PAP smear without Speculum

Background:

My wife is 30 and has a Gyno appointment scheduled soon. She has not been in 5 years since her last appointment was very tough on her with a doctor that didn't understand her issue and ended up not being able to insert a speculum and fought my wife's (at the time fiancé) legs open to do a bi-manual while she was going to cry. Through later learning we now know my wife has vaginismus and after 3 years of marriage have been having sex with no issue. However, she has never let me finger her and very little outer rubbing either, but insertion for sex is now okay. This seems like more of the physiological side of vaginismus now that we have been having sex for 3 years, but a finger is still uncomfortable for her, let alone 2 and a speculum, and the thought of it going in to feel her ovaries etc. grosses her out. In the past couple weeks we have been practicing finger insertions and I let her know that I know more about Gyno exams than she may have thought. Now after 3 practices she is okay with one finger in but is still scared by the moving around and two fingers have also gone in with little to no movement, very tight.

My wife was told by a friend that to have a PAP Smear taken , which she needs to do as her GP has been asking her every year at her normal physical and she has agreed, they don't have to use a speculum, but she could ask for a "fingers only exam". I think her friend is confusing a true PAP smear with a regular bi-manual pelvic exam where she would just have her ovaries etc. felt to make sure no cysts/palpable irregularities exist (along with a breast exam) without getting smear results (which is what the GP wants to have on file).

With all that said question is this:

Is there such thing as getting a PAP smear without use of a speculum that I am unaware of?

Being female I would of thought the the only way to get a look at the cervix and take the relevant sample a speculum would need to be inserted, especially if your wife is tight or not had any children .It may also be impossible without a speculum.Maybe she should ask for a plastic speculum. I find these less intrusive as they don't seem as long as a metal one. I personally don't think they open you as wide either. Hope it goes ok.

It's possible to get a cervical sample without a speculum...but I think the biggest issue with a "blind" pap is the quality of the sample sent to the lab...a good probability of rejection...and so a repeat pap. There is a very narrow Pederson that can be used. The trade off is that a wider speculum gives a better view of the cervix. Most exams I've seen the doctor goes for the larger speculum as a matter of routine

My better half has a small introitus but generally handles a medium graves just fine in a real exam. On occasions where she is not so comfortable I've not observed much of a change either with speculum size or as far as the bimanual goes.

So I'm wondering ladies...or guys who attend - how accommodating is your gynecologist in deciding to change speculum size during an exam? And f you suffer from vaginismus how helpful are they in that respect?

Bigjoe57 it is possible to perform a Pap smear without a speculum, however as doc4u72 said it is the quality of the obtained sample as well as the skill and experience of the doctor or nurse performing the procedure so success is not guaranteed and so defeats the purpose . A poor sample would be rejected.

Bigjoe57 there is a small sized speculum designed for visualizing the cervix on virginal patients, so the wife's gynecologist could used that to both visualized and obtain the cervical sample without much discomfort. Best the best advise would be to talk to her doctor about her concerns and about her vaginismus as they may be familiar with this condition. Hope it all goes well for you both.

If her Physician is an OB/GYN they should know plenty about her condition. It IS something our specialty treats. Should they grab a larger speculum just ask for a small, or virginal, speculum. They should accommodate. And, with your wife's condition, I would say a speculumless Pap is impossible. It would take at least two fingers stretching her enough to still get a cervical view.

I think there may be a bit of anxiety here on her part that's causing all the problem. The doctor can inject her with a sedative that'll relax her but still allow subdued consciousness just before the exam and then he can conduct the pap smear in a normal fashion so he can get a good sample.