Jan is Cervical Cancer Awareness Month

*No trigger warning needed here as this blog will not feature any invasive images, cartoon or otherwise, of a pelvic exam, only the devices used, so breathe easy and read on*

I've been waiting to write a blog about getting through a gynecological exam and what better reason to do so than Cervical Cancer Awareness Month! No one likes going to the gyno and we often forget why we're actually doing it. If you're anything like me, you're enduring that annual pelvic exam just to get a birth control prescription, and when you're not on the pill, you just don't go because you feel like you can skip the appointment altogether now. However, the pelvic exam does serve a purpose beyond just making sure everything looks and functions normally, and it's to detect the big C.

What is a pelvic exam and when/how often do I need it? Once you go through puberty and definitely once you become sexually active, it's important to go the gyno and get a well woman exam. This will include a breast exam where the doctor will press firmly around your breasts to check for lumps (making sure you don't show any early signs of breast cancer), checking you weight and blood pressure, and once you turn 21, doing a pelvic exam. The age used to be 18, but unless you are having issues that need to be checked out, or are already having some kind of sex involving the vaginal/vulva area, you shouldn't need an actual pap smear before the age of 21. So back to the exam, you will undress and put on a paper gown once the nurse leaves you and then wait for the doctor to come in. First, she will look at your vulva to make sure everything looks normal and then she will move on to the internal part of the exam. This is where she inserts a device called a speculum (pictured below) and uses it to spread the top and bottom walls of your vagina to allow space to insert a long brush to scrape s sample from the bottom of your cervix. This part is called the pap smear and allows them to test your cells for cervical cancer. The 3rd part of the pelvic exam is the manual one where the gyno will insert a finger and press down on your pelvic region with the other hand to check your uterus, ovaries, and fallopian tubes for cysts, tumors, or pain. This is super important if you suspect you have PCOS, Endometriosis, Adenomyosis, or some other condition related to your reproductive organs. If you've already had manual therapy done with a pelvic floor therapist then you know that is similar and you can handle it. If not, please remember that the doctor's finger and the speculum will always be lubricated and they will walk you through the whole process step by step to make sure you're ready. This exam should be done at least every 3 years, but possibly more often if you have certain issues your doctor needs to keep an eye on.

What does it mean to receive an "abnormal" pap smear test result? This means that the cells taken from the cervix sample during the pelvic exam tested as pre-cancerous or cancerous. When this happens the pap is often done again just to make sure it wasn't a fluke (be aware of this if you don't have insurance because you will be charged twice if you are in America). Sometimes an abnormal pap can mean you have HPV, which they now often vaccinate against when girls turn 13. However, even if you do test positive for HPV, this does not necessarily mean you have cervical cancer. This means they will do what's called a colposcopy, and then a biopsy, if necessary. For this procedure you will be positioned just like a pelvic exam and they will wash your cervix with a vinegar-like solution, which may burn, to look inside to see abnormal cells easier using a colposcope, which is like a set of binoculars. If something abnormal does appear then the doctor will perform either a biopsy of the outside of the cervix, the inside, or both, where they scrape off the pre-cancerous cells to keep them from spreading upward and becoming cancerous. This feels like a pinch or a cramp and is really uncomfortable for up to ten minutes. Don't feel embarrassed or scared if you do end up needing this procedure. Many women have this done (I personally know my mother did a decade ago, a friend is currently, and 2 coworkers did at the same time in 2019). This can happen to anyone born female at any age, which is why any woman with a cervix should get tested regularly, regardless of what, if any, type of birth control, she uses. It could literally save your life.

What if I have vaginal or vulva pain? How can I get through a pelvic exam without physical and emotional trauma? My first suggestion is of course finding a gyno who is a specialist in Vaginismus and Vulvodynia because they will be the most gentle and patient with you, allowing the whole process to go at your own pace. Once you have solidified this, do some preparation at home for a month before your exam. This may sound excessive, and may be for some people, but since I have PTSD from the gyno, this is what it's taken for me to continue going back the past several years. Someone on my worldwide Vaginismus forum suggested purchasing a metal, pediatric speculum to practice with at home. I got mine for like $10 on Amazon 5 years ago. Now I know the metal ones look more like torture devices than the plastic ones, but hear me out, they are smaller. The thinnest one is actually easier to insert than a light tampon and the metal with lube added helps it slide in rather easily. It is very important while doing this that you hold the handle in a way to keep it closed so you don't hurt yourself. I don't actually open the speculum to stretch myself because I can do that with the dilators. I only insert it myself nightly to get used to the way it feels and anticipating the coldness of it. At the appointment by gyno lets me insert it myself then takes it from me to open it herself and take the sample from my cervix.

Another new option (yay, something good came out of 2020!) is the Nella Speculum, which is plastic and opens in 4 places instead of just 2. That probably doesn't sound very comfortable when you hear it, but the idea is that opening deeper inside the vagina, rather than stretching the vestibule, makes it better suited for more sensitive people, and it is thinner than the standard plastic model used by most practices. You probably don't want to be a guinea pig having your gyno try this out on you before anyone else, so I would contact the office and mention it before making an appointment, to see if it's something they already have or would consider purchasing and learning to use. I don't have any experience with this device yet, because COVID kept me from getting an exam last year, but I'm hoping to go in this summer and see if I can try it out then.

My other biggest advice for your exam is to bring something comforting with you. If you have a partner who can go and hold your hand, great. If not, bring a small stuffed animal you can squeeze and some headphones to listen to a calming song. The actual exam is so quick, but if you have anxiety about it then you may need to take some time beforehand to decompress and take deep breaths beforehand. Remember, reverse kegeling will create space for the speculum to fit, so push out like you are birthing a baby once the speculum reaches your vaginal entrance and it should not hurt at all. While having your feet in the stirrups is very vulnerable and not fun, it spreads your legs in a way that should keep the speculum and the long brush or Q-tip device they inset from ever touching your vulva. The idea is to have them both go straight in so you don't feel anything but a stretch and then a pinching sensation that's over in about 10 seconds. Even if it takes a lot out of you emotionally to go get this done, it's so important for your health in the short and long run. Remember we are here for support if you need it before or after!