Tips to Reduce Exam Anxiety at the OB/GYN

Do you feel anxious when you have to see a gynecologist? If you answered yes, you’re not alone. More than half of the women included in a 2009 study published in the journal Midwifery felt anxious or worried about a pelvic exam, which is a common part of a gyno visit.

There are many reasons why you might feel anxious about seeing a gynecologist:

— It’s your first pelvic exam, and you don’t know what to expect.

— You worry that it will hurt. That may come from what you’ve read or heard from others. Or, you may have experienced pain during a previous visit.

— You’re a sexual trauma survivor.

— You feel nervous about seeing certain medical specialists. Dr. Mary Jane Minkin, a clinical professor of obstetrics, gynecology and reproductive services at Yale University in New Haven, Connecticut, has patients who take a day off of work to get both their dreaded gynecological and dental appointments done.

— You worry that a Pap smear or a mammogram could lead to findings of cervical cancer or breast cancer.

— You come from a religious or cultural background that views gyno exams and sex as “dirty.”

— You feel generally uncomfortable during a gynecological exam because of the way you have to position your body. At its best, the experience is awkward, says Dr. Anne-Marie Amies Oelschlager, a professor of obstetrics and gynecology and an adjunct professor of pediatrics at University of Washington School of Medicine and Seattle Children’s Hospital in Seattle.

— You’ve read a lot of information online about gyno exams or conditions, and what you read makes you feel nervous or uncertain.

— You’re afraid of passing gas or leaking urine.

— Vaginal dryness makes gynecological exams more uncomfortable.

[READ: What Are the Early Signs of Cervical Cancer?]

Why You Shouldn’t Put Off Your Gyno Exams

If you’re anxious about seeing the gynecologist, it can be easy to put off those appointments.

“This avoidance fosters more avoidance,” says licensed clinical psychologist Annie M. Varvaryan of Couch Conversations Psychotherapy and Counseling in Los Angeles. Next thing you know, a couple of years have flown by. Yet there are some important reasons to not put off gyno-related exams and procedures:

Exams can help catch problems early. For instance, if there are abnormal cells on the cervix, it’s a lot easier to treat them when they are pre-cancerous versus when they’re cancerous, Minkin says.

You could have a health problem in your pelvic area, such as heavy bleeding or a polyp that requires attention. “When we’re doing exams, we want to make sure we’re not missing anything that we wouldn’t know about,” Oelschlager says.

Exams offer preventive care. For some patients, particularly those age 26 or younger, the exams offer you the chance to get the human papilloma virus vaccine. This helps to prevent health problems like vaginal or vulvar warts, or cancer on the cervix, which would require even more invasive exams.

Current guidelines from the American College of Obstetrics and Gynecology recommend a Pap smear every three years for most women. For those ages 30 to 65, an HPV test also can and should be done every five years. Both the Pap and HPV tests involve taking cells from the cervix and send them for testing. This involves the use of a speculum, a device used to open up the cervix.

A well-woman exam, recommended every year, usually includes a clinical breast exam and a pelvic exam. The pelvic exam involves looking at your vagina and feeling around the pelvic area.

So, what should you do if visiting the gynecologist makes you feel anxious?

[See: How to Prevent Pelvic Floor Problems.]

11 Tips to Cope With OB/GYN Anxiety

1. Find a provider who you like.

The right person sometimes can make all the difference for your gynecological visit. If you don’t already have a trusted provider, here are a few suggestions:

— Check who is covered by your insurance, if you have it. Read online reviews of those covered under your plan to look for positive experiences.

— Ask a friend or family member for recommendations. They will know your personality and can say if a provider they know is a good match.

— Before scheduling a physical exam with a potential provider, see if you can meet with them briefly. Some offices will schedule phone-, video- or in-person consultations so you can make sure you feel comfortable with the provider. In addition to experience, gender and location, consider other factors, such as potential treatments the provider can offer and whether you feel your concerns are validated, Varvaryan advises.

2. Bring a friend or family member with you.

You can decide if you want that person to stay in the waiting room or join you in the exam room. However, don’t be surprised if your provider wants a couple of minutes of one-to-one time with you, Minkin says. This is to give you the chance to share any sensitive information, such as domestic abuse.

3. Ask questions.

One source of anxiety about gyno exams is not knowing what will happen, Varvaryan says. If this is the source of your worry, then ask in advance about what to expect. You can ask what will happen during the visit and how long will it take. If you have a friend or family member who’s had a recent gynecological visit, ask if they are willing to talk about their experience. You can also find out if a pelvic exam is actually needed, Oelschlager says. There are many cases when a pelvic exam may not be necessary, even when seeing a gynecologist.

In addition to asking questions so you know what to expect, write down ahead of time any questions you have for the provider, Minkin suggests. If you’re nervous, it’s easy to forget what you want to ask in the moment.

4. Use these six simple words.

“Pelvic exams are hard for me.” Letting your provider know in advance that pelvic exams (or any other part of the gyno visit) is challenging can help the provider and staff tremendously, Oelschlager says. They have many ways they can try to help you relax or make the exam a little more comfortable.

What’s harder to do is to conduct an exam without knowing that someone feels anxious. If you don’t want to explain why you feel nervous — perhaps you have previous sexual trauma, for example — you don’t have to say more, Oelschlager explains. Alternately, you can give more detail regarding your anxiety if you want.

5. Realize that you have control over the exam.

The more in control you feel about the visit, the easier it should be, Varvaryan says.

“We’ll only do an exam if you are 100% on board,” Oelschlager says. If there are parts of the visit that you really don’t want to happen, let the provider know. There may be alternate ways they can examine you. If a lack of understanding your anatomy is the problem, many providers will give you a mirror so you can see what’s happening. Your provider can also explain your vaginal area anatomy, which can help you better understand your body.

[SEE: 13 Tips for a Mammogram.]

6. Relax your muscles and breathe.

It may sound like a cliche, but deep breathing really can help you relax. It also will help you relax your pelvic muscles, which makes exams easier and quicker. During more painful procedures such as intrauterine device (IUD) placement, Oelschlager and staff members will lead patients through some deep breathing techniques to help.

Sometimes, patients who have trouble relaxing their pelvic muscles will get referred to pelvic floor physical therapists. These specialists can help instruct them on relaxing those muscles.

Another tip Minkin learned early in her career: Focus on relaxing the muscles in your forehead. In fact, try it right now. When you relax the muscles in your forehead, it’s hard to keep other muscles in your body tense, including your pelvic muscles.

7. Move your legs way down.

During a gyno exam, your feet are in metal stirrups, and your legs are bent while the rest of your body is laying on the exam table. Providers say they are always asking patients to bring their bodies further down on the table. When you bring your body further down and put your behind slightly off the exam table, it makes it a lot easier for your muscles to relax. Next, try to let your knees flop apart in a relaxed way.

Other quick tips: If you’re worried about cold stirrups, wear socks. If you’re concerned about a cold speculum, ask if it can be warmed up, Minkin says. Ask for a smaller-sized speculum if that would make you feel more comfortable.

8. Find distractions.

Distractions can help you focus on something more pleasant. Ask if the provider or staff members have a few distractions they can use, be it music, games on an electronic tablet or funny videos.

Oelschlager, who sees teens and young adults, has a nurse with a farm that has baby alpacas and mini donkeys. The nurse will show videos and tell stories about the animals during challenging points of the visit. Not every nurse will have an alpaca farm, but you may be able to work with them to find something similarly amusing or distracting.

9. Address dryness in advance.

If you’re in menopause or post-menopause, vaginal dryness may make a gyno exam more uncomfortable. Ask your provider in advance if it’s OK to use an over-the-counter vaginal moisturizer to help make things more comfortable.

Not all providers will want you to use this type of product in case it interferes with any Pap smear results. Also, you may need to start using the product a couple of weeks in advance so it will work by the time of your exam, Minkin cautions.

10. Ask about medications to help manage pain and anxiety.

A routine pelvic exam may be awkward or a little uncomfortable, but it shouldn’t be painful enough to require a pain reliever, Oelschlager says.

Other procedures such as IUD removal/placement or a biopsy are typically associated with some pain. You can try using a pain reliever like ibuprofen before arriving at the office. This will ensure the medication works by the time you arrive. You also can ask in advance if the provider can prescribe a one-time dose for an anti-anxiety medication such as lorazepam or alprazolam before uncomfortable procedures, Minkin says. Just make sure you have someone who can drive you home, and make sure your primary care doctor is fine with any medications you use.

Additionally, many gynecologists can use a numbing gel around the entry of the vagina to help with pain management. Finally, if procedures like IUD placement are overly stressful, some offices will do them using light sedation, Oelschlager says.

11. Consider cognitive behavioral therapy.

Also called CBT, this approach helps you to identify unhelpful thinking patterns and gain awareness of what emotions you are experiencing around that thinking, Varvaryan says. “It’s best used when someone is willing to make changes in their thinking patterns and is open to changing their perspective about a situation,” she explains.

If anxiety about gyno visits is affecting your overall health, then counseling and CBT could be helpful.

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Tips to Reduce Exam Anxiety at the OB/GYN originally appeared on usnews.com

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