Hi! I know other people have sent similar asks before but I thought I'd send my own just to be sure. I can't fit more than a finger... up there. And even then its a tight fit. That's enough for me but I'm worried about if I go for a pap smear (I think that's what its called, I have a bad memory): something has to go up there right? Will it fit? What happens if it doesn't? Is it going to be a hassle to request a woman? How much do I need to "clean up"? No pressure to respond right away, I get that you're busy. I just wanna know what to expect. Thank you! 😊❤
Hi Anon!
How old are you? You don't need a pap smear until 21, and you don't need a pelvic exam at all before then unless you've got some kind of complaint or you want to get fitted for an IUD. If you are 21+ and have had zero sexual contact, you can discuss a modified schedule with your provider.
PELVIC EXAMS
Reminder - pelvic exam is when the doctor/midwife examines your pelvic area and vagina. This can include the use of a speculum or not, and be done for a number of reasons. Pap smear is a screening test where we take a cell sample (like a cheek swab) from your cervix to check for HPV/precancerous lesions. A pap smear is usually conducted in conjunction with a pelvic exam, but not all pelvic exams include a pap smear, as you don't usually need one every year.
Let's go through your questions one by one. But first I want to start by saying that medical consent is the same as regular consent - you have a right to refuse or defer any procedure or examination, or to stop one at any time. You have the right to fully understand everything you're consenting to, and ask as many questions as you need to feel comfortable. If you make an initial appointment with an OBGYN or midwife, and she doesn't pass the vibe check, you are not obligated to go through with the exam. It can be scary to stand up to someone who seems like they're in a position of power, but you should know that you can.
"Something has to go up there, right?"
At your first GYN appointment, nothing has to go anywhere. You'll meet with a provider, she'll take your full medical history, your menstrual and sexual history, your family history, ask if there are any concerns you want to discuss. At this point, you should talk to her about your issues with insertion and your anxiety about it. She may want to have a look (literally just eyeballs) to ensure there's nothing going on, but she will ask permission before doing any touching, and explain everything she's doing. If she thinks it's worth attempting a pelvic exam, she would start very slowly and only with your full buy-in. It may be necessary to try to figure out if you've got an underlying problem.
When a pelvic exam is warranted (like when you need a pap), the provider may first insert fingers while pressing on your belly (called a bimanual exam) to assess your anatomy, and then use a device called a speculum, which allows us to actually see the inside of the vagina (speculum exam). The speculum will be lubricated, and the provider will coach you through the insertion process. You can also ask about inserting it yourself. Usually, you lie back and put your legs up in stirrups, and are coached to let your knees fall out and give a deep breath out, so as to relax your pelvic floor muscles, while the speculum is inserted down and back (towards your tailbone) in a smooth motion. You'll then feel a bit of pressure as the blades of the speculum are slowly opened so the provider can peek through. It shouldn't hurt, but it can be uncomfortable. I don't know anyone who actively enjoys speculum exams, but most people would say they're not too bad. The whole thing is over in a matter of seconds.
"Will it fit?"
Speculums come in a wide range of sizes, in plastic or metal (if metal, it will be warmed). You can ask for the smallest speculum they have (they make pediatric-sized speculums, so there are definitely small ones - see middle device in the image below, about the size of a finger). The provider will use one that should fit based on your history, anxiety/preferences, and her visual inspection of you - but don't be afraid to speak up.
"What happens if it doesn't?"
If you have an anatomical variation that means even a pediatric speculum could not fit, the provider will likely catch this before you get to the speculum stage. If you've got something going on like vaginismus, this will help her diagnose you. The most likely scenario is that you just need a competent and compassionate provider you trust and some good coaching. But what will NOT happen is the provider trying to jam something into you that doesn't fit!
"Is it going to be a hassle to request a woman?"
Absolutely not. It's very normal to have gender preferences with medical providers, especially for something so sensitive. Just ask for a female provider when you're requesting your appointment. You can also ask to see a midwife -- we're something like 96-99% female-identified, with most of the rest being AFAB trans/GNC/NB. (There ARE a few male midwives, but they're really rare).
"How much do I need to 'clean up'?"
If you've got time and it would make you feel better, take a shower before you come, wash with soap and water like normal. But if you can only get in on your lunch break or something, that's fine. Otherwise, you don't need to do anything! I promise your pubic hair is not so forest-like that we will not be able to examine you. Don't douche, or use any fragrances or lotions unless you would like some patient education about how you should not use "feminine products."
Okay Anon, that's an initial GYN visit in a nutshell!
