If any penetration, including that from a transvaginal ultrasound, is unbearably painful, it’s likely you have a particular condition that’s often misdiagnosed.

• Have you never been able to have sex due to an agonizing pain that’s like no other?

• Does this even prevent you from inserting a tampon?

• Does it make an internal pelvic exam and Pap smear from your doctor impossible?

• Is the pain absent as long as there is no attempt at any penetration?

• These symptoms perfectly describe vaginismus.

The second the vaginal muscles “detect” that something’s about to make entry, they go into spasm and tighten, narrowing the vaginal entry, making penetration difficult and sometimes impossible.

As the penetration progresses, even if done with a pediatric sized swab, the sensation is that of a knife ripping into a structure full of ultra-sensitive nerve endings, and it feels as though “something” is resisting.

Vaginismus prevents sex between married couples. Women with vaginismus have been known to avoid Pap smears at all costs.

Transvaginal Ultrasound: Penetration Unbearable

When a woman with vaginismus (and more times than not, she doesn’t even know it has a name, or has been misdiagnosed) learns she needs a transvaginal ultrasound, she will panic.

She herself may be instructed to insert the transducer or “wand” into her vagina. But there’s little consolation in cases when the technician or doctor inserts.

A transvaginal ultrasound requires the patient to be awake, to respond to the technician’s instructions as far as wand insertion; so heavy sedation is out of the question.

Vaginismus is the involuntary spasming of the vaginal muscles. The key word is “involuntary.”

A woman doesn’t think, “Okay, time to tighten my vaginal muscles.” She has no conscious control over these reflexive muscles; they are not like biceps.

This involuntary spasming will occur when she or someone else attempts to insert the transvaginal ultrasound probe.

Transvaginal Ultrasound Intolerance with Vaginismus: Solutions

“If a transvaginal ultrasound is absolutely necessary such as to view the endometrial lining, then lidocaine cream can be used prior to the ultrasound if vaginal lubricant is not sufficient,” says Mylaine Riobe, MD, founder of Riobe Institute of Integrative Medicine. Dr. Riobe, who’s board certified in ob/gyn and integrative medicine, is the author of “The Answer to Cancer.”

The Riobe Method focuses on the prevention of diseases, not the prevention of death from diseases.

“Lidocaine will cause numbness of the area where it’s applied and is temporary. Effects will wear off in a few hours.

“How is this accomplished? Lidocaine can be applied with a vaginal applicator very similar to the applicators available for the use of Monistat vaginal creams.”

A laparoscopy is not an option. “Laparoscopy would not be useful to see inside the uterus,” says Dr. Riobe.

“If you’re looking for uterine fibroids, a transabdominal U/S can be done and avoid the need for transvaginal U/S.” This can also be used to look at the ovaries.

“MRI can also be used to visualize fibroids and certain types of uterine anomalies.

“A hysteroscopy can be done to visualize the inside of the uterus, but requires some form of analgesia and is more invasive than U/S.”

Kegel Exercises and More

Next, if a woman wants to go ahead with the transvaginal ultrasound, and it can wait for several weeks, she can practice Kegel exercises in preparation.

These will strengthen the vaginal muscles, making them a little less tensed up—but it won’t prevent the problem.


The action of doing Kegel exercises is actually what you’d do to stop a urine stream while sitting on a toilet.

Contract your pelvic floor muscles for three seconds.

Relax for three seconds.

Repeat 10 to 15 times a day, even when you’re seated.

A vaginal dilator kit may be an option, though some women will find this intolerable, as it involves practicing self-penetration.

Furthermore, her doctor may want the ultrasound done very soon — before “training” with the kit would make a big difference.

A really good trick to make a transvaginal ultrasound more tolerable is to get acquainted with a woman’s female anatomy.

Once you see that there is nothing “resisting” the penetration of a swab or wand, and instead it’s just an illusion created by spasming muscles compressing upon the inserted tool, you’ll be able to relax better.

Also ask the technician or doctor to narrate what she’s doing every step of the way during your transvaginal ultrasound. This will really help.

If you’re tempted to order, “Take it out!” then cover your mouth, clench your teeth, take deep breaths, whatever it takes to prevent those words from escaping your mouth.

Finally, total relaxation is a must. Let your body go limp. Tensing up from anxiety will only make the vaginal muscles angrier during a transvaginal ultrasound or Pap smear.

Dr. Riobe has helped thousands of patients overcome difficult illnesses by addressing root causes, not just masking symptoms. She has over 15 years’ experience using integrative techniques to treat diverse patients.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.