Pelvic Exam Tips


Many interstitial cystitis (IC) patients dread or avoid routine pelvic exams and Papanicolaou (Pap) smears because the exam can be painful and precipitate flares. But cervical cancer, which the Pap smear detects in its precancerous state, is a serious disease. Thanks to Pap smear testing, there has been a decline in deaths associated in this cancer.

How Often Do I Need a Pap Test?

Although Pap tests are important, they may not have to be done as often as you think. Both the American College of Obstetricians and Gynecologists (ACOG) and American Cancer Society (ACS) recommend that women have an annual pelvic exam—but note that not all women need an annual Pap test.

American Cancer Society guidelines:

  • All women should have a Pap test about three years after they begin having vaginal intercourse, but no later than when they are 21 years old.
  • Have a Pap test every year with the regular Pap test—but every two years using the newer liquid-based Pap test.
  • Starting at age 30, women who have had three normal Pap test results in a row may get screened every two to three years. Or, get screened every three years (but not more frequently) with either the conventional or liquid-based Pap test, plus the HPV DNA test.
  • Women 70 years of age or older who have had three or more normal Pap tests in a row and no abnormal Pap test results in the last 10 years may choose to stop having Pap tests.
Of course, be sure to check with your gynecologist to see if these guidelines apply to your particular situation.

Tips to Help IC Patients Avoid Pain

Increasing recommendations for longer intervals between Pap tests can help IC patients avoid some discomfort, notes Deborah Metzger, PhD, MD, Director of Helena Women’s Health in Helena, Montana. But, Dr. Metzger said, when you do have a Pap, there are steps you and your gynecologist or nurse practitioner can take to make both the speculum exam for the Pap test and the pelvic exam easier on you.

Dr. Metzger offered these tips to help IC patients avoid pain with the speculum exam:

  • Use an over-the-counter anesthetic preparation, like Lanacane, on the vulva about an hour beforehand. But be careful not to get any of the cream or gel in the vagina, because that can interfere with the Pap test.
  • Ask your gynecologist or nurse practitioner to use a small Pederson speculum or a pediatric speculum (it’s likely the Pederson) instead of the usual Grave speculum. Unlike the Grave speculum, the Pederson does not expand at the end, so it’s easier to insert into the vagina.
  • Ask your gynecologist or nurse practitioner to place the speculum blades laterally (left and right) rather than in the usual anterior and posterior position (front and back). This avoids putting pressure on the bladder.
  • Take phenazopyridine (Pyridium) or some type of bladder anesthetic prior to the exam; these medications can help to prevent your symptoms from worsening after the exam.
  • To numb the area, place an ice pack wrapped in a towel over the vulvar area to help make you more comfortable before the exam or to help bring relief afterward.
  • For relief after the exam, you can use an over-the-counter anesthetic or lidocaine gel, which your doctor can give you, in the vulvovaginal area. This can be helpful for IC patients who may also have vulvodynia or vulvar vestibulitis.
The second part of the routine gynecologic exam is the bimanual exam, in which the physician checks your pelvic organs by feel. That can also be painful for IC patients, but there are ways to make that easier, too, said Dr. Metzger.

  • Ask your gynecologist or nurse practitioner to do the exam with only one finger. "Usually, a physician uses two fingers in the vagina, "and when that’s two male fingers," she pointed out, "it’s even harder" for IC patients.
  • Your gynecologist or nurse practitioner can help you relax your pelvic floor muscles, which helps reduce pain. "I will put finger in the vagina and feel my patient’s muscles, and if they’re really, really tight, I’ll have her contract around my finger and then do some relax-contract, relax-contract exercise and [I'll] start talking to her about fun things—shopping for shoes, something that’s just "girl talk." As I do this, she’s relaxing, and that makes a big difference," said Dr. Metzger.
Doing this means that your physician or nurse practitioner needs to listen to you and take time. "Talk to your physician or nurse practitioner ahead of time about any of your concerns. Discuss your IC and pelvic pain symptoms. If he or she blows you off, don’t go to that person for an exam. You need to find someone else," she advised. But, Dr. Metzger added, be confident. "Because this is a common condition, there are physicians out there who understand." She also suggested that a nurse practitioner may be the more appropriate health professional to do these exams for you because, typically, that person can take more time with patients than physicians can.

The bottom line, Dr. Metzger said, is feeling in control, which is an important part of healing. "IC and all of the pain syndromes that occur in the pelvis can make you feel out of control. But you can feel in control by choosing your healthcare providers—choosing YOUR team."

Revised January 31, 2011