Screening and History
Going Beyond

1. Introduction

This section is for clinicians who are comfortable with vulvar anatomy as well as reviewing cognitive behavioural therapy with patients.

For physicians who are comfortable, introducing the following strategies can help prepare your patient for the physical examination. For some patients, this may help to decrease the stress associated with the examination.

2. Preparing for Visit 2: Techniques

Self-Exam Techniques
Patients can be taught how to do their own external genital exam
  • It is an area of the body that can carry a lot of misinformation, emotion, and body response.
  • Many patients have never seen their own genitals.
The patient can lie back against a pillow against the head of the bed or on the floor with their knees bent
  • They can use one or both hands to identify and become more familiar with the parts of the vulva.
  • They can observe movement of the pelvic floor at the vaginal opening by contracting and releasing the pelvic floor muscles.
Patients can lubricate their index finger or thumb and do an external genital exam starting with the outer lips, moving to the inner lips, particularly at areas of 3, 6, and 9 o’clock of the genital area
  • They can observe whether there is any discomfort with touch as well as any thoughts or emotions that they experience before the touch.
    Cognitive behavioural therapy journaling
    • This can be done prior to and post self-assessment to get an idea of the patient’s thoughts, feelings, and body response/behaviour when engaging in self-touch in a clinical way.
    • Anticipated pain can lead to thoughts, feelings, and behaviours even before touch begins.
    • Writing about these thoughts, feelings, and physical responses can provide insights about their pain experience that are also helpful for the healthcare provider to know about before beginning the genital exam in the clinic.

    3. Follow-Up: Review Self-Examination and Journaling

    Prior to the physical exam in the physicians office, it can be very helpful to review the patient's cognitive behavioural therapy journaling with them to:

    • Better understand their general self-knowledge (i.e. anatomy)
    • Understand their thoughts, emotional responses, and behaviours as they relate to vulvar pain

    ‍Note: it is common for patients to experience anxiety and avoidance when completing the selfexam

    Why Does This Help?

    If the patient was able to do the self-exam and journaling practices at home:

    • Thoughts typically become less negative, more confident, and their stress/anxiety decreases
    • Patients can gain insight into the interactions between their thoughts, emotions, and behaviours in the context of vulvar pain
    • Patients can become more aware of the role of stress in vulvar pain
    • Can facilitate the development of patient confidence for self exams and examinations in the physician's office
    1. Introduction
    2. Preparing for physical Exam: Techniques
    3. follow up: Reviewing and Journaling