How To Have An Empowered Pelvic Exam

Pelvic exams are part and parcel of being a woman or having a vulva and vagina.

From smear tests (in the USA they are called, “Pap Smears”), to examinations, maternity, having an IUD fitted, or many other reasons, if you have a vagina, you are guaranteed to experience some sort of pelvic examination in your life time.

This is part and parcel of being responsible and empowered about your health, and as a sex coach, I highly encourage you to get your regular smear tests, get regular STI screenings, and get very familiar with your wonderful vulva.

However, there is something very vulnerable about stripping down from the waist, lying on your back, hoisting your legs in stirrups, and having a complete stranger examine your foof, let alone start prodding around inside, isn’t it?

At best, a pelvic exam is uncomfortable and pinchy, and at worst it can be re-traumatizing. It can all depend on who is doing the examination and whether they listen to you and your own internal resources.

Ouchy

The history of gynecology is pretty grim, and every woman/vulva owner has a horror story of a medical practitioner who was at best, clumsy and inconsiderate, and at worst, violating their body.

While modern medicine is a miracle, it is also skewed against women and people with vulvas.

Every woman (especially women of colour) will tell you a story of being dismissed, disbelieved, and gaslit by a medical professional at some point in their life. Or at multiple times.

Research into women’s/gynecological health is shockingly underfunded and undervalued. There have been many lawsuits and counts of malpractice in women’s medicine, from the Essure sterilization procedure to vaginal mesh (please do not ever, ever, consent to this procedure), to the Dalkon shield, to violations of consent against women in labour, to the average time to be diagnosed with endometriosis to be between 7-12 years.

There seems to be little understanding or respect for a woman’s bodily autonomy, even in the most basic of health checks, the humble pelvic exam.

While for a medical professional it’s all in a day’s work, there seems to be little understanding or respect for the fact that your vagina is a sensitive area and needs to be treated as such.

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It doesn’t have to be this way.

You are not a body to be prodded and poked, you are a sovereign human being.

While a pelvic exam may not be something that gets you skipping with joy, you can absolutely turn it into an empowering experience where you feel like you are working together with the medical professional.

This applies whether you are having a general examination, an STI test, getting a smear test, an IUD/IUS fitting, to pre-natal, labour, post-natal examinations, or even a LEEP/LETZ procedure.

Basically, any time somebody is going to be sticking their fingers and/or a speculum up your vaj, you get to be empowered.

For the purposes of this piece, I will use the term “professional” or “medical professional”, as an umbrella term to refer to whoever is doing the examination, whether it’s a nurse, doctor, gynecologist/OB-GYN, midwife, pelvic physiotherapist, doula, or somebody else.

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Your body. Your rights. Your rules.

While medical professionals are highly trained and knowledgable, they cannot know what it is like to be inside your body, your trauma responses, or your tolerance for pain.

If it feels painful or unbearable for you, don’t let them convince you otherwise.

Nobody has the right to do anything to your body without your consent, including a medical professional.

Create an affirmation for this that reminds you that it is and always has been your body.

Do a self vulva exam

If this is physically possible for you, I highly, highly, highly recommend you make a regular practise of looking at your vulva in the mirror. I get all my clients to do this and I do it myself. Most womxn do not have regular contact with their vulvas, but this is a key part of being empowered about your body.

Learn all the anatomical parts, get super familiar with yours. If you find this too emotionally difficult, then it’s time to get support. Learn more about working with me 1:1 here.

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Before your appointment

Think about what you would need in place for this to be an empowering experience. Think about any potential roadblocks and then brainstorm potential solutions. For example, if you know that you dissociate or freeze, what would you need to happen or for somebody to do?

For example:

• Bring a support person/cheerleader/wing woman along with you
• If you’re feeling anxious, take some rescue remedy or do something soothing and grounding
• Or do some dancing to raise your energy
• If you anticipate it being painful (especially for an IUD/IUS fitting), take some painkillers beforehand
• Make any travel preparations such as getting a lift or a taxi
• Buy your favourite drinks and snacky treats. Chocolate all the way!

Make it a ritual

You don’t have to be particularly into the woo to make this a sacred experience for you. Think about how you could incorporate your own spiritual practise into it, or add some.

For example:

• Visualize yourself connecting with your vagina and cervix. Imagine sending love and healing to those areas.
• Put on some music and do some sensual dance
• Tao tantric qi gong to bring energy to your pelvic area
• Placing your hands on your heart, vulva, and/or wombspace and sending love there
• Creating a mini altar in your living space or buying a few sacred objects to honour your vulva/vagina. Or buy some fun merch like badges, earrings, stickers, or anything else that celebrates the vaj. Check out The Vagina Museum or look on Etsy.

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Pain Relief

If you are having a specific procedure done such as having an IUD or IUS fitted, a colopscopy, a LLETZ or LEEP procedure, or you already have vulva/vaginal pain, you MUST (imagine I am wagging my finger at you), ask about what pain relief options you will have. 

You will need both pain relief during the procedure, and pain relief afterwards too.

This is a non-negotiable, end of.

Ideally, ask about them before your procedure and then ask again at the appointment to be sure.

Usually they will also ask you to take some painkillers before the procedure too, such as Ibuprofen.

Please do this but also this is not an excuse for them to not give you effective pain relief during the procedure too.

At some places you can also ask for gas and air, but the very least they should offer you is a local anaesthetic and numbing gel. Not all medical facilities have gas and air, but as my mother always says, “If you don’t ask, you don’t get!”

For my second IUD fitting I was offered gas and air and it was brilliant. I was high as a kite for the whole procedure and it went super quickly. For my third IUD fitting, the clinic sadly didn’t have it, but I was given a local anaesthetic and numbing gel which was very effective.

Your healthcare provider must provide it for you, it is your right to ask for it and have it. 

If they try to fob you off and insist it shouldn’t hurt that much, insist on a different provider or move to another clinic. They are either lying, are completely misinformed, or have refused to listen to any of their previous patients’ pain.

Either way, you do not want this person as your healthcare provider. You have the right to somebody who will listen to you and take your pain seriously.

I don’t want to fear monger, but I am being realistic about the expected pain levels of these procedures and that women have been historically gaslit about our pain.

Contrary to what some doctors say, there are many nerve endings in the cervix– why else would we be able to have cervcal orgasms?

You are being your own best friend by insisting on pain relief.

At the appointment

When you arrive at the appointment, here are some really important things to remember.

1. Tell the practitioner you feel nervous and speak about any concerns you have, and especially any pain or trauma you experience so that they know. Tell them what you need from them if this happens, for example, “I will need you to stop or go slower.” or, “I will need you to reassure me.”
2. Especially tell them about any pain you experience and request that they go gently and slowly.
3. Ask for pain relief and you can also ask for a smaller speculum if you need.
4. You can ask for more lube. Ask for all the lube you need. If you have a particular sensitivity to a certain brand or type of lube, tell them and ask for a different one.
5. The most important thing of all: You can put the speculum in yourself. Yes, you can!
6. You can ask them to stop at ANY time. Don’t let them rush you, so take all the time you need.
7. You can keep your hand close to your vulva or just on your body. This helps remind yourself that it’s YOUR body.
8. Visualize your vagina and cervix opening and expanding, with the intention that you are ALLOWING them inside you.
9. Try and find the funny. Humour reminds you that this really isn’t the end of the world and you will survive it. Can you find something humorous in this? I bet you can. Crack a few jokes with the professional, find some silliness in the situation. Your legs in the air, you may feel like a plucked turkey, there may be random farts or queefs. Humour can be a sanity saver if you can’t stop the panicky thoughts and feelings.
10. Keep talking to the professional if you can. Ask questions about your body, ask them what they are seeing. Now could be the time to ask them to take a picture of your vulva and cervix for you to look at afterwards- because your vagina is a marvellous thing.
11. When it’s finished, put your hands on your body and give yourself a cuddle. YOU DID IT! Thank your vagina and your body for being an awesome person. Go on, give yourself a high five.

Emergency key phrases

Here are a few simple phrases to remember when you’re feeling in a pinch. Was that pun too much? #SorryNotSorry, terrible humour is how I roll around here!

“Can you stop for a second?”

“Can we pause for a second?”

“I’m going to take a few deep breaths”

“Can you give me a minute?”

“Can you pull out of me, please?”

Afterwards

Celebrate! Have a dance, buy a luxurious hot chocolate, play your happy playlist. You did it!

When you get home you may want to do another vulva/womb meditation, or you may want to self-pleasure.

Know your rights

You always have rights as a patient. The days of blindly trusting your doctor and doing everything they say is over, because you are the expert on your own body.

You have the right to pain relief, you have the right to change doctors, you have the right to make a formal complaint.

If you feel uncomfortable with a professional or they are not listening to you, you have the right to ask for a different one. Or even move to another clinic.

You do not have to put up with any shit from anybody, especially if they are in the position of looking after your body.

If a professional has been insensitive, has not listened to you, or you have had a traumatic experience, you have the right to file a formal complaint.

Your body. Your rules. Your choice.

Now go book that appointment!

Lucy x

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