Sonogram

Ultrasound is a cyclic sound pressure at average frequency of 20 kHz, above the human’s hearing ability.

Gynecologic sonogram works like a sonar in a submarine: it sends a beam out, and if the beam encounters a solid object (i.e. another submarine, a rock, a cyst, a fibroid, cancer) it returns its image by displaying it on the screen.  There are many other uses for ultrasound and you can do your own search for general knowledge.

There are two (2) types of diagnostic gynecologic sonograms that are typically used to visualize the female pelvis:

• Trans-abdominal, which is completely external: the transducer (ultrasound wand, or probe) is rolled on the belly/lower abdomen after the patient has drank enough fluid to fill the bladder that will act as the needed water medium for the sound waves.  During pregnancy (obstetric ultrasound), the amniotic fluid acts as the water-medium while the test is done to assess the development of the fetus; the parents-to-be benefit by being given an image photo of their baby.
• Vaginal, an internal procedure: the transducer is inserted into the vagina and is moved about the organs (uterus, cervix, ovaries, bladder, fallopian tubes) for best visualization.  To provide a water medium, the transducer is inserted into a lubrication-filled protective cover that looks like a condom.  This test provides the best imaging of the internal organs.

Vaginal ultrasound may pose a problem for women who struggle with vaginismus or are just nervous about ‘anything going into the vagina.’  A useful tip: let the person who does the test (the doctor, the radiology technician, etc.) know that you would like to insert the transducer yourself.  Once it is in, have them grab hold of it and proceed with the procedure.

If penetration is not at all possible, ask for a trans-abdominal ultrasound instead, and return for a vaginal one as soon as you have cured your vaginismus.

To learn more about the test and to see what the equipment looks like, click here.

About stirrups

During gynecologic exam, the woman is asked to slide down to the edge of the examination table for best visualization of the area and to accommodate the use of the speculum.  This position is medically known as the dorsal lithotomy position.

Stirrups were invented by Bert H Simpson in 1908 and patented in March 1909 – only 100 years ago.  See photo below.

Many women would rather not use stirrups because they cause them embarrassment and much distress.  Are they mandatory?

Apparently not: a 2006 study suggests an alternative to discuss with your doctor: keeping feet on bed.  The study is worth reading.

Vaginismus, returns?

Vaginismus is a common condition that affects women worldwide regardless of their culture, religion, education, sexual orientation, or family status.  Vaginismus is a somatic (body-mind) reaction to fear/apprehension of vaginal penetration.  It happens instantaneously and involuntarily.

Women with vaginismus tend to suffer in silence and shame, thinking they are the ‘only one’ with this problem, which is why prevalence is not available.  A certain measure of anxiety is typically associated with this condition, ranging from minimal to severe, the latter may also include panic and OCD (obsessive compulsive disorder).

Vaginismus is curable and the cure should be life-long as long as the woman follows discharge instructions, which should include specific management of the residual anxiety/panic/OCD.  In other words, once the woman can have vaginal penetrations without a problem, why fear them any longer?

Does vaginismus come back? It can, if the woman did not follow up on discharge instructions and is again ‘allowing’ the anxiety/panic/OCD to regain control and interfere with vaginal function.  Sad, isn’t it? To have gone through a treatment process only to then be non-compliant.

On a good note, it is rare that the woman will regress to a complete vaginismus: she will typically be able to have (some) penetration/s but with trepidation and under the effect of her un-managed anxiety.  In some cases, the vaginismus could remain cured but other somatic reaction/s may appear, such as IBS (irritable bowel syndrome), neck or back aches, TMJ (jaw joint pain), headaches, etc.

Bottom line (no pun intended): vaginismus is a body-mind phenomenon and both aspects must be properly resolved for a life-long cure, a joint effort between a skilled clinician and a responsible patient.

Vagina, sterile?

Women often believe that their vagina is a sterile environment and that special cleaning methods are needed to keep it as such.  If it were true, then men should have sterilized their penises before penetration, right?

Fact: the vagina is not at all sterile but rather a a host to many type of bacteria, all composing the vaginal flora that promotes vaginal health.

According to Ann S Botasch MD, the composition of vaginal flora changes with age, stress, hormonal influence, general health status, and sexual activity, and disruption of this balance will lead to breakdowns such as irritation, infection, bleeding, etc.

So, ladies — make sure whatever ‘visits’ the vagina is clean and that you keep a balanced vaginal flora, but do not worry about the vagina being sterile.

Vaginismus or Vestibulitis?

It is common to group vaginismus and (vulvar) vestibulitis into one and it takes a proficient clinician to know the difference.

Generally speaking,

• Vaginismus = unable to have vaginal penetration/s, or able to have them but with pain and distress.
• Vulvar vestibulitis = penetrations are usually available but the pain/burning/discomfort surrounding the area may complicate matters.

Unfortunately, vaginismus remains an elusive diagnosis while (vulvar) vestibulitis has become the (quick) answer to vulvogenital problems.

Anxious gyno exam

The reflexive reaction during gynecologic exam is to tighten up the pelvic floor (PC muscles) as the clinician is about to ‘go in.’

The physical fact is that the more you tighten up, the more discomfort you will feel.

So, what is the trick?  Minimizing this reflexive reaction.

As you lie there, feet in stirrups, genitals ‘airing out,’ focus not on the exam (it is not your job anyway) but rather on ‘butt down, legs open, vagina welcoming penetration…’  Keep your breathing at meditation rate – no hyperventilation – and keep telling yourself to just ‘whatever it.’  If you can do that, the exam will be quick and easy.

If you and your vagina are on anxious terms, such as with vaginismus, do your best.  If the exam is not doable, seek treatment and then come back as a WINNER!

Love gyno exam?

Who loves going to the doctor for a gynecologic (pelvic) exam?

Nobody really, just like not loving going to the dentist and having all that work done in the mouth.   But, we do them all for health reason, for preventive or corrective medical intervention.

Gyno exams should be done in neutrality – neither loving nor hating them.   The woman should be able to lay there (yea, heels in stirrups, air flowing into the vagina, we know…), keeping her butt down and her vagina relaxed while allowing this quick procedure to take place.  For a great video, click here.

To help assume such a positive attitude, you may want to understand what will be done and never hesitate to ask the clinician to give you a hand-held mirror and to show you the ‘inside’ of your vagina — it is yours and you should know what it looks like.

Knowledge is power, and power is control.  Do not delay your next pelvic exam; reward yourself afterward with something that you can love!

P.S.  Some women will not be able to have a gyno exam ‘in neutrality’ because of vaginismus, menopausal vagina, post-raditation, severe anxiety, history of sexual abuse/trauma, or other conditions that may interfer.  We encourage them to seek professional help to resolve those road blocks.

Vaginismus, you say?

Vaginismus is the inability, or great difficulty, to have basic vaginal penetrations: finger, tampons, vaginal applicator, gynecologic exam, and intercourse (or dildo).   If you suffer from it or know someone who does, you can appreciate their physical and emotional anguish.

But what if your friend/daughter/whomever tells you that she has vaginismus and you’ve never heard of it before? The common reaction is, “Vaginismus, what? What do you mean you cannot use your vagina? Just relax and let it happen…”

Such lack of understanding will make the sufferer feel even more isolated and inadequate…

Suggestion: let her know that although you may not know what vaginismus is all about you are behind her and will help find support and resources.  Team up with her.  Give her hope.  Make her feel that she is still equal to you despite her medical condition (vaginismus).

The speculum…

The speculum is a ‘duckbill-like’ instrument that is used at time of a gynecologic exam to hold the vaginal walls open so that the ‘inside’ can be visualized. Sort of like you putting your hand into a sock and spreading your fingers to hold it open.

A speculum size ranges from very small to large, with most exams being done using a medium, ‘regular’ size.

A speculum can be made of clear plastic, or of metal. Women are often concerned with the differences, so here they are:

• Both plastic and metal are used the same way and do the same thing.
• The plastic speculum is lightweight and disposable.
• The metal speculum is a bit heavier, a bit colder, and need to be sterilized after each use.
• The plastic speculum clicks when it is opened; the metal has a screw that needs to be turned, thus the associated sound.
• Both plastic and metal have rounded edges, are smooth, and safe.
• Your clinician may elect to use the disposable plastic speculum, or may elect to stay with his/her supply of metal specula (the plural of speculum) and autoclave (sterilize) them on a regular basis.
• A pediatric speculum is typically made of metal.

Bottom line: no need to worry about the type of speculum used. Just be there, relax, and let the exam take place — it only takes a few seconds.

Tips for gyno exam

When scheduled for an elective (non-emergency) gynecologic exam, you may want to follow these tips:

• Bring a list containing date of last period, names of prescription medications you are taking, socks if you like your feet kept warm in the stirrups, and questions you want to ask.
• Keep the vagina off limit for about 48 hours prior to the exam so that the Pap smear will not be altered by the presence of leftover semen (ejaculate), contraceptive gel/foam, lubricants, moisturizers, etc. That way you will avoid a phone call telling you that your smear came back abnormal and that it will need to be repeated in the near future. It will spare you of unnecessary worrying while you wait for the next Pap smear…
• Also for 48 hours prior to exam: refrain from using tampons and from sitting in water (bath, jacuzzi, whirlpool, chemically-treated water such as a pool, etc.) so that your vagina will stay naturally moist. Why? To ease the way in for the speculum, that metal or plastic ‘duckbill instrument’ that is used to hold the vagina open during the internal exam. But do take a shower as part of your daily hygiene routine!