Urgent question regarding upcoming colpo

I am scheduled to undergo a colpo and endometrial biopsy; I have always overreacted to pain. I passed out after pinching my finger between grocery carts, after an in-office mole removal I had to have all others in an OR because of LBP. With each pap - especially since the new "pinch" ones, I often am dizzy, ill, and have LBP. During an HSG test I passed out with LBP and was hard to revive (amb called, 3 ammon sticks, etc.).

1. Is it possible to overstimulate the vagus nerve through the cervix/endometrium?
2. Is it possible if there is over-stimulation that I might experience the same problems as the HSG test or even worse?
3. Is there anesthesia available - under twilight or some other - that can help shut down the vagus nerve response?
4. I had a medical friend tell me that if I wasn't in neurogenic shock with the HSG test that I was close. The concept of "mild syncope" didn't add up and it wasn't just mild bradycardia. Does my response to the HSG test suggest something more than mild syncope? If so, what are the risks of undergoing a procedure that is even more invasive and sustained of the cervix?
5. Is there a specialist you can suggest that I can contact? It's pretty clear that among ob/gyns and even GPs that the idea of a "sensitive" cervix is somewhat unusual. Rather than looking at this as an ob/gyn issue is there some other way to look at this that can help shed light on the problem?

[Elaine Brown, MD]

Hi!
It is pretty well known that manipulation of the cervix and uterus can cause a vasovagal response.  Your response to the HSG sounds like a classic vasovagal response.  Usually these types of responses are worse in people who are athletically fit and have a low blood pressure anyway.
If you were my patient, I would assume that you WOULD have a vasovagal response to a colposcopy and endometrial biopsy.  I would be surprised if you didn't!!!
I would offer you two options:
The first would be an injection of atropine in the cervix pre-procedure.
The second, and my personal preference, would be to do the procedure in the OR with Anesthesia in attendence and IV sedation.  This way your blood pressure is continuously monitored as well as your heart rate, and atropine could be administered as needed for any reaction.
For the type of procedure that you are planning, a gynecologic/oncologist would be the type of specialist to see.  If your doctor is not aware that manipulation of the cervix/uterus can cause a vaso vagal response, you may want a second opinion!
Good luck!
Dr B

[pghparent]

Thank you very much for responding to my questions. I greatly appreciate your taking the time to do so.
I have two follow-on questions based on your response.
First, my procedure is being done by an ob/gyn. Should I switch to a gyn/oncologist? I've read a bit suggesting that with the atypical glandular cells it's important to have an oncologist do the types of procedures I'm scheduled for. Is this your experience or is an ob/gyn fine for now?
Second, are there dangers to the vasal vagal response you noted above besides passing out? Are there risk factors that exacerbate these dangers, if the answer to the preceding is affirmative?
Again, thank you very much - your answer is very helpful. I was able to get my ob/gyn to go for IV sedation in an OR. That's a relief at least! :-)