortable exam:

• Before the exam gets underway, talk with your provider about your past experiences, fears, or anxieties about penetration and the exam. Let her or him know that you want to maximize your comfort and you'd like them to work with you towards that end.
• Don't hesitate to talk with your provider about types and sizes of speculums — often s/he may have a smaller speculum they could use if you speak up. 
• Ask the examiner to warm up the speculum and the lubricant used with it. This may ease the introduction of the speculum into your body and cause less pain.
• Hunt for your perfect gynecologist. The health care provider doing your exam has a huge impact on your overall level of comfort for the exam. If you feel your current gynecologist just isn't taking enough measures to put you at ease, find an annual exam provider you can absolutely trust. This will also create an environment of familiarity and trust, which will help you to relax during exams.

Students at Columbia can make an appointment at Primary Care Medical Services by calling x4-2284 or logging on to Open Communicator. As an additional option you may want to check out health care providers that specialize in LGBT health. In New York City, Callen-Lourde Community Health Center offers primary health services, including reproductive health services, exclusively for lesbian, gay, bisexual, and transgendered individuals. Such a place may be a good fit to meet your Pap smear needs.

More power to you for recognizing the importance of this annual routine, and for addressing your discomfort with such a proactive attitude. Your diligence in working towards comfort and relaxation will surely pay off at your next pelvic exam.

Alice

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