Agonising smear test - any ideas why?

[Smearwegoagain]

I've had yet another scream inducing smear test which left me in tears. I'm supposed to have them every six months at the moment because of mildly abnormal results a while ago and I'm getting a bit anxious at the thought of them so put this one off for a year.

I never had a problem with them until the first one I had after I'd had DS (now 3). That one and every one since has been agony - worse than childbirth - I feel like I'm being stabbed when the speculum is moved around. It doesn't hurt when it's put in though.

I had an emergency caesarean so it can't be because anything was damaged down there during the birth. The doctor said maybe I had a sensitive vagina, possibly to do with oestrogen levels, but she said everything looked ok and it wasn't to do with me being tense.

I haven't had sex for ages so don't know if that's relevant.

Anyone else had anything similar or know what it might be?

Thanks.

[rabbitstew]

Are you having your smears done exactly mid-cycle? I find smear tests agonising if I am ovulating. I also find I get a lot of irritating comments about the amount of discharge, which prompted me to ask last time I had a smear test done why on earth women are specifically asked to come mid-cycle if large amounts of clear discharge get in the way of collecting a good sample. The GP agreed with me that the advice is frankly a bit silly and counterproductive for some people... you can get a smear test any time, although preferably not when you are bleeding. You should always give an accurate date for when your last period started, though, as this will enable the person reading the smear to get an idea as to what he or she should be seeing down the microscope...

Another possibility is that your cervix is slightly retroverted (actually, it relates to the position of the uterus, but the effect is for your cervix to be tricky to find...), resulting in the speculum banging up against your uterus, which certainly can feel pain even if your cervix shouldn't be sensitive to the speculum banging into it. I also have this, so smear tests are rarely discomfort free, but can be perfectly bearable if the smear taker does a quick internal examination prior to inserting the speculum, so as to ensure it is angled properly to find the cervix straight away, rather than heading in the wrong direction and then having to be wiggled around to make the cervix come into view.

[Smearwegoagain]

Thanks rabbit. Not quite mid-cycle this time and have had them at different times previously. Haven't had any comments about discharge either.

Not sure about the retroverted cervix but no doctor or nurse has ever mentioned this. I have always asked if they can tell me what the problem is and no one has ever been able to put it down to something they can see, so I would imagine that this isn't the case.

I'm stumped!

[reikizen]

The GP may be able to prescribe some diazapam as a one off dose pre-smear (it is quite common as a pre-op or for anxious dental patients). Don't know if that would help. Anxiety can make things much more painful than the physical nature of the procedure would imply.

[Sidge]

Hmm. Tricky one.

You may have some adhesions from your emergency section, which means when the speculum is manipulated the 'stretching' is pulling the adhesions on the 'other side' of the top of the vagina.

Could be a cause of the stabbing pains, but I'm obviously speculating.

(I know you said you haven't had sex for ages, but has sex been painful? It can be when you have adhesions.)

[Smearwegoagain]

Thanks reikizen - I forgot to say, I begged her to give me something last time I went to see her before I would agree to having another smear done! So I took diazepam, ibuprofen and paracetamol before I went this morning - it didn't make the blindest bit of difference. Still hurt like buggery.

It's not a problem with being 'tense' or 'tight' apparently, so it doesn't seem to be caused by anxiety. But yes I have become anxious about having them because I know how much it hurts. But I really think it is a physical issue. I wasn't really in the right frame of mind for a discussion with the GP this morning about why I might have a 'sensitive vagina' or what on earth would cause this. Sounds bizarre to me.

It seems to hurt when the speculum is opened and then moved.

[Smearwegoagain]

Thanks Sidge, x-posted.

Now, when I say I haven't had sex for ages, I mean AGES! Am separating from husband who refused to have sex with me from the minute I got pregnant. So haven't had actual sex since having DS to know if it's painful!

If it was adhesions from the CS where would the pain be? It feels like it's inside my vagina.

[Sidge]

Ah gotcha.

Well when you have a lower segment C-section it's the bottom part of the uterus that's cut, so I'm postulating that maybe the bottom part of your uterus which is near the cervix could be slightly scarred or have adhesions, and so be pulling when the cervix is opened and maniulated.

As I said I am only speculating, but it might be a reason. Unfortunately I can't imagine much that might help. You could try having your smear in the left lateral position next time - ie laying on your left side. It's usually good for women where the cervix is elusive or tilted but may help you as the speculum can then be manipulated in a different way which might not hurt so much.

[Smearwegoagain]

Thanks Sidge. I will ask about that next time - has got to be worth a try.

If it was because I had a 'sensitive vagina' what would cause this?

[rabbitstew]

Vaginismus? That's a sensitive vagina, anyway...

What do you mean by moving the speculum around, by the way? Surely they shouldn't need to move it around much, if they find the cervix quickly - just insert gently and then crank open? If you mean pulling it in and out and moving it around because the cervix has not immediately popped into view, then that is what tends to happen if your uterus and therefore cervix are retroverted.

Did the GP do a manual internal examination prior to inserting the speculum? If not, then she wouldn't really be in a position to tell you confidently whether or not you have a retroverted cervix/uterus. The fact that the speculum was moved about a lot once inserted implies to me your cervix didn't immediately pop into view, anyway - there shouldn't really be the need to move the speculum around much.

Whilst it is not uncommon to be born with a retroverted uterus, it is also possible for this to happen to you after childbirth, which is why some people only suffer symptoms post-childbirth. And I'm sure it is, as Sidge suggested, also possible to get pain from uterine adhesions following surgery.

[LadySanders]

i have a retroverted cervix and smear tests are always pretty unpleasant - it all gets a bit james herriot with doc/nurse trying to find the bloody thing

[rabbitstew]

Although having said that, the stabbing pains I get when my uterus is bumped into don't feel like they are inside my vagina - they do feel deeper in than that.

[Smearwegoagain]

Thanks ladies, will ask about the retroverted uterus/cervix next time.

Not sure what's going on with the speculum to be honest - it feels like it's being moved around and I assumed that's what was causing the pain. Unless it is a lengthy process to open it?

I also wondered whether there is any difference with the new plastic speculum as they always used to use a metal one back in the days when it didn't hurt...

[cabbageroses]

I have a retroverted uterus and have never had any issues with pain.

I know this won't help but- do you think that you have a low pain threshold generally?

I don't think anyone enjoys a smear- and if you are tense it will make the discomfort worse.

They don't really move the speculum- they just insert and crank it open. For most women this is slightly uncomfortable, as you aren't in a relaxed or aroused state!

[Smearwegoagain]

Hmm. There's nothing worse than people telling you it's in your head or that it shouldn't hurt. Just because you don't experience pain with something doesn't mean someone else doesn't.

I know for most women it doesn't hurt. Smears never used to hurt me at all. They weren't even slightly uncomfortable. Now it feels like (I imagine) being raped with a sharp knife. I'm not tense - that isn't the problem. There must be something going on that is causing the pain. That's why I'm trying to get to the bottom (so to speak) of what it is. If it's something that needs treating then perhaps I could get it treated and I wouldn't have this problem any more.

I don't have a low pain threshold, no. I managed a long labour with a TENS machine without any screaming. I also had an emergency CS when the epidural didn't entirely work and believe me that hurt. BUT, this pain is the worst pain I have ever felt.

[rabbitstew]

cabbageroses - what offensive comments. Whether a retroverted uterus causes pain or not has nothing to do with your pain threshold. I have had pain free smears and colposcopies, when the person taking the smear knows what they are doing. I have also had extremely painful ones. And I certainly don't have a low pain threshold. I gave birth to two children without any pain relief. It is not the law that a retroverted uterus will cause pain during sex or a smear test, it's just a fact that it does in some people - maybe that depends on the degree of retroversion and what is close to what, internally, in that particular person. It can also be exacerbated by endometriosis, which can cause a retroverted uterus in a formerly anteverted uterus. And a retroverted uterus can be caused by pelvic inflammatory disease. There are lots of reasons why your retroverted uterus and lack of pain are pretty irrelevant to people who are seeking help for pain.

[cabbageroses]

what is it that hurts?
They do use brushes now which means they have to insert the brush right into the cervical canal, rather than using a wooden spatula which used to skim the outer surface of the cervix. This does make it hurt more for me.

Do you think this might account for more pain?

I recently had an investigation in hospital which involved being cranked open for 30 minutes,and i can tell you it hurt!

I do think the plastic speculums are shorter but also have neds that "nip" a bit. It is also harder to adjust the width of them- i asked the dr if he could let it down a bit and he tried, but it was between 2 latches, IYSWIM, so he had to leave it open on the higher latch which made it more painful.

[cabbageroses]

ouch rabbit- I wasn't trying to be offensive at all- I was simply trying to say that pain is subjective and as our bodies change for all kinds of reasons, it may be that the OP is experiencing pain for a reason that is not yet clear.

[Smearwegoagain]

It is the speculum that is causing the pain - not the brush.

As soon as it is opened it is agonising. If I had to have an investigation that meant the speculum being open for 30 minutes I'd scream the place down.

I do wonder if it would be less painful with the old fashioned metal ones.

[coldtits]

Gosh, that's unusual, I'm almost ashamed to say i don't even know what she's doing down there as i get a brief chill, some tickling, then it's done!

[coldtits]

and my pain threshold is actually really low ...

[starfishmummy]

My uterus is tilted which seems to make it extra uncomfortable, but the practice nurse told me to remind her to use the long speculum (it was she who told me about the tilt) and this does make it better - not least because she doesn't have to stop and change speculums.

[PassionKiss]

Smearwegoagain, this thread caught my eye because my last smear test was absolute agony - my first since childbirth, and it never hurt at all pre-childbirth!

I don't have a low pain threshold at all - I'm well hard usually but it brought tears to my eyes! I will be dreading the next one.

[BelaLugosiinStripes]

I had this problem and it was due to having an ovarian cyst, so there really wasn't enough room for them to open the speculum properly. It also turned out that I have endometriosis - so it may well have been a combination of the two. It was exquisitely painful, to the extent I was biting my hand.

OP: as you're on follow up for low grade abnormalities, it may be helpful to know that the NHS CSP is bringing in HPV triage for low grade abns from April. Info here from the trial sites as to how it works in practice.
If you have another abn result it will get tested and if you're high risk HPV negative then you'd be back on routine recall. If it's postive then you'd be referred for colposcopic assessment.
It might be worth asking to be seen at colposcopy for your next test, as the staff should have experience with this sort of thing.

[Smearwegoagain]

PassionKiss - do you know what caused the pain in your case? Did the nurse or doctor say anything?

I know another friend who had a similar experience after having her first baby - she also had a CS so no vaginal damage that could be to blame.

Bela - thanks for the information. Sounds like a very good idea. Wouldn't be nearly so bad if I only had to have one every 3 years. Might forget how bad it is by then!

Have had colposcopy as well and I was terrified that they might have to treat me for something - not because of having cancer or anything - just because it would mean having to have the speculum in for so long!

How did you find out about the ovarian cyst? And the endometriosis? I don't have very heavy periods so I'm assuming I'd know if I had that? Hope you're ok now.

[BelaLugosiinStripes]

Re the ovarian cyst - um it was the solid lump in my abdomen that kind of gave it away eventually! The op for that was when they found the endometriosis - had no idea until then but completely explained my problems. Also the cyst turned out to be benign :)

I wonder if it is as Sidge says and related the lower uterine segment and post-cs scarring.
Fingers crossed something helpful happens next time round :)