Smears without tears: a guide to making a speculum examination more comfortable

Intimate examinations are needed for routine smear tests and to investigate certain problems. Some people find them very uncomfortable, or even acutely painful or distressing, particularly if they already suffer from vulval pain. The aim of this guide is to help you minimise any discomfort or distress by planning ahead.

Who will examine me?

This guide refers to a doctor, but you may be seen by a doctor or nurse. You can ask for a woman if one is available, but a man may be just as helpful. For a smear test at the GP surgery you can book a longer appointment to give the doctor more time. You can even ask to have it done by specialists at the colposcopy clinic.

Hang on a minute...

Before you visit the loo, check whether the doctor will need a urine sample.

Who will be in the room with me?

You can take a friend in with you. They can sit by your head to hold your hand, take notes and speak on your behalf. Make sure they know your needs. Clinics should provide a chaperone (usually a female nurse) but you may have to ask. Your friend could act as chaperone.

You may prefer to talk to the doctor alone. This is especially important if you need to disclose any sexual abuse. You should be fully dressed when discussing this, unless you need to show the doctor something.

Students attend consultations as part of their training. You may refuse to allow them at yours, but anything they learn from you may help other patients. When doctors are teaching students, they are likely to explain things more carefully.

Can I explain something?

It’s important for the doctor to know how much pain you have. A long-handled mirror may help you to show exactly where it hurts. You can take a note of your symptoms and medical history to help the doctor understand your situation better. This can save time and avoid repeating unhelpful treatment.

What are they going to do to me?

Before you undress, be sure you know what to expect. The door or screen should be secured for your privacy. If you feel cold or exposed, ask for a blanket or your clothes to cover you.

• You can look at any instruments the doctor will use. If you know you need a smaller speculum, say so.

• Ask the doctor to tell you step by step what they are going to do and to go slowly. You can stop the procedure at any time.

• If anyone does anything which causes you pain or distress, tell them – how else will they know?

• Ask the healthcare practitioner to slide the speculum fully in, then open it slowly, just as far as you can bear. Then it won’t over-stretch the vaginal entrance.

• Some people find that it helps if the speculum is opened sideways, not up and down.

What position do I need to be in?

Stirrups may help - they tilt your hips and make the cervix (womb entrance) easier to see. Or try this (practise at home first).

1    Lie on your back with pillows under your head to make eye contact with the healthcare practitioner easier.

2    Place a pillow under your hips to tilt the pelvis to a better angle.

3    Place your feet shoulder-width apart to make it easier to relax.

4    Slide your heels up close to your hips, then let your knees open.

How am I supposed to relax?

1    Rest both hands on your tummy, one below your ribs and the other above your pubic bone.

2    Keeping your tummy soft, breathe so that your hands rise and fall but your chest doesn’t.

3    As you breathe in, gently push your vulva outwards.

4    Ask the healthcare practitioner to tell you when the speculum is about to go in.

5    As it starts to go in, push a little more as if you are having a poo.

6    Keep breathing and keep your tummy soft.

What if I have joint problems?

Rest your knees against the wall, or your chaperone, or both. This will help your hip joints relax. Don’t let anyone lean on your legs, as this might make you tense up. The doctor will have enough room to work if your knees are shoulder-width apart.

Can I use a different position?

You may be more comfortable lying on your side with your knees bent up to your chest. This may not be possible for all examinations, but smear tests can be done in this way.

Can I ask them to use lubricant?

The speculum will glide in more easily if it has lubricant on it. You can insist that you need this - it will not spoil a smear sample if it's done carefully. Made-for-sex lubricants are very effective, even in tiny amounts. Take your own, or ask the healthcare practitioner to use plenty of lubricant.

What happens next?

The doctor should allow you privacy to dress afterwards before any discussion. If it’s uncomfortable to sit or perch on the edge of the chair, you can stand. If the doctor has been helpful, say so, but if not, it’s important to follow it up. For details, see ‘Where do I go if I have a problem?’ at the end of this leaflet.

What about the next time?

If you need a follow-up appointment, ask to book it before you leave, to give you more choice of dates. You can ask to see the same doctor again if they are available. Ring just before the date to check that they will be there. 

Be aware that the same person may not be able to see you if there is an emergency.

Where do I go if I have a problem?

If you have a problem with any aspect of your care, contact the hospital’s Patient Advice & Liaison Service (PALS). PALS officers in each NHS Trust can help you resolve a concern, or explain how to make a formal complaint. If this doesn’t resolve your issue, you may be able to get free support through The Advocacy People, an independent advocacy organisation supporting people with NHS complaints: www.theadvocacypeople.org.uk