How can I relax and be calm during my cervical smear?

[Smokering]

For the back story, read my blog posts here, here and here. Basically I had one traumatic cervical smear (technically two, one right after the other) and now I need to have another one because, despite normal test results, the nurse thought my cervix looked "funny" and I admitted to having spotting after sex two or three times, MONTHS ago. Which wasn't even "spotting" per se, more like pink-tinged cervical fluid. (I had it after the darn smear, too.)

Anyway.

I hate medical procedures. Hate them. I don't cope well. The minute I'm lying on my back or baring an arm I start to feel very small, very helpless and very victimy. All shades of empowered rationalism disappear and I start to suffer, even when not much is going on. I also have a fear of needles and a low pain tolerance. I don't look like I'm losing it - in fact, I tend to look very calm. (My midwife said she found it hard to tell when I was having contractions, even when I felt like I was screaming and flailing around - it was very surreal!) I freeze up, which tends to give people the impression I'm Doing So Well and encourages them to poke about even more.

What can I do to make this next cervical smear less horrific? It really HURT last time - not "discomfort", pain. I'm going to ask for the pre-childbirth-size spatula this time, as the nurse even admitted last time that it was too big and asked if DD had been born naturally. (Whereupon, being out of my head, I started gabbling on about prostoglandin gel before I realised she meant "vaginal or C-section". I guess I've internalised natural birth philosophies!) I tried going to my "happy place" (Disneyland, heh) and imagining a desert island, but it didn't help. I don't "do" homeopathy or Bach flower essences, and I can't take a knock-out drug because I have to walk home after the procedure. They say it's easier if you relax, but how the heck can you relax when they're shoving a - well, you know what cervical smears are like. And I seem to have a particular Thing about having foreign objects in my vagina - I hate the Diva cup and even tampons.

What can I do?

[amcal]

I think you need to talk to who ever is doing the procedure. Be honest with them. Tell them what your experience is and ask them to help you. To talk you through it. To check in with you throughout the procedure. To not do anything without explaining to you exactly what they're doing.

Also, would it help to have a nurse stand up by your head holding your hand or talking to you?

I typically do very well with medical procedures but, I had a very traumatic colposcopy a couple years back. The doctor was HORRIBLE. I left there hysterical and I'm not a hysterical person.

The next procedure I had to have (with a different doctor in a different practice) caused me tremendous anxiety. But, I explained to them what happened before and they could not have been more wonderful. They went slow, talked me through everything and a nurse stood next to me and held my hand and just talked to me. Before I knew it, it was over.

[pianojazzgirl]

You say you can't take a knock-out drug because you need to walk home, but I have taken Ativan (anti-anxiety med) before a couple of scary-to-me procedures (wisdom tooth removal and MRI of my brain), and though I was slightly "stoned" feeling I wouldn't have felt uneasy walking home afterwards (though I certainly wouldn't drive!).

Also, can someone (partner, friend, sister?) come with you to the exam?

[Smokering]

Ativan, eh? How far in advance do you have to take it? Can you get one dose over the counter? Would the doctor give it to me? Could I take it even though I'm breastfeeding?

I really don't want a support person to witness the sordid scene, but I will tell the doctor about last time (if only to vent about this bally nurse- heh). Last time she actually did tell me what was about to happen, and it made it worse - I'd rather focus on zoning out and let them do their thing as fast as possible, you know?

My sister did suggest I ask for a pediatric speculum and try a lateral position, so that might help.

[Oubliette8]

Honestly, it sounds like you're getting bullied into something you don't want to do and don't find necessary. Why not cancel and skip the whole thing? I can't see any reason to put yourself through this. It might help for you to do some research on cervical cancer screening, actual rates of cervical cancer vs the rates of false positives that lead to invasive testing, risk factors etc.

From my research, cervical cancer is comparatively rare, with just a few thousand deaths in my country (America) a year. Compared to breast or lung cancer that number is tiny. Its even behind ovarian and endometrial cancer, and when was the last time you worried about those?

Pap tests also have an astonishingly high rate of false positives, which lead to more invasive treatments like biopsies etc. IF your test came back positive, would you be able to tolerate further treatment? How would you feel if you went through with further, risky testing, only to find out you never had cancer at all?

Also, 70% of all cervical cancer is caused by HPV. First, most people clear HPV all on their own. But second, if you and your partner are monogamous and were virgins before meeting, your chances of having HPV are very low.

You should also be aware that pregnancy and childbirth can both cause changes in the cervix that lead to false positives, so its best to try and avoid testing if you are, or recently have been pregnant.

You might also want to look at screening recommendations in other developed countries. In Britain, for instance, they don't start testing until 25, and then its every 3 years, every 5 years after age 50. They explain their reasoning here- http://www.cancerscreening.nhs.uk/cervical/index.html

I let myself get talked into it once, then had a few just because I was in for other issues and it was easier to give in. After that, I educated myself, and decided that for me, when I weighed all the information, I'm just not interested in regular screening.

I'm not saying you shouldn't, or that you'll reach the same conclusion, just that I think you should look into the info and make an educated decision based on your comfort level, rather than feeling bullied into it by a nurse you dislike. Your last smear was negative, I can't imagine what she might think she might have seen that would necessitate another one so soon after a negative smear.

ETA- to answer the title question- can you request a new nurse? I find feeling comfortable with the caregiver is very important- as is having someone who will respect my decisions. You deserve to have someone who will listen to you and not push into things.

I also find it helps to give them a heads up that you have issues- mention it when you make the appointment or call ahead of time so they know to perhaps schedule a bit more time, have someone who is good with nervous patients available, etc.

I also find it helps to do it on my terms. In my case, I cant stand getting completely naked and just wearing that gown, so I request I be allowed to leave my shirt on. If I need to take it off, we do it half at a time, so I'm never more than half undressed. I've requested that the doctor meet with me before while I'm completely clothed as well. I feel safer explaining my problem and we can discuss what will happen while I have my clothes on. I find its less threatening- if they try to push something, well, they cant do it because I have my clothes on. Either we come to an agreement, or I am free to leave- which is also much easier when I am fully clothed!

You can also discuss what you would like them to do. Some women find it calming to have every step explained to them. Other women are calmer if its just done as quickly as possible. Maybe you find a certain word triggering, and you can ask it not be used. I have PTSD and explain that to them, and what will happen if I'm not ok- I'm like you, you cant tell, but I freeze inside. When they know that they tend to check in more often- How are you doing? Are you ok? etc. For me, I've found that talking through it helps keep me grounded, but I ask we NOT talk about the procedure. So we talk about the weather, or baseball or whatever instead.

I would also mention that you've had pain before. A good provider will take steps to minimize this, and will want to know if its hurting, so they can help.

[Smokering]

I'm totally being bullied into it, but I suspect if I don't go the bally woman will keep ringing. I do plan to talk to the doctor (a woman, nice, I've seen her before) and tell her I'm there under duress. Hopefully she'll agree that a second exam isn't necessary, and if nothing else I can at least voice my annoyance at the nurse for being so unbelievably pushy.

I like the idea of talking about non-medical things throughout the procedure. I might try that - although I remember once, years ago, a nurse asked me about the colour of my bridesmaids' dresses during a blood test, and I went "um" for five minutes trying to remember. I'm not at my most lucid when being deprived of bodily fluids.

Cervical cancer is supposed to be the 5th most common in NZ. DH did have one partner before me (damn him!), otherwise I'd totally decline the procedure. If thisone comes back clear I'm definitely not doing next year's, anyway - the only reason they have the first two a year apart is in case of false negatives, and the chances of having two false negs is rather remote. That, and I'd rather be forced to watch The Phantom Menace for 48 hours straight.

[pianojazzgirl]

Originally Posted by Smokering

Ativan, eh? How far in advance do you have to take it? Can you get one dose over the counter? Would the doctor give it to me? Could I take it even though I'm breastfeeding?

I don't think you could get Ativan over the counter, at least you couldn't here in Canada. My dr prescribed me 5 pills when I had the MRI coming up (though you only take 1-2 pills at a time). It worked so well to relax me during the MRI that I took it again for the wisdom tooth extraction. You would have to have it prescribed ahead of time and then take it 45 mins to an hour before the procedure. I took 2 mg (2 pills) though for some 1 mg might be enough (I was VERY nervous about the MRI and needed the stronger does to chill me out). My dr suggested that a couple of evenings before the MRI I take one pill to test it out to see if it seemed like a strong enough dose.

Is it safe for breastfeeding? Well, I was breastfeeding my ds when I took it, but at that point (he was almost 2.5 yrs old) he wasn't nursing very often so it was out of my system by the time he nursed again. That said I did do a little research into it and it seems like it is ok to take while nursing. I suggest doing a quick search on kellymom.com so you can read for yourself.

[Marnica]

I don't "do" homeopathy or Bach flower essences

Just wondering about this. You don't do them because you've tried them in a similar circumstance and they are not effective or you have never tried them and don't think they work?

I have taken drugs (like ativan and other benzos) and find homeoptahy and rescue remedy to be far more effective (and safer!) in calming me when I have anxiety. I too LOATHE medical procedures and get very anxious/nervous.

[Smokering]

Well, it's over. It was actually a lot less traumatic than I expected. The doctor was lovely, and when I requested a smaller speculum she said "I'll find you a TINY speculum!" and bounded away and got one - she wasn't taking swabs or anything, just looking at my cervix, so it wasn't quite as invasive. AND she found my cervix right away instead of yanking the speculum this way and that.

Apparently the Nurse of Doom from the other day damaged my cervix by all her fossicking about, which is why it appeared red/irritated when she finally found it. In normal circumstances, ie. yesterday, it is a fine and upstanding cervix and doesn't look suspicious at all.

Hmph.

She gave me her card and tactfully told me to ask for her next year, not one of the nurses.

Marnica: I have objections to the science of homeopathy etc, though I've heard enough anecdotal evidence to make me willing to believe that something works - be it placebo or some mechanism we haven't yet discovered. I don't believe it can work for the reasons stated, though, and that sort of puts me off the whole enterprise. My midwife did give me some Labor Aid when I was in labour and too feeble to resist; she then gave me 500ml of fluids intravenously. Afterwards, she was all "I love how you perked up after the Labor Aid!" and I was like "Yeah, OK, or the fact I wasn't dehydrated any more", and we were both happy. I'm not utterly "against" them, but it goes against the grain to pay money for a product with no active ingredient in it. I may well come to it one day, though. Anyway, yesterday I didn't get around to taking anything beforehand and the procedure was pretty quick and way less painful than last time. So, yay. I do hope to do Hypnobabies with my next birth though, partly so I can use it in situations of medical angst!

[pianojazzgirl]

Yay - glad it is over and wasn't too bad this time!

FWIW my first thought on reading your OP was "hypnobabies" (I used it with ds), but I didn't suggest it cause of course you wouldn't have time to do the program before your appointment!

[Marnica]

Originally Posted by Smokering

Well, it's over. It was actually a lot less traumatic than I expected. The doctor was lovely, and when I requested a smaller speculum she said "I'll find you a TINY speculum!" and bounded away and got one - she wasn't taking swabs or anything, just looking at my cervix, so it wasn't quite as invasive. AND she found my cervix right away instead of yanking the speculum this way and that.

Apparently the Nurse of Doom from the other day damaged my cervix by all her fossicking about, which is why it appeared red/irritated when she finally found it. In normal circumstances, ie. yesterday, it is a fine and upstanding cervix and doesn't look suspicious at all.

Hmph.

She gave me her card and tactfully told me to ask for her next year, not one of the nurses.

Marnica: I have objections to the science of homeopathy etc, though I've heard enough anecdotal evidence to make me willing to believe that something works - be it placebo or some mechanism we haven't yet discovered. I don't believe it can work for the reasons stated, though, and that sort of puts me off the whole enterprise. My midwife did give me some Labor Aid when I was in labour and too feeble to resist; she then gave me 500ml of fluids intravenously. Afterwards, she was all "I love how you perked up after the Labor Aid!" and I was like "Yeah, OK, or the fact I wasn't dehydrated any more", and we were both happy. I'm not utterly "against" them, but it goes against the grain to pay money for a product with no active ingredient in it. I may well come to it one day, though. Anyway, yesterday I didn't get around to taking anything beforehand and the procedure was pretty quick and way less painful than last time. So, yay. I do hope to do Hypnobabies with my next birth though, partly so I can use it in situations of medical angst!

I'm glad you didn't have a bad experience. Just want to clarify that there are active ingredients in homeopathics. They are just not pharmaceutical in nature. They originate from mineral, plant or animal. Homeopathic active ingredients attempt to stimulate a physiological reaction of the body's healing mechanisms.

[Smokering]

I was under the impression that homeopathics were diluted so severely that the fnal product contained no discernable traces of the active ingredients. Is that wrong? I read something comparing the dilution to a teaspoon in the Pacific Ocean (or was it a drop? Some tiny amount). It's not something I've studied hugely, though.

pianojazzgirl: How effective did you find Hypnobabies during labour? I'm fascinated by it - in fact, I might just pop over to Birth and Beyond to ask about it. If it really genuinely zoned me out, I might even be able to donate blood one day!