Facing a gynaecological examination with vaginismus

But here’s the good news: with the right approach and the right professional, you can take this step safely, gently, and at your own pace.

Whether you're preparing for your first appointment or have had difficult experiences in the past, this guide will help you feel more informed, empowered, and in control.

Why It’s Important to Speak Up About Vaginismus

Before any examination begins, it's essential that you inform your doctor, gynaecologist, or nurse that you have — or suspect you may have — vaginismus. You don’t need to explain everything in detail. A simple sentence like “I have vaginismus, and I need the exam to be done slowly and gently” is enough.

Letting the medical professional know in advance allows them to:

• Block extra time so you’re not rushed
• Use a smaller speculum or avoid it altogether, if appropriate
• Explain each step clearly so there are no surprises
• Check in with you throughout to ensure you feel safe and in control
• Adjust or stop the exam entirely if it becomes too uncomfortable

You are not being difficult or dramatic by making these requests. You are advocating for your health — and your nervous system.

What Happens During a Gynaecological Exam?

Knowing what to expect can help reduce fear and uncertainty. Here's a step-by-step breakdown of what typically happens during a routine pelvic exam:

1. Discussion First

Before anything physical happens, the doctor will ask about your medical history, cycle, symptoms, and sexual activity. You can also use this moment to mention any fears or past negative experiences.

2. Preparation and Privacy

You'll be asked to undress from the waist down. In some countries, you'll receive a paper drape; in others, you may be asked to undress without a covering. You’ll lie on a table or in a gynecological chair, with your legs supported.

3. External Genital Exam

The provider will examine the vulva — looking for irritation, swelling, or visible signs of infection. This part is external only.

4. Speculum Exam (Optional)

If needed, a speculum is gently inserted into the vagina to allow visualization of the cervix. This can be the most intimidating part for vaginismus sufferers. Requesting a paediatric or small-sized speculum, asking for it to be warmed, and staying in full control are key. You can stop or delay this part at any time.

5. Pap Smear (if indicated)

If you’re of age or due for one, the doctor may use a soft brush to collect cervical cells. This part is usually very quick and may feel strange but should not be painful.

6. Bimanual Exam

This involves two fingers inserted into the vagina while the doctor gently presses on your abdomen from the outside. It helps assess your uterus and ovaries. You can request to skip this if you’re not ready — it’s not mandatory in every case.

7. Aftercare and Next Steps

After the exam, you’ll be given privacy to get dressed. The provider will then explain any findings and discuss follow-up care if needed.

Know Your Rights and Set Boundaries

You always have the right to:

• Request a female doctor or midwife
• Bring a trusted person into the room
• Ask for the exam to be done in stages
• Say "stop" at any time — no explanation needed
• Choose to delay or skip parts of the exam

If something doesn’t feel right, you can always walk away. There is no such thing as being “too sensitive” or “too much.”

What About Transvaginal Ultrasound?

Sometimes, especially when you're dealing with pain or cycle irregularities, your doctor may recommend a transvaginal ultrasound (TVUS) — also known as vaginal sonography.

Here’s what that involves and how you can prepare:

What is a Transvaginal Ultrasound?

This is a safe, non-invasive way to get detailed images of your uterus, ovaries, and cervix. It’s often clearer than an abdominal ultrasound, especially for early pregnancy or pelvic pain evaluations.

Step-by-Step:

• Empty Your Bladder – Unlike abdominal scans, a full bladder isn’t needed.
• Positioning – You’ll lie down like in a standard pelvic exam.
• The Probe (Transducer) – A slender, wand-like device (much smaller than a speculum) is covered with a sheath and gel and gently inserted into the vagina.
• Image Capture – The probe sends out sound waves to create detailed images. The sonographer will gently move the probe to capture different angles.
• Completion – Once images are captured, the probe is removed and you can get dressed.

If You Have Vaginismus:

• Let the technician know beforehand
• Request the smallest probe available
• Ask them to pause if needed
• You can choose to delay the procedure or discuss alternatives

You Deserve Gentle, Trauma-Aware Care

As someone with vaginismus, you are not “difficult” or “broken.” Your body is responding to fear and perceived threat with the only tools it knows — tension, shutdown, or panic. These are survival responses, not character flaws.

With the right knowledge and support, you can take back control.

And if you’re looking for a supportive path to gradually overcome vaginismus in your own time, check out The Vaginismus Zone — my private online coaching program that includes doctor-designed video lessons, anonymous chat rooms, and compassionate support every step of the way.

You deserve care that honours both your body and your emotional well-being.

You are allowed to set the pace in that room — always.
Warmly,
Dr Julia Reeve

Gynaecologist · Psychotherapist · Sexologist · Author of The Vaginismus Book

Dr Julia Reeve

Gynaecologist, psychotherapist and sexologist based in Amsterdam, with over thirty years working with women experiencing vaginismus. Author of The Vaginismus Book and creator of the TVZ dilator companion app.

This article is for general information and education. It is not a substitute for individual medical advice. If you have persistent pain or distress, please see a qualified healthcare professional.