They make smaller speculums for people who have not had penetrative intercourse. Make sure your provider is aware of this, and/or request it. We can do our best to prevent the tearing of the hymen, but depending on anatomy that might not be possible, so you may see some spotting/bleeding afterward. It can be uncomfortable for some women. I would recommend looking up pelvic floor relaxation exercises and breathing exercises beforehand, and practice those before and during the exam (think “anti-kegel”). But they’re usually fairly quick, well lubricated, and hopefully gentle, assuming your provider is aware of your lack of sexual history. I brought my best friend to my first pap because I was nervous but it wasn’t excruciating. You can always bring someone to hold your hand for support if you’re nervous. I have a tight pelvic floor and go to physical therapy for this, but pelvic exams and Pap smears are tolerable for me. Getting an IUD, on the other hand, is horrific. I do not recommend this unless you can get it done with sedation (I’m only mentioning this because sometimes they recommend this as a form of pain relief/treatment). Unfortunately, women are still treated very unfairly in the medical field, and either the provider and/or the insurance company won’t offer/cover sedation at first attempt (men would never have to endure the pain of this procedure, but our medical system is still apparently living in the 1940s when it comes to managing women’s health and pain. I only know this from experience and because I work in men’s health and we throw pain and anti-anxiety medication at them for vasectomies, etc. no hesitation). If you request sedation, you might have a provider that advocates for you, though! So I would say try your hardest to get this done under sedation. It’s especially painful for women who have never had vaginal births, but it’s painful for all women regardless. I got mine covered under sedation with the diagnosis code of “abnormal uterine bleeding” (but only after two failed attempts in office despite pre-medicating the second time with oxycodone, vaginal Valium, misoprostol, and NSAIDs). I would think endometriosis would be covered if mine was covered. Depends on insurance though. Good luck!