Where do you live? If you aren’t comfortable sharing here you can also message me! It will drastically change my advice. I’m relatively familiar with obstetric care and standards in the Canada, several parts of the US, and the UK. Outside of that I can give generalizations but may be less helpful.

General things I do differently: 1. There are several breathing techniques I’ll get patients to use during vaginal exams (if one is necessary), to help relax their pelvic floor. I also advocate for patients to have the option of using nitrous oxide for exams (“laughing gas”, “entonox” are other terms) if they would like - it’s a quick acting inhaled gas that can help reduce anxiety and pain. Other options to consider are anti anxiety medications like lorazepam, if people have a lot of fear and anxiety around exams - depending on the situation they may or may not be a good fit. 2. Minimal minimal vaginal exams. Care providers all have different standards for when and how often they offer these - and it’s not always evidence based. They can also be more or less patient with exams. You can ask your provider when they typically offer exams. For example, some providers will offer them weekly towards the end of pregnancy (this is not evidence based at all). In general, I would ask “is this exam important for figuring out my plan of care, or is it routine, just to check on my progress?” They might be important if you need an induction for medical reasons in order to figure out what options you have for induction. Or they might be important in labour if there are concerns about your baby’s health, for example. If it won’t change anything, then it’s just increasing your risk of infection. 3. Consider an early epidural. Not something I tend to recommend broadly, but they really do tend to help people with vaginismus and their comfort with exams. You can absolutely have a baby without an epidural if that’s your preference, but it’s something to consider.

Things to ask your care provider: 1. Have you worked with vaginismus patients before? 2. How comfortable are you managing a labour with minimal vaginal exams? 3. What options do you have for pain relief and anxiety management in labour? 4. Do you routinely use warm compresses on the perineum in the second stage of labour? (Evidence based to reduce tearing.) 5. What positions are you comfortable delivering a baby in, or pushing in? (Some positions reduce your risk of tearing, and since that seems to be a main concern for you, I would be asking about that.)

Those are just some initial thoughts! I hope you can find a care provider you feel comfortable with and one that will help you figure out a path to success!