• Bring a friend or ask for nurse support.
• Request the smallest size of speculum.
• Ask your doctor to describe what is being done as it is happening.
• Ask to adjust your body positioning for maximum comfort.
• Relax your stomach, thigh, and buttock muscles. Breathe slowly and deeply.
• Speak up in response to overt pain or discomfort, and only continue at your discretion.
• Distract yourself by focusing on something else like a picture in the room or talking with your support person.

A typical pelvic exam involves two parts: a visual examination of the outer genital area and an internal exam using a speculum and/or finger. The exam takes place while you are lying on your back on an exam table with your knees spread apart. Your abdomen and thighs are covered with a paper sheet or blanket.

Note: Some women will not be able to complete the pelvic exam due to involuntary vaginal tightness. This is a common symptom of vaginismus and will be taken into account by the doctor during the diagnostic process. 

External Exam: The doctor will visually inspect the outer genitalia, which includes the clitoris, vaginal opening, urinary outlet, and the labia. Any signs of unusual redness, discharge, irritations, or growths the doctor notices are recorded. A cotton swab may be used to touch several spots around the vaginal area to check for any spots sensitive to pain, which you will confirm.

Internal Exam: When vaginismus is suspected, doctors will often begin the internal exam by inserting one or two lubricated fingers into the vaginal opening to see if there is any resistance and to check for any tenderness or abnormalities along the vaginal walls. Depending on how the finger insertion goes, the doctor may then move on to inserting a speculum.

The speculum is a tool that separates the walls of the vagina so that the vagina and cervix can be clearly visualized for examination. To increase comfort, most doctors lubricate and warm the speculum to body temperature before inserting it. You may feel a slight pressure as the speculum is opened to widen the vagina.

A small spatula or tiny brush is then used to collect cells from the cervix for a Pap test or Pap smear. This test, conducted in a laboratory using the sample, screens for any abnormal cervical cells. You may feel a cramping sensation as the doctor collects the sample. Cultures of cervical discharge may also be taken using a swab. After the needed samples are collected, the speculum is removed. 

A pelvic exam also includes assessment of the shape and/or size of the uterus, as well as a check for any fibroid growths, cysts, and/ or signs of infection. For this part of the examination, the doctor may place two fingers into the vagina while pressing down on the uterus.

Physicians encountering a tight opening may suggest surgery instead of recognizing the presence of vaginismus. Typically, women with vaginismus have normal genitalia. The vaginal muscles simply tighten up and then return to a relaxed state once the threat of penetration is over.

Surgery is not necessary nor helpful in treating vaginismus. The potential for muscle and tissue damage, scarring, and recovery pain of these types of surgeries only leads to more issues.

Sometimes, tightness is misdiagnosed as a hymen problem with a prescribed solution of a hymenectomy. However, hymen problems are rare. By adulthood, the hymen (if still present) is normally thin and elastic and does not prevent intercourse.

Seek a second opinion if any surgery to widen the vaginal opening has been recommended.