Power Behind the Stirrups: Advocate for Comfort During a Pelvic Exam 

I have been wanting to write a think piece on this! I am sharing my thoughts as a clinician who witnessed women patients assume their pelvic and pap exams had to be painful and/or traumatizing.  Here are my thoughts and expertise…

At this point in my career, I have now completed thousands of paps on women. When I hear women discuss past experiences of discomfort during a pap or pelvic, I inquire about which aspects of the exam were uncomfortable before the procedure so we can proceed while being mindful of their concerns.

I have had many women avoid or refuse screening due to discomfort they expect during a pelvic exam.  Sadly, I have had women show up to their appointments intoxicated, serial no-shows, or decline an overdue pelvic exam over fear of the sensitive exam.  Due to previous trauma or concerns about the exam, it is understandable how some patients protect themselves by showing up ready to dissociate from the experience. Unfortunately, many times these same women have never been empowered to speak up for themselves regarding these exams.  Mainly because they are not aware of what comfort measures can be implemented to give them more control during the procedure.

A pap and pelvic may both involve a speculum and manual exam.  Women who have a history of pelvic pain, sexual assault, birth trauma, and/or general concerns should communicate reservations before the procedure.  I encourage women who have a fear of sensitive exams or difficulty with pelvic evaluation to approach this exam with a plan. 

Speaking to a healthcare provider about the procedure and any dysfunction of pelvic floor history may improve your next experience. Consider: 

• Engaging in open communication before, during, and after your exam with your healthcare provider

• Requesting a small speculum 

• Inquiring about a topical pain cream as a local treatment option before any kind of penetration

• Requesting an anti-anxiety treatment before your pelvic exam 

• Bringing a support person to your exam 

• Discussing a plan to stop the exam if intolerable regardless of how close the exam is to completion

• Bringing in a weighted blanket for comfort

• Requesting a pelvic physical therapy consult

• Speaking to a behavioral health provider regarding trauma history and chronic symptoms  

Proceed only if and when you feel comfortable with a plan created and communicated with your clinician.  

Women’s Health & Wellness Tips

What is the purpose behind annual/screening labs?

Routine and preventative health can be monitored with some screening labs.  Annual labs may include kidney, liver, thyroid, general blood count, cholesterol, and blood sugar metabolism screening.  Given that some of these levels may result abnormally without overt symptoms, routine checks can allow for close monitoring of pre-disease, chronic, and acute disease states.   

If your provider has ordered screening labs, make sure you understand when and how you will receive communication regarding your results.  If you have a secure patient portal and plan to look at your labs, do you have directions on who will answer your questions?  Will you have labs ahead of your clinic appointment and discuss results during your scheduled visit?  If you have multiple providers, do you have directions/plans to ensure each provider has access to lab results?

Your screening labs are also a chance to understand normal reference ranges, and the correlation of labs to disease functioning or pre-disease monitoring standards.  Use this time to ask questions and get clarification on the needs of your current and future well-being.

If there are screening labs that have not been checked that you are interested in having checked, have a discussion with your healthcare provider(s) on the utility of any specific labs you wish to have monitored. 

Further, prepare for your annual lab testing by learning how to eat for your wellness: Healthy diet (who.int)

Soul-Full ‘Scripts

7 Ways To Self-Nurture Daily [In a Noisy World]

Connect with nature - involve your senses when engaging with nature daily. Inhale, touch, and view what is surrounding you in the most effortless form of abundance.

Interpersonal relationships - schedule or make impromptu plans to be with the people who support and love you.  Making and taking time to pour into these connections can increase your energetic assets.

Renewal hygiene (quiet time, release, sleep) - consider the daily time taken to be quiet with yourself, how you decompress, release any stressful events of the day, and the quality of your sleep are all important aspects of daily renewal. Renewal at both the macro and micro levels impact your overall self-nurture practice. 

Tend to your environment - is it cluttered, non-hygienic, disruptive, or unsafe?  Consider how you want to feel in your professional, personal, and romantic spaces and list out what is missing in its current state.   Are there small steps you can take to improve how your environments serve you presently?

Creative outlets - feeding this aspect of yourself may take freedom and inspiration that you don’t tend to daily.  Allow yourself uninterrupted time daily to engage in an activity that feeds the creative joy within you.

Setting boundaries - protect the peace of your physical, emotional, and cognitive space. This can be with professional duties, interpersonal relationships, or goals you've set for yourself.  Outside stress and distractions do not have to be assumed daily disruptions. 

Let’s Get Clinical: Ask Dr. Johnson a question

Is there an age when I no longer need contraception?

There is not a definite age that a woman can be told that she will no longer need contraception. Rather there is a hormonal state that can be determined when fertility is no longer possible. 

Since menopause marks the time in a woman’s life that she no longer has ovarian function, it is also a state which she can no longer experience fertility. The average age of menopause is ~51 years old. So theoretically, most women will not need contraception beyond their early 50s. Keep in mind that menopause should be confirmed clinically with cessation of menses for a year and/or with labs if deemed appropriate.

It should not be assumed that a woman no longer needs contraception when she has irregular menses, reaches her 40s, or is at an age when other women in her family no longer bear children.  Until there is confirmed cessation of ovarian function, contraception planning should be regularly discussed.  A thorough conversation regarding individual history and contraceptive needs should be the expectation for every woman with their clinicians.

Enjoying the content? Please visit www.beyondthestethoscopes.com for more content.