An unhurried, gentle approach is valued by this age group during what is often their first genital examination. The doctor should give some thought to minimizing discomfort. Choosing a warm, small speculum for the first smear is one obvious kindness. The question ‘Will it hurt?’ should alert the doctor to the possiblity that the patient may have some degree of ‘dis-ease’ with that part of the body, which may present as vaginismus. Allowing time to explore what may be behind a question like that, rather than attempting to reassure or give opinions, may allow the patient to reveal anxieties. More significant in terms of psychosexual problems is repeated procrastination or cancellation of smear appointments. All too often this type of behaviour is seen as irresponsible, when instead it should alert the doctor to the possibility that the patient may have a psychosexual problem. The young patient knows that exposure of this part of the body will expose her sexual difficulty and is fearful (consciously or unconsciously) of doing so.

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