Why Does the Speculum Hurt During Examinations?

At some point, most adult women will come into contact with a vaginal speculum during a pelvic examination for health check purposes. This is standard practice during routine cervical cancer screening, for example. Speculums are designed for insertion into the birth canal, which may be uncomfortable but does not usually cause pain. If the speculum hurts during examinations, there may be something wrong.

In this article we will look at why the speculum may hurt during a gynecological examination, and what you can do if this is the case.

The vaginal speculum consists of a hollow cylinder with a rounded end that is split into two parts by hinges. It looks a bit like a duck’s bill, and is usually made of metal or plastic. Speculums comes in different sizes, and your Doctor will select one based on your age, the size of your vagina and any known conditions you may have.

During a pelvic examination, the Doctor or practitioner will gently insert a speculum into the vagina in order to dilate it. This separates the walls of the vagina, holding them open so that the Doctor can fully access and assess the vagina and cervix.

Speculums may hurt during gynecological examinations if you have any of the below conditions:

Vaginismus

Vaginismus is characterized by fear of penetration, which generally relates to sexual intercourse. Some women may have severe anxiety at the thought of a pelvic examination too, which also causes the symptoms of vaginismus to flare up; namely muscle contractions and tightening of the birth canal, potentially causing pain. Attempts to penetrate during contractions can worsen the pain considerably.

Understandably, pelvic examinations can be stressful for vaginismus sufferers. If you know that you have vaginismus, ensure you visit a physician trained in examining women with this problem. It is possible that the speculum will hurt during your examination, but it may just be uncomfortable. Sometimes asking the Doctor to use more lubricant and take their time may help.

Vaginal Atrophy

The main symptoms of vaginal atrophy are dryness, irritation, and painful intercourse. Menopausal and post menopausal women often develop this, since the estrogen supply to the vagina decreases during this time. In non-menopausal women, the estrogen decline may be due to chemotherapy or radiation therapy, which can also lead to vaginal stenosis.

If decreased vaginal depth or capacity is present, it is important that your Doctor knows this before a pelvic exam; otherwise the speculum may hurt you during the examination.

Vulvodynia

Vulvodynia is the term for chronic vulvar pain. Symptoms are typically severe burning, pain, irritation, itching, or stinging in the vulva area. You are likely to know if you have this condition, whether you have an official diagnosis or not. Make sure that you inform your examiner well ahead of the examination.

If you have vulvodynia, your Doctor will carefully evaluate the appearance and structure of your vulva, before gently touching areas of it with a Q-tip to locate sensitivity. This in itself can be painful, so ask your Doctor to explain what they are going to do before each step.

For women with vulvodynia, the speculum can cause a lot of pain during examination. If the examination is too painful or causing distress, it may need to be postponed until successful treatment is underway, unless it is urgent.

Lichen Sclerosus

Lichen sclerosus (LS) is a disorder of the vaginal skin in which it thins, whitens, and wrinkles. Symptoms also include pain, soreness and chronic itching. LS most often presents in postmenopausal women. The skin can become sore if it tears or breaks down in any way, which can happen during in a pelvic examination.

If you have been diagnosed with Lichen Sclerosus, the speculum may well hurt you at a gynecological examination. It is important to inform your examiner, or insist on being examined by a Doctor with experience in this in order to minimize pain and prevent tearing.

Don’t suffer in silence! Let the doctor know the speculum hurts during your examination. This way they will be able to slow down, change the size of the speculum, use more lubricant or even halt the examination if necessary.

A speculum should not damage or injure you if your Doctor is trained, but if you are undiagnosed, the chances are higher that you’ll experience pain at the very least. Being open and honest about your condition or the symptoms you feel is imperative. If you suspect you have a pelvic pain problem but are unsure what (or you don’t know who to consult), we can help you to find a pelvic pain specialist.  

To learn more about Pelvic Pain conditions Click Here