How to Make Your Pelvic Exam Not Suck
Oh, pelvic exams. Most of us hate them, but they are oh so necessary. I remember how scared and unprepared I was when I had my first one done. I thought it would be easy and that my friends were just trying to scare me with their horror stories. It turns out, my first experience was pretty horrible. Which meant that I kept putting off getting my next pelvic exam done. I was so afraid of another horrible exam, that I could not see the benefits of getting the exam done. Then I read Leah's article and became a sexual health worker. I realized when I implemented the suggestions below, my pelvic exam was no longer as horrible or as scary. Now I get a pelvic exam done every year.
If you are like me and are afraid of another horrible pelvic exam experience, I want to stress that pelvic exams do not have to be horrible. There are things that you can do and ask your doctor to do to make your annual exam more comfortable. The amazing Leah Lakshmi Piepzna-Samarasinha has graciously given me permission to post her excellent article on this subject:
How To Make Your Pelvic Exam Not Suck
I am an educator with Project Prepare, one of
a network of “gynecological teaching associations," and I have the
most amazing, well-paid job teaching med students and doctors how to
give pelvic exams that are pain-free, empowering and respectful of
women’s and trans bodies and trauma histories. Emerging from the
second wave feminist health care movement of the 70s, GTAs were
started by dedicated feminists and lezzies who were appalled at the
shitty standards of care given by most gynecologists, and the fact
that back in the day, most med students learned how to give pelvics
either on rubber models of the vagina (which can’t really say, “Ow, no,
stop,”) or (even worse) on anesthetized surgery patients in teaching
hospitals (who also are not awake women and trans people who talk back
and have needs.)
In response, GTAs teach med students and medical professionals how to
give pain-free pelvic exams in an empowering, respectful way. We are
the most crazily empowered patients these students will ever meet- I
get paid $75 an hour to be incredibly bossy, tell them they’re doing
it wrong and reward them when they’re doing right. As such, I have a
grip of tips to make your pap smear much better than the tension
ridden, gross experience it may have been in the past. Read on:
Ask your practitioner to raise the back of the exam table so you can
sit upright during your pelvic exam. Many practitioners were trained
to keep the exam table flat, so that during your exam you are flat on
your back, which makes many people feel disempowered and out of
control of what is going on. There is absolutely no medical reason to
lie on your back during the exam. Sitting up during the pelvic exam
means that you can maintain eye contact with your practitioner, making
you feel more in control and less likely to dissociate. Your abdominal
muscles will relax, and it’ll be easier for you to focus on deep
breathing and staying present.
Don’t take your clothes off and get into that freaking gown til you
have to! Some practitioners will ask you to change right away.
However, most annuals include a patient interview before it even gets
to checking out your breasts/chest and genitals. If they ask you to
change right away, ask if you’re doing the patient interview first and
politely tell them that you’ll change when you get to the physical
part of the exam. Doing the patient IV fully clothed makes you feel
more empowered. The practitioner- or you- should drape a cotton drape
over your knees just enough to make you feel like your shit is not on
display to the entire universe, but not enough to make you feel like
you’re drowning in fabric. You can hold or move the drape to where
it’s comfy for you, as long as the doc can still get a look at your
genitals.
Your practitioner should explain what s/he is doing every step of the
way and ask you to guide any internal exams (with either their finger
or a speculum) with your breath- asking you to take a deep breath,
saying, “You’ll feel my touch/ you’ll feel my inserting the speculum”,
and inserting on your exhale. They should also ask you to raise a hand
or speak up right away if anything feels uncomfortable. If they don’t,
fuck them! Don’t come back. But, make sure you say, “Hey, stop, I need
you to withdraw your finger” if anything is hurting.
Speculums can be freaky. Many people take one look at the metal
speculum and wince- it looks like something out of a Terminator movie.
Believe me, I’ve felt the same way. However, it’s just a tool- a tool
your practitioner, or you, uses to hold the walls of your
vagina/cunt/junk open so they can see your cervix. The walls of the junk stick together so you can’t just take a look and see the
cervix with the naked eye. Cervical cells are growing all the time,
and sometimes they get wonky, and the whole point of the pelvic exam
is that if you get your cervix checked out, any weird cervical cells
can be treated way, way before they turn into cervical cancer. Try
thinking of the speculum as a tool, just like a cordless drill or a
ruler or a sewing machine. Play with one if you can- demystify it.
Some folks freak less if your practitioner uses a plastic spec. They
also come in different sizes- ask for a small if you know you have a
history of painful exams. You can hell of use them at home, too. And
if fantasizing about medical fetish play gets you through your exam,
by all means, do it.
Minor discomfort during the pelvic exam (like if the practitioner is
palpating your ovary and you have a cyst, or right when they collect
the cervical cells during the pap smear) may be inevitable; severe
pain is hella not. If you are hurting bad, tell the practitioner to
STOP and withdraw their finger/spec. If you are hurting hella bad,
they can do as much of the exam as they can- which may mean palpating
your belly to feel your ovaries and uterus for any swelling and
checking out your external genitals for any swelling, discharge etc-
which is still a step towards your health.
A note about vaginismus, aka screaming intense vagina pain: Vaginismus
is a brilliant survival mechanism your body may use when you’ve had
pelvic trauma or survived abuse. In it, your vagina, which is a really
strong, intelligent and flexible muscle, literally spasms shut at the
first suggestion of any kind of penetration. I’m an incest survivor,
and I hella had vaginismus, and I couldn’t have any penetrative sex or
exams for almost a decade because of it. I got good therapy and did
what I needed to do to heal, and I walked back into being able to be
penetrated, slowly.
The vagina is a muscle, and a really smart one. Focus on being all yoga and taking deep breaths,
releasing tension with each breath and visualizing when you’re
inhaling that the deep breath is going to your genitals. It may help
to get comfortable with penetration at home first- use a small cock or
your fingers, breathe, and get used to the sensation. Check out Staci
Haines’ body exercises in Healing Sex: How To Have An Empowered Sex
Life After Abuse- they are awesome ways of changing your relationship
to your body and pelvic region, whether you’ve lived through abuse or
have an uncomfortable history with your pelvis for other reasons. I’ve
also hella fantasized about good sex I’ve had in order to relax my
pelvic muscles while on the table. Above all else, know that no matter
how conflicted, fearful or traumatic your relationship to your genital
are, it can change drastically for the better.
Give yourself a pep talk. Tell yourself that you’re doing this so you
can live, that your body is your own, that you do not want to die of a
totally preventable disease, that The Man wants you to die of cervical
cancer but fuck that, you will not let him.
Bring a friend or advocate. Make an advanced plan about what you want,
what your limits and triggers are, and why you are in the room. Think
about what you would like your friend/ advocate to do- hold your hand
during the exam? Tell you how tough and badass you are? Tell the
practitioner to knock it off with certain things?
Your practitioner should use non-yucky terminology. At Project
Prepare, we aggressively teach the students to use the words “healthy
and normal” “genitals” “insert/withdraw” during the exam, because we
DO NOT WANT any practitioners to say, “Everything looks so beautiful!”
“You’re perfect down there!” “I’m going to penetrate you!” or other
totally icky terms that are giant nos!
Ask questions: From my work's website:
Project Prepare believes that all medical examinations should be
interactive. GTAs encourage women to feel empowered to say or ask
their health care providers any of the following:
I didn't understand that. Would you explain that to me?
Why are you asking me that question?
What are you doing?
Please stop, that is painful.
Is there anything I, or you, can do to make this more comfortable for me?
Why do you have to do that procedure?
What can I do to prevent this problem in the future?
Thank you for explaining that to me.
I appreciate the extra time or care you took with me.
If you are transmasculine or butch and you are not comfortable with
the terms vagina, labia, etc being used to refer to your junk, ask
them to refer to them as “genitals” (or whatever other term you
prefer.) They should also refer to the bills of the speculum (the
longer parts that open and hold the walls of your junk apart so they
can see the cervix) as “bills” not “blades” - no one wants a sword in
their vagina.
When you are booking your exam, ask them if they use the Cytobrush for
the pap smear or the older, wet mount method- and try to go to someone
who uses the Cytobrush! In the older wet mount paps, a small amount of
cervix cells is gently scraped off your cervix, put on a slide, and
checked out for abnormalities or cancer. However, in order for it to
be a readable sample, there needs to be nothing else on the slide-
which means they can’t use lube. Fuck that! Lube, as many of you know,
makes everything easier. The Cytobrush, on the other hand, sweeps some
cells off your cervix, which are then put through a centrifuge so all
other cells (lube, blood, juice) are swept away. Cytobrush=
lube= more comfy!
Try to book your exam for right after your period is done. You can get
a pelvic any time, but right at ovulation (around 14 days into your
cycle) or when you’re PMSing you can be more sensitive and it can be
more uncomfy.
Try to find a queer/trans or feminist clinic, or a practitioner who is
listed as queer or kink approved in a directory. This does not mean
they will be great or you will love them- I hated the willowy hippie
lesbian feminist doctor who was at the queer free clinic in Toronto
ten years ago. You will have to talk to any practitioner and tell them
your needs. However, a queer/feminist clinic or practitioner is likely
to be a lot less busted than someone you pick out of the phone book.
There can definitely be good practitioners elsewhere- I loved the
brisk, warm, no-nonsense, totally non-judgmental nurse practitioner
who was my GP at my local Toronto neighborhood clinic (she’d say,
“Okay, sex? Women, men, someone else, neither? Great!) If you live in
an area with no queer or feminist clinic, try calling or emailing the
closest LGBT center and asking them if they have a referral list of
doctors- most do.
If you get a pap that is abnormal, showing dysplasia (abnormal cell
growth, which can be a precursor to cervical cancer): go to a
naturopath! Western medical science will want to give you a pap a
month and treat the dysplasia by burning it off, but won’t really have
a clue about things you can do to heal it for good. You may need
surgery, but taking herbs, supplements, quitting smoking and changing
your diet helps A LOT with dysplasia. I arrested my stage 3 dysplasia
by quitting smoking (chemicals in cigarettes show up in paps when
you’re a smoker- meaning they go straight from your American Spirit to
your cervix cells, ew) and going to a naturopath who put me on an
awesome and affordable herb and nutrition regimen to maximize my
immune system and help my cervix heal up. Other friends who’ve had the
same condition and no naturopath have had hell of reoccurrences, but
my shit is just fine. Many natuopaths offer sliding scale rates.
Buy yourself breakfast or flowers or a new leather implement
afterwards as a reward.
and most importantly: REMEMBER THAT YOU ABSOLUTELY DESERVE TO BE
TREATED WITH RESPECT, THAT PAIN FREE PELVICS ARE HELLA POSSIBLE, AND
THAT YOU ARE TOTALLY A VAG/JAM WARRIOR FOR MAKING SURE YOUR SHIT IS
HAPPY AND HEALTHY AND WILL BE AROUND ANOTHER DAY
I am an educator with Project Prepare, one of
a network of “gynecological teaching associations," and I have the
most amazing, well-paid job teaching med students and doctors how to
give pelvic exams that are pain-free, empowering and respectful of
women’s and trans bodies and trauma histories. Emerging from the
second wave feminist health care movement of the 70s, GTAs were
started by dedicated feminists and lezzies who were appalled at the
shitty standards of care given by most gynecologists, and the fact
that back in the day, most med students learned how to give pelvics
either on rubber models of the vagina (which can’t really say, “Ow, no,
stop,”) or (even worse) on anesthetized surgery patients in teaching
hospitals (who also are not awake women and trans people who talk back
and have needs.)
In response, GTAs teach med students and medical professionals how to
give pain-free pelvic exams in an empowering, respectful way. We are
the most crazily empowered patients these students will ever meet- I
get paid $75 an hour to be incredibly bossy, tell them they’re doing
it wrong and reward them when they’re doing right. As such, I have a
grip of tips to make your pap smear much better than the tension
ridden, gross experience it may have been in the past. Read on:
Ask your practitioner to raise the back of the exam table so you can
sit upright during your pelvic exam. Many practitioners were trained
to keep the exam table flat, so that during your exam you are flat on
your back, which makes many people feel disempowered and out of
control of what is going on. There is absolutely no medical reason to
lie on your back during the exam. Sitting up during the pelvic exam
means that you can maintain eye contact with your practitioner, making
you feel more in control and less likely to dissociate. Your abdominal
muscles will relax, and it’ll be easier for you to focus on deep
breathing and staying present.
Don’t take your clothes off and get into that freaking gown til you
have to! Some practitioners will ask you to change right away.
However, most annuals include a patient interview before it even gets
to checking out your breasts/chest and genitals. If they ask you to
change right away, ask if you’re doing the patient interview first and
politely tell them that you’ll change when you get to the physical
part of the exam. Doing the patient IV fully clothed makes you feel
more empowered. The practitioner- or you- should drape a cotton drape
over your knees just enough to make you feel like your shit is not on
display to the entire universe, but not enough to make you feel like
you’re drowning in fabric. You can hold or move the drape to where
it’s comfy for you, as long as the doc can still get a look at your
genitals.
Your practitioner should explain what s/he is doing every step of the
way and ask you to guide any internal exams (with either their finger
or a speculum) with your breath- asking you to take a deep breath,
saying, “You’ll feel my touch/ you’ll feel my inserting the speculum”,
and inserting on your exhale. They should also ask you to raise a hand
or speak up right away if anything feels uncomfortable. If they don’t,
fuck them! Don’t come back. But, make sure you say, “Hey, stop, I need
you to withdraw your finger” if anything is hurting.
Speculums can be freaky. Many people take one look at the metal
speculum and wince- it looks like something out of a Terminator movie.
Believe me, I’ve felt the same way. However, it’s just a tool- a tool
your practitioner, or you, uses to hold the walls of your
vagina/cunt/junk open so they can see your cervix. The walls of the junk stick together so you can’t just take a look and see the
cervix with the naked eye. Cervical cells are growing all the time,
and sometimes they get wonky, and the whole point of the pelvic exam
is that if you get your cervix checked out, any weird cervical cells
can be treated way, way before they turn into cervical cancer. Try
thinking of the speculum as a tool, just like a cordless drill or a
ruler or a sewing machine. Play with one if you can- demystify it.
Some folks freak less if your practitioner uses a plastic spec. They
also come in different sizes- ask for a small if you know you have a
history of painful exams. You can hell of use them at home, too. And
if fantasizing about medical fetish play gets you through your exam,
by all means, do it.
Minor discomfort during the pelvic exam (like if the practitioner is
palpating your ovary and you have a cyst, or right when they collect
the cervical cells during the pap smear) may be inevitable; severe
pain is hella not. If you are hurting bad, tell the practitioner to
STOP and withdraw their finger/spec. If you are hurting hella bad,
they can do as much of the exam as they can- which may mean palpating
your belly to feel your ovaries and uterus for any swelling and
checking out your external genitals for any swelling, discharge etc-
which is still a step towards your health.
A note about vaginismus, aka screaming intense vagina pain: Vaginismus
is a brilliant survival mechanism your body may use when you’ve had
pelvic trauma or survived abuse. In it, your vagina, which is a really
strong, intelligent and flexible muscle, literally spasms shut at the
first suggestion of any kind of penetration. I’m an incest survivor,
and I hella had vaginismus, and I couldn’t have any penetrative sex or
exams for almost a decade because of it. I got good therapy and did
what I needed to do to heal, and I walked back into being able to be
penetrated, slowly.
The vagina is a muscle, and a really smart one. Focus on being all yoga and taking deep breaths,
releasing tension with each breath and visualizing when you’re
inhaling that the deep breath is going to your genitals. It may help
to get comfortable with penetration at home first- use a small cock or
your fingers, breathe, and get used to the sensation. Check out Staci
Haines’ body exercises in Healing Sex: How To Have An Empowered Sex
Life After Abuse- they are awesome ways of changing your relationship
to your body and pelvic region, whether you’ve lived through abuse or
have an uncomfortable history with your pelvis for other reasons. I’ve
also hella fantasized about good sex I’ve had in order to relax my
pelvic muscles while on the table. Above all else, know that no matter
how conflicted, fearful or traumatic your relationship to your genital
are, it can change drastically for the better.
Give yourself a pep talk. Tell yourself that you’re doing this so you
can live, that your body is your own, that you do not want to die of a
totally preventable disease, that The Man wants you to die of cervical
cancer but fuck that, you will not let him.
Bring a friend or advocate. Make an advanced plan about what you want,
what your limits and triggers are, and why you are in the room. Think
about what you would like your friend/ advocate to do- hold your hand
during the exam? Tell you how tough and badass you are? Tell the
practitioner to knock it off with certain things?
Your practitioner should use non-yucky terminology. At Project
Prepare, we aggressively teach the students to use the words “healthy
and normal” “genitals” “insert/withdraw” during the exam, because we
DO NOT WANT any practitioners to say, “Everything looks so beautiful!”
“You’re perfect down there!” “I’m going to penetrate you!” or other
totally icky terms that are giant nos!
Ask questions: From my work's website:
Project Prepare believes that all medical examinations should be
interactive. GTAs encourage women to feel empowered to say or ask
their health care providers any of the following:
I didn't understand that. Would you explain that to me?
Why are you asking me that question?
What are you doing?
Please stop, that is painful.
Is there anything I, or you, can do to make this more comfortable for me?
Why do you have to do that procedure?
What can I do to prevent this problem in the future?
Thank you for explaining that to me.
I appreciate the extra time or care you took with me.
If you are transmasculine or butch and you are not comfortable with
the terms vagina, labia, etc being used to refer to your junk, ask
them to refer to them as “genitals” (or whatever other term you
prefer.) They should also refer to the bills of the speculum (the
longer parts that open and hold the walls of your junk apart so they
can see the cervix) as “bills” not “blades” - no one wants a sword in
their vagina.
When you are booking your exam, ask them if they use the Cytobrush for
the pap smear or the older, wet mount method- and try to go to someone
who uses the Cytobrush! In the older wet mount paps, a small amount of
cervix cells is gently scraped off your cervix, put on a slide, and
checked out for abnormalities or cancer. However, in order for it to
be a readable sample, there needs to be nothing else on the slide-
which means they can’t use lube. Fuck that! Lube, as many of you know,
makes everything easier. The Cytobrush, on the other hand, sweeps some
cells off your cervix, which are then put through a centrifuge so all
other cells (lube, blood, juice) are swept away. Cytobrush=
lube= more comfy!
Try to book your exam for right after your period is done. You can get
a pelvic any time, but right at ovulation (around 14 days into your
cycle) or when you’re PMSing you can be more sensitive and it can be
more uncomfy.
Try to find a queer/trans or feminist clinic, or a practitioner who is
listed as queer or kink approved in a directory. This does not mean
they will be great or you will love them- I hated the willowy hippie
lesbian feminist doctor who was at the queer free clinic in Toronto
ten years ago. You will have to talk to any practitioner and tell them
your needs. However, a queer/feminist clinic or practitioner is likely
to be a lot less busted than someone you pick out of the phone book.
There can definitely be good practitioners elsewhere- I loved the
brisk, warm, no-nonsense, totally non-judgmental nurse practitioner
who was my GP at my local Toronto neighborhood clinic (she’d say,
“Okay, sex? Women, men, someone else, neither? Great!) If you live in
an area with no queer or feminist clinic, try calling or emailing the
closest LGBT center and asking them if they have a referral list of
doctors- most do.
If you get a pap that is abnormal, showing dysplasia (abnormal cell
growth, which can be a precursor to cervical cancer): go to a
naturopath! Western medical science will want to give you a pap a
month and treat the dysplasia by burning it off, but won’t really have
a clue about things you can do to heal it for good. You may need
surgery, but taking herbs, supplements, quitting smoking and changing
your diet helps A LOT with dysplasia. I arrested my stage 3 dysplasia
by quitting smoking (chemicals in cigarettes show up in paps when
you’re a smoker- meaning they go straight from your American Spirit to
your cervix cells, ew) and going to a naturopath who put me on an
awesome and affordable herb and nutrition regimen to maximize my
immune system and help my cervix heal up. Other friends who’ve had the
same condition and no naturopath have had hell of reoccurrences, but
my shit is just fine. Many natuopaths offer sliding scale rates.
Buy yourself breakfast or flowers or a new leather implement
afterwards as a reward.
and most importantly: REMEMBER THAT YOU ABSOLUTELY DESERVE TO BE
TREATED WITH RESPECT, THAT PAIN FREE PELVICS ARE HELLA POSSIBLE, AND
THAT YOU ARE TOTALLY A VAG/JAM WARRIOR FOR MAKING SURE YOUR SHIT IS
HAPPY AND HEALTHY AND WILL BE AROUND ANOTHER DAY
3 comments:
this was a fabulous article. thanks for sharing. :)
Ellecubed says
Thank you for the comment Melita. I think pelvic exams are oh so important.
kazari says
Thank you for re-iterating that they are NOT SUPPOSED TO HURT!
I didn't know that for my first couple of pap smears, and it was brutally uncomfortable. then i got somebody who knew what they were doing and it was a major epiphany.