The gynecological examination for women suffering from vulvodinia is often an anxious time, especially when the professional uses the speculum. “In fact, it is necessary to start from the assumption that in the context of a pathology as complex as vulvodinia, which sees a disabling chronic pain condition, even the smallest tactile stimulus, such as the one that can provoke a gynecological examination through the use of the speculum, results in increased burning and suffering,” explains Dr. Filippo Farina, a specialist in gynecology in Ferrara.
A soft approach
“While it is, of course, a good idea to always proceed with all possible precautions for a patient to feel comfortable during the visit, it is even more so in the case of a professional dealing with a woman suffering from vulvodinia,” the gynecologist continues.
“In any case, the initial approach should be modulated according to age: if one is dealing with young girls, since vulvodinia can strike even in adolescence, or with women who have not had penetrative intercourse, the visit is less problematic since one can limit oneself to external inspection of the genitals, which in itself can already offer some data on possible irritative or infectious situations that may be part of the complex picture of the causes of a multifactorial pathology such as vulvodinia.”
Requesting consent
Decidedly more complex is the situation if the patient is in menopause. “Often, in fact, the vulvodinia is superimposed at this stage of life by a condition of vulvovaginal atrophy due to the drop in estrogen, which imposes an approach that is, if possible, even more careful and delicate at the time of the visit.” In any case, it is basic that the physician always asks for consent before proceeding to the internal examination and, in agreement with the patient, decides to limit himself or herself to visual assessment only if the pain is so intense that he or she suggests postponing the internal inspection until a time when the condition is found to be improving
Explain, the first step
The sworn “enemy” of somewhat all women, but of those suffering from vulvodinia in particular, is the speculum, an instrument that is otherwise indispensable to the gynecologist for a thorough inspection of the genital area. The first step? “Prepare the patient on what the instrument you are going to use is by explaining its function, which is to allow visualization of the vaginal walls and the cervix to diagnose any pathologies affecting these areas,” explains Dr. Farina
Choosing the speculum carefully
“The key step in containing painful sensations as much as possible during the examination is to choose with particular care the speculum to be used,” the expert points out. “It is advisable to opt for a small speculum to reduce the pressure on the sensitive tissues of the vulvar vestibulum, preferably one made of plastic so as to avoid the reflex muscle contraction that occurs on contact with the metal of traditional speculums.” Good news: a new gynecological speculum could revolutionize examinations, especially for women suffering from intimate pain. Called Lilium, it is flower-shaped, made by two Dutch researchers from semi-flexible medical rubber and designed to be less painful. In preliminary tests, patients and doctors expressed a clear preference over the traditional model: more comfort, more respect for the woman’s well-being during the visit, and greater effectiveness. It will still be some time before it is produced and disseminated worldwide, but it is significant that there is increased attention and sensitivity to this aspect
Proceed gently
“Before use, it is important that the speculum be lubricated very well to limit friction and make it easier to slide,” Farina continues. “The introduction of the instrument must proceed slowly and carefully: it can be useful while performing the operation to try to distract the patient as much as possible by talking to her and inviting her to think of something pleasant. Important is the final gesture to which we often risk not paying attention: even the removal of the speculum after inspection should be done slowly and gently. But even before the technical expedients, which still remain fundamental, it is basic to create a relationship of trust with the patient by entering into a state of empathy that helps reduce anxiety even in a delicate moment like the gynecological examination,” concludes gynecologist Farina.