Monday, September 19, 2016


I’ve already complained about painful pelvic exams, not just the clumsiness of it but the even worse doctors' (FEMALE) sneering references to “senile vaginas” which I always deflect with Margaret Mead’s indignant retort when accused of having an “incompetent cervix” meaning that the constriction wasn’t strong enough to keep the baby inside.  “No part of me is incompetent!”  (They still sewed her cervix shut until birth was imminent.)

But then I thought, I google everything else — why not painful pelvics?  Whoa!  There’s a LOT of material out there about our sensitive little sea creatures.  I’ll append the advice of Deborah Metzger, the director of Helena Women’s Health, but before that I have some thoughts.

The unordered catalogues of gizmos for seniors that I get all the time often include a couple of pages of insertional sex toys: bright, plastic, battery-operated with cute names.  If someone somewhere is thinking about such things and selling them, they must not always be painful.  Why can’t someone do something about the stainless steel clamps that hold the vagina open?  You may have seen these speculums in movies about early feminists who were on hunger strikes: they were used to hold their mouths open so food could be poured in while they were strapped down.  Oral rape.  Torture.

This time I did get bold enough to ask the doc to warm the speculum before inserting it so I didn’t jump three feet in the air when the cold steel hit a tender part used to being warm.  I didn’t know you could ask for a small one or even a plastic one, but I suspect the latter would not be on hand.  They were very popular during another feminist interval when everyone was peering into the origin of life contained in each other.  One woman was fearless enough to look into her own mother and said,  “I can’t believe I came through a hole that small.”  It’s called the “os,” AKA the cervix.

"Graves speculums"  Set of five.

But here’s the bottom line:  the “senile” thing is properly called “vaginal atrophy” and is simply caused by decreased estrogen, which is easy enough to apply topically or even increase without pills by eating plants that include the vegetable version:  beans, soy products, sweet potatoes and yams, and some other stuff that easy to google.  “Atrophy” is not a lot better than “senile” but the connotations are slightly less offensive.

It’s likely that what the operator of the speculum blames on senility is actually an inflammation of some kind, even endometriosis, some affliction that took advantage of atrophy.  Of course the reason for inspection is to look for cancer or infection.  Yeasts love vaginas, esp. those that are sat on all day.  The “senility” thing is a precursor, not an affliction.  It’s a normal condition that makes an older person a little more vulnerable in one of the many ways we age.  To tell someone she has a “senile vagina” is aggressive and blaming.  Basically, “too old to fuck.”  Women doctors are the worst if they don’t have their own anxieties or tough defenses under control. 
A 3-D print-out of a dissected-to-be separate clitoris.
On an intact person one can only see and touch the tip of the little hook at the top.

Of course, men who are good lovers have much more experience with the ‘“love oyster” and its tubular connection to the inner sea of the thoracic chamber.  They know where things are, and how to get them slippery.  Lately, thanks to techies, one can print out a model of the clitoris, which surprisingly is mostly an internal organ.  Only the end of the curved part at the top can be seen or touched.  The bulbous parts on either side are what become engorged until they empty at the moment of orgasm.  Maybe some docs are too afraid of stimulating the clitoral structure.

Left half has the operating buttons, right half has the battery.

The latest thing in insertional sex toys is not just battery-operated to vibrate but also can be operated via Blue Tooth over the Internet.  Not necessarily by the handler, but always "on" for the manufacturer as market research.  What the trendy were slow to realize is that any such gizmo — like the computer controls of your refrigerator or furnace that you can check from the office — is sending all the information about time, intensity, location of the signal and so on back to a massive database.  It’s “Onstar.”  

Major assurances about your privacy are , made, of course, unless some resourceful sex researcher like Ogi Ogas and Sai Gaddan, who wrote “A Billion Wicked Thoughts” from online porn hits, decide to analyze it all.  (Kinsey’s original research data has still never been released.)  I’m looking forward to “Blue Bloods” working that into a crime story.  “Where were you at 11PM on Wednesday and what were you doing?  Can anyone else testify to that?”


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.

Before the exam gets underway, talk with your provider about your past experiences, fears, or anxieties about penetration and the exam. Let her or him know that you want to maximize your comfort and you'd like them to work with you towards that end.
Don't hesitate to talk with your provider about types and sizes of speculums — often s/he may have a smaller speculum they could use if you speak up. 
Ask the examiner to warm up the speculum and the lubricant used with it. This may ease the introduction of the speculum into your body and cause less pain.

Hunt for your perfect gynecologist. The health care provider doing your exam has a huge impact on your overall level of comfort for the exam. If you feel your current gynecologist just isn't taking enough measures to put you at ease, find an annual exam provider you can absolutely trust. This will also create an environment of familiarity and trust, which will help you to relax during exams.

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