Painful Pap Smears?

While pelvic exams, pap smears, and other gynecological examinations may not be the most comfortable, it is not "normal" to be in pain during these visits. If you have found that these exams are painful for you, consider these options to help you feel more comfortable in the moment and consider connecting with a pelvic floor physical therapist or occupational therapist to find more long-term relief.

Go in feeling prepared.

Bring notes of the symptoms you are having and your medical history. This can be helpful to ensure you get all the information across in a limited amount of time and to ensure your concerns are heard. This can be as simple as a note on your phone or as detailed as a printed timeline.

Get on the same page before the exam.

While it may be difficult to bring up some of these topics, this will be especially helpful to ensure a smooth pap smear or well-woman exam. Consider asking your provider if you can show them where you usually have pain. You could ask for a mirror to do this if that is helpful for you. Ask if they could verbally walk you step-by-step through what they are going to do and when and if they could move slowly throughout the exam. Having these conversations beforehand can put you at ease and ensure you feel heard.

Consider bringing a support person, such as a friend.

It may be helpful to have them to support you and your wishes during the appointment. They may be by your side during examinations to hold your hand, offer encouraging words, or just have a calming presence. They can be positioned out of site of the exam by staying up by the head of the table. If you would rather talk to the medical professional alone, perhaps to disclose any personal details or history, your support person could be present for only the physical portion of the exam if preferred. It is completely up to you.

Ask if a smaller speculum could be used.

Talk with your physician to see if this option would be appropriate for you and if they can still get the same outcome by doing so. Even if a smaller speculum was used at a prior visit, it is helpful to repeat this request each time.

Remember that you can stop any examination at any time.

Think about how you will navigate this. If you would like to stop at any time or any reason, have a plan for what you might say or do. This can be as simple as saying, "Can we take a break?" or perhaps a “stop” hand signal would work better for you. Communicate any pain you are experiencing with your provider during the exam so that they are aware and can pause, discontinue, or come up with a more comfortable game plan before proceeding.

If the typical setup in stirrups is not working for you, see if you could try out these positions.

-Propped up with pillows behind your head and back so you can see your provider better.
-Try legs bent with feet shoulder width apart with feet on the table instead of in stirrups.
-If stirrups must be used, try to have one knee/leg relaxed off to the side first, keeping the other leg more upright in the beginning. Then, slowly relax that other leg to the side as you feel ready. This can be before an exam or as the exam is progressing and you feel more at ease.
-Try a pillow under your bottom to shift your pelvic position.
-Butterfly position is preferred for some folks and may be an option.
-If the provider insists on your feet being in the stirrups and this is not comfortable for you, see if they can be used for only the pap smear portion and try an alternative position for the visual assessment and/or pelvic exam (the part without the speculum).

Oh if I could just relax...

Of course this is easier said than done. Nothing is more frustrating than hearing "just relax" or "just breathe" when you are anticipating or experiencing a painful exam. These strategies may help with getting you through the appointment for the time being.
-If you have asked the physician to tell you when the speculum or finger is about to enter, try gently bearing down (pushing) right before they insert while keeping your stomach relaxed. Visualize your vagina or even your anus releasing and opening as you do so. Try to breathe during this and avoid holding your breath. This will keep the muscles of your pelvic floor relaxed too. This will be helpful to practice before your appointment.
-If that’s too much to coordinate in the moment, focus instead on your breath. Try a nice long inhale followed by an even longer exhale. Place your hands on your ribcage or your stomach and feel the rise as you inhale and fall as you exhale.

Consistency may be helpful for you.

Consider requesting the same medical professional at each visit when you schedule any follow ups. This may help with continuity of care while also helping you to anticipate how the visit will go and limit some of the worrying of the unknowns leading up to the appointment.

Find a pelvic floor physical therapist or occupational therapist.

If you experience pain with these exams, seek out support from a pelvic floor therapist. While these strategies may help make a typically negative experience for you a little more bearable, they are not yet getting to the root of the problem or the underlying reason why the exams are so painful. Pelvic floor physical therapists and occupational therapists specialize in the pelvic floor and work specifically with people experiencing pelvic pain, as well as bladder or bowel concerns. They can help you better understand what is going on and provide you with individualized recommendations and treatment to decrease any pain you are experiencing long-term. When pap smears or well-woman exams are painful, co-occurring concerns can include pain with sex, feels like hitting a wall during penetration, or pain with tampons. It is always recommended to share any of these concerns with your physician as well. Your pelvic floor therapist can support you in effectively communicating your experience with your doctor and support you through navigating any uncomfortable diagnostics if necessary. You are not alone in your pain with gyno visits, and it does not have to last forever. Relief is possible. Bloom’s pelvic floor therapists in Tampa, FL are here to assist.

For more information on pelvic health, related concerns, and other helpful tips we wrote a large blog “The Complete Guide to Everything to Know about Your Pelvic Floor Health and Pelvic Floor Therapy”