Can you be numbed for a pelvic exam?

A pelvic exam is an important part of women’s health care. It allows a doctor to visually examine a woman’s vulva, vagina, cervix, ovaries, fallopian tubes and uterus to screen for cancers, infections, and other conditions. While a pelvic exam is typically quick, it can cause anxiety for some women. Discomfort, pressure or pain may also be felt during parts of the exam. This leads many women to wonder: can you be numbed for a pelvic exam?

Table of Contents

What is a pelvic exam?

A pelvic exam consists of three main parts:

Visual examination of the vulva – the doctor looks for signs of infection, irritation, cysts or other conditions
Speculum exam – a speculum (instrument to widen the vagina) is used to view the vagina and cervix. Samples for pap smears are often collected during this part.
Bimanual exam – the doctor inserts gloved fingers into the vagina and places the other hand on the abdomen to feel the shape and size of the uterus and ovaries.

The exam typically takes less than 10 minutes. An ultrasound or other tests may also be done, depending on the reason for the visit.

Why do women find pelvic exams uncomfortable?

There are a few reasons why women may find pelvic exams uncomfortable or painful:

Insertion of the speculum can cause pressure or pinching sensations.

Movement of the speculum during the exam may cause discomfort.
Collection of a pap smear by gently scraping cells from the cervix can cause some cramping.
Having fingers inserted into the vagina and pressure applied to the abdomen in the bimanual exam may be uncomfortable.

Psychological factors like anxiety, fear of pain, embarrassment and concern over having a reaction to the exam can increase discomfort.
Women who have conditions like vaginismus, endometriosis, ovarian cysts or vaginal atrophy may have higher levels of discomfort.

While mild discomfort is common, severe pain is not and should be reported to the doctor.

Can you request numbing medication for a pelvic exam?

Yes, it is possible to request numbing medication to help ease discomfort during a pelvic exam. Here are some key points about numbing medication options:

Topical numbing medications are often used. These are creams, gels or sprays applied directly to the vaginal opening and cervix. They contain lidocaine or similar anesthetics.
Oral pain relievers like ibuprofen may also be used prior to the exam.

In some cases, injectable lidocaine may be given at the vaginal wall or cervix, but this is less common.
Requesting numbing medication in advance allows time for the anesthetic to take effect before the speculum portion.
The numbing effects last about 10-15 minutes. Reapplication may be needed if the exam is lengthy.

Numbing does not impact pap smear collection or test results.

If you are concerned about discomfort, speak to your doctor early about numbing options at your next visit. They can walk through choices and make a plan to help you feel as comfortable as possible.

What options are available for numbing medication?

The most common types of numbing medication used are:

Lidocaine gel or spray

Lidocaine is a local anesthetic that blocks pain signals. It comes in gel or liquid spray form. Options include:

Lidocaine jelly – Applied with a swab directly to the cervix 5-10 minutes prior to the exam. Lasts about 10 minutes.
Lidocaine spray – Sprayed onto the vaginal opening and cervix. Provides rapid numbing in 2-5 minutes.

Diclofenac gel

Diclofenac is an anti-inflammatory pain reliever. The gel form is rubbed on the vaginal opening about 10 minutes before the exam and lasts 30-60 minutes.

Oral pain relievers

Medications like ibuprofen or acetaminophen taken by mouth prior to the exam may help reduce prostaglandins that cause uterine cramping.

Injectable lidocaine

Injections of lidocaine directly into the vaginal wall or cervix are effective, but not commonly used. The injection itself is painful, so topical numbing is generally preferred.

Are there any risks or side effects?

Numbing medications are considered safe with minimal risks. Potential side effects include:

Mild burning, stinging or irritation where applied
Leakage of numbing gel from the vagina

Rare allergic reactions in those with lidocaine allergies

Using a small amount of gel, allowing it to absorb for 5-10 minutes before insertion of the speculum and carefully removing excess gel with a swab minimizes leakage and irritation.

Are there reasons not to use numbing medication?

Reasons numbing medication may not be recommended include:

Allergy or sensitivity to lidocaine or other numbing agents
Recent application of vaginal medication that could interact
Vaginal or cervical lesions requiring close monitoring of pain and touch sensation

Assessment for vaginal or vulvar pain conditions

Talk to your doctor if you have any of these factors to determine whether numbing medication is advised or if precautions are needed.

What else can help ease discomfort?

Along with numbing medication, other ways to help make a pelvic exam more comfortable include:

Communication

Tell your doctor if you feel any severe pain or discomfort during the exam.
Ask your doctor to explain the steps before doing them to know what to expect.
Let the doctor know if you have any sexual trauma or anxiety about the exam.

Relaxation techniques

Take slow deep breaths during the exam to relax the pelvic muscles.
Listen to calming music during the procedure.
Use mindfulness exercises to divert attention from the exam.

Proper positioning

Have an empty bladder before the exam.
Lie on your back with knees bent, feet in stirrups and buttocks at the end of the table.
Keep your shoulders and arms relaxed and supported.

Taking an over-the-counter pain medicine like ibuprofen an hour before the exam may also help.

Conclusion

It is possible to get numbing medication for a pelvic exam. Topical lidocaine gel or spray are most commonly used. This is applied to the vaginal opening and cervix several minutes prior to the speculum insertion to allow numbness. Oral pain relievers and relaxation techniques may also ease discomfort. Communicate with your doctor so they can help minimize any pain or anxiety during the exam.