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 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.
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.