Smear test pain - why? Is diazepam really needed?!

[InescapableDeath]

I had a failed smear test today.

I thought it would be painful as my last one was. What I don't understand is (sorry, back story), I've had IVF and dye tests and other things that have involved speculums, albeit several years ago. I recall them being uncomfortable, but not painful. I was able to withstand it for long enough to have embryos transferred multiple times! So why can't I manage now?

Re the smear test, I was okay with her inserting the speculum, but the moment she opened it up, it was excruciating - couldn't stop myself crying out!

She was sympathetic and helped me with some breathing exercises and we had another couple of goes, but apparently my cervix was so far away she couldn't get to it anyway (and I was too in pain to try for long/started bleeding).

I felt so silly, even though she was lovely. We've rearranged for another appointment in two weeks and she has given me a prescription for diazepam to take beforehand.

Will this really help? It's so strange, logically I am not worried about smear tests at all. The insertion isn't a problem. It's just the bloody opening the speculum! Why does my body fight back at that point?

I'm worried the diazepam will make no difference (never had it before).

Bump, has anyone else experienced this?

I've read about vaginismus but it's only a problem for me when the speculum is opened wide. I don't get it. I'm a little nervous before but I never avoid the smear test. I quite happily booked it and went along!

Strange. How old are you. I had a smear in December and found it painful for the 1st time ever. My result came back inadequate. Funnily enough I went for my repeat test this morning and told the nurse that I had found it painful last time. She said that when ladies get to a certain age ( I am 49) that dryness sometimes makes it uncomfortable. It wasn’t as bad this morning a little uncomfortable but not painful like last time. Hopefully, she got enough cells this time.

I have vaginismus so find smears a nightmare, and also find the speculum really, really hurts inside my pelvis, I can only liken it to having a tooth pulled out in terms of pain . For those reasons I can’t put anything else up there eg tampons etc ... whole thing is very complex and hard to figure out what to do . NHS said need quite specialist help that just isn’t available so ...

One of the things I’ve noticed is I’ve had a lot surgery down there and bladder stuff and I automatically clench up at the sight of a GP couch, or gynaecologist appointment, I tense up all over . As if my body and brain aren’t engaging . Even if I know I’m just talking to them . I’m not sure if that might be similar for you ?

Diazepam definitely helped me but I was given quite a bit, plus two codeine tablets, and diazepam the night before . Appointment was made for 8.30 am so I was still quite groggy from night before’s diazepam .

It was absolutely fantastic, I dozed through the appointment, nurse walked me to the car after and went home back to bed . Very effective . So I’d definitely try that if you can !

GP and gynae have also previously suggested diaphragmatic breathing, or breathing as if trying to blow bubbles, and trying to keep a soft face . Not sure if that makes much difference but it might .

I was about to suggest age too. I’m peri and haven’t as much stretch as I used to!

I've had painful experiences too: insertion fine, but open the speculum and it feels like someone is clamping my urethra extremely hard. I had one unsympathetic nurse who told me dismissively just to relax - which is bloody difficult when she's causing me excruciating pain. I was nearly levitating off the table and digging my fingernails into the ceiling.

The next time I warned the nurse in advance (a different nurse) and she suggested placing my hands under my lower back to tilt the pelvis up. Since then it's been fine - don't know if it's the change in posture or just coincidence.

I've read that the cervix changes position over the month: sometimes it's low down and sometimes high up, so you might find that a different time of month makes it easier for the nurse to reach it.

It can depend on the nurse/doctor And their technique ..I had one which Took several goes and had me in tears, they wanted another swab so I went the same afternoon to another nurse (The other site practice) no pain, over before I knew it. I was pathetically grateful and couldn’t stop saying thank you.

My smears have all been a nightmare. A 40 minute hunt for my cervix last time. And they are all always very painful - I have a tilted womb so I think that might contribute to the problem.

I’ve had endometriosis and the nurse thinks that makes it worse for me. So painful and no amount of ‘just relax’ made it better. I was spotting afterwards too.

I’m overdue mine and now I’m Dreading it as I’m peri which I think is going to make it worse.

Thanks all.

I'm 40. Haven't noticed other issues with dryness etc.

@donttellher I don't know if I have the condition (haven't used tampons for ages but have in the past), but anxiety does v quickly go from my mind to my body. For example if I think about a tricky work issue, I instantly need the toilet. Logically I'm not bothered, but the moment I feel that speculum extend... So glad to hear the diazepam worked.

@Plumpciousness insertion was fine for me too! I tried the hands under my bum thing and it helped but my cervix was too far away. I'm on the mini-pill so I wonder/suspect that means it will never naturally come down as I take it continuously. I remember from my ttc days that it used to move about!

@Redcrayons The endo thing is interesting. I have some hip pain and bowel issues and wondering if I have some endo going on.

I'm so sorry you've all had pain but also glad it's not just me. I really didn't get why I could stomach half of it but not the main bit!

You have my sympathy OP. I’m 52 and I get this too, very painful and it bleeds, but always comes back fine. It started happening when I was in my late thirties but is way worse now (I've had a baby AND the menopause in between!).

What was very interesting to me was that the middle chunk of this time (including the baby-having) was in a foreign country where they did American-style gynae exams and ALWAYS put your feet up in stirrups. I had two or three smears done this way and - zero pain!! I couldn't even feel that she'd done it!

I guess maybe they don't need to use a speculum if your feet are up? But tbh it was over so fast and I was so shocked that I didn't even think to ask. So anyway I hate British smear tests now. I don't know why they don't use stirrups. Could you suggest/request it? Idk if that's possible, never tried, I’m just glad I only have to have smears every five years now instead of every three!

Mine was so painful I didn't have one for around 20 years then my last was fine. Weird.

I think one problem is the nurse using a too large speculum. They should not hurt when they open them. That happened to me. I think they see middle aged woman who has birthed multiple babies and reached for a large speculum. It hurt! So I told them, take it out now and get a smaller one, the smallest you have. They did, and that one did not hurt.

I've always used diazepam for mine. It just relaxes me. If the nurse has given you enough I'd suggest taking one before the smear just so you know its effects (personally I just feel relaxed, no other feelings really).

I always ask for the smallest (I am a lesbian and have not had children) still find it so sore and have been referred to the hospital a few times because they can’t enough cells - but lucky they did as I ended up having CIN2 Cells and having to have treatment - so regardless how sore or uncomfortable please please get tested

I used to be fine with smear tests until after I had my first child (which was a c-section delivery so no vaginal damage). Then the first one I had was as you describe, they just couldn't do it. I managed to go back for a second attempt and they got a sample but it was very difficult. The results came back inconclusive so I had to go to the hospital to see a specialist as I needed a third test. The hospital test was so much better so I assume the practictioner doing the test makes a difference.

Anyway, 3 years after that I had another booked and I was dreading it so I took a co-codemol before hand which helped me to relax (or maybe it was the placebo effect) and it was all fine. So I would take the diazepam if it's offered, as even psychologically it might help.

I don't think this is rare or strange. I get referred to a hospital (Colposcopy) unit now because I always found it very painful. They use stirrups/a specifically designed chair as this makes the process less painful - how typical that this isn't more commonly used or offered to women, because you know, who cares about women's health/the take up of smear tests. Interesting how in the U.S. they are routinely done in stirrups.

I was always embarrassed about this, but as I've got older I've got more annoyed about it instead, it isn't something I should feel embarrassed about. Once I asked the nurse in the unit if it was common that women find them painful or are referred to the unit and she laughed and said yes, very.

But for anyone reading this having them done in the unit was much less painful, if at all! (hence going there!)

For me, smear tests suddenly became painful about 3 years after the menopause. Before that, I hardly noticed them. I had my last one ever last year, thank goodness.

@LindaFromMCC Yes I've had it done overseas using stirrups and felt literally nothing! I even asked her when she was going to do it and she said 'Oh I've done it'! Whereas in the UK, ever since having a (late) baby I've found it agonising and always bleed.