I’m sure most of us could think of many more pleasant ways of spending a free hour, than having to come in for a woman’s health appointment. Either feeling mildy uncomfortable or abjectly dreading the examination with every fibre of your body is very common. If your experience of it lies more on the latter end of the spectrum, I thought I would share some tips that might make your experience more tolerable……
Speculums come in different sizes to suit different body shapes and sizes:
These are the plastic instruments that doctors use to look at the walls of the vagina and cervix. Normally I use the standard sized one that fits most women without too much discomfort, but if I have someone that tells me they are very nervous, have had previous bad experiences or are very petite, I will always try the smallest one first (along with lots of chatting, deep breathing and general distraction). So if you are very nervous for whatever reason, please let us know.
Gel is a must for a cervical smear test:
When I was a medical student, we were told that we mustn’t use lubricating gel when we do pap smears as because of the older technology, it interfered with the accuracy of the result and so we had to use water instead. Thankfully, the technology has moved on and this is no longer the case: cervical smear results are not affected by lubricating gel but lubricating gel makes a huge difference to how tolerable the insertion of a speculum is and the likelihood that that woman will come back to see us year after year. So if you remember your first smears way back when being very uncomfortable, please know that things have changed.
HPV testing can increase the time you can safely have between smear tests:
There are many women who are very comfortable with and keen to have cervical smears at every annual woman’s health check-up and if that is you, that is completely fine. But, there some that would prefer to avoid that part of the check-up every year if at all possible without compromising their safety, and those that would welcome doing so if they have the reassurance that their health won’t be negatively impacted. Well, with HPV (human papilloma virus) co-testing (doing a smear test and testing for HPV infection at the same time), this is a safe approach. We know that women over 30, who have never missed a smear test and have always had normal ones, that test negative for HPV are at extremely low risk for developing abnormal changes to their cervical cells. So, if that applies to you and you are happy to co-test, you only need do your smear every 5 years (but an annual women’s health check is still a good idea).
Local anaesthetic for coil insertions:
Moving on from cervical smears to coils, by which I’m referring to intrauterine contraceptive devices (IUDs) that are inserted through the cervix and then sit in a T shape in the uterus (a.k.a The mirena/The Levosert/The copper coil/intrauterine system). There are some women that can have these put in with no anaesthetic and be completely fine, however, there are others for whom that experience is so painful that the procedure has to be abandoned or they tolerate it, just, but will never put themselves through the experience again next time. There are lots of reasons why the coil may not be suitable for everyone but if that reason is unbearable pain on insertion that could potentially have been avoided, then I think that is a real shame, as it immediately rules out one of the best remedies we have not only for contraception but for heavy periods, painful periods and HRT in the menopause*. Local anaesthetic in the form of an injection (with a tiny dental needle), spray or cream can really make all the difference to the experience.
The mirena coil, isn’t the only coil with hormones:
I mention this for two reasons. One is that one of the biggest misconceptions about coils is that they can’t be used in women who haven’t had a baby. This isn’t true for all of those women, some yes, but some will absolutely be able to have them inserted and have a good experience with them. Especially if we don’t use the mirena and use one of the smaller hormonal IUS’ (intrauterine system is used instead of device if the device contains hormones but it’s just semantics) available like the Jaydess or Kyleena. These both have smaller insertion diameters (the part that needs to go through the cervix) than the mirena (3.8mm versus 4.4mm which seems small but can make a big difference). So if a woman would like a coil only for contraception*, and is worried about tolerating the procedure, choosing one of these instead is a good idea.
The other reason is that some women may want a coil primarily for contraception, wouldn’t mind some reduction in bleeding as a bonus if it happened, but want to reduce the chance of having hormonal side effects as much as possible, then the Jaydess and Kyleena are again good options to try as they contain much less progesterone than the Mirena does (13.5mg vs 19.5mg vs 52mg respectively).
* These other benefits only apply to the Mirena and Levosert brands specifically, not the other IUDs or IUS’ mentioned. Only the Mirena and Levosert are licensed to treat heavy menstrual bleeding and in HRT for the perimenopause/menopause.