How long can I put off reproductive health exams?
Heather Corinna replies:
I am a 22 year old female, but I have never had a breast and pelvic exam. I know what happens (I've read your articles as well as other websites), and I'm terrified. I don't like people touching me in general (people sitting right next to me, my parents putting a hand on my shoulder), and the only person who can touch me is my long-term (over 1.5 year) boyfriend. I've discussed this fear with my doctor. I'm also a very private and am not comfortable being around others if I'm not fully clothed, even changing my shirt with my roommate in the room - another problem I have with prospect of the exam.
My boyfriend and I have recently decided we'd like to have sex, so I've gotten a prescription for the birth control pill. However, the doctor said she will not prescribe it year after year without doing a regular breast/pelvic exam; she hopes that after I've been having sex for a while I'll become more comfortable with the idea of the exam, but I'm not. I understand why I should have this exam, so I've even tried just scheduling one to force myself to do it. Unfortunately, after a few hours I began to panic and didn't calm until I cancelled the exam. There is no history of breast cancer or any sort of reproductive problem in my family, and I do a monthly breast exam on myself. How long can I safely put off the breast/pelvic exam from the doctor? My boyfriend will come with me, and the doctor said she can give me anti-anxiety medicine, but I'm still worried even if I go through with it I'll become depressed afterward (I have struggled with depression before). Even though these things would help, I'm still terrified, and I begin to panic whenever I think of it. I know I should have had an exam already, but I'd like to know how much longer I can safely delay it.
Honestly, women need some from of preventative reproductive health care. Can you live without it? Some women can, but that is a gamble, and if you look at women in nations without any, you can get an idea for how that really just isn't often healthy. Too, once you become sexually active it is vital to get that care every year. You can't accurately check yourself for cervical cancer, HIV or other sexually transmitted (or other) infections; you can't check yourself for ovarian cysts or other health problems. Even if you could, you'd not be able to treat yourself for those issues, so someone would have to take a look sometime.
Too, when people get phobic about something, that phobia tends to become worse and worse when they don't deal with it. The longer you wait, the scarier something that really isn't that scary is going to become. Getting an exam now rather than ten years from now not only safeguards your health, it makes it a lot more likely that your first exam will be a positive experience for you. That panic you're having is very likely far more intense NOT getting the exam than it would be if you just went through it, and do bear in mind that those exams only last for a very short period of time.
It sounds to me like you have a pretty amazing doc who is going to do everything in her power to make you comfortable, and that's fantastic. The anti-anxiety meds sound like a great idea to me, and I'm sure you can also talk to her about having your breast exam under your shirt rather than a gown if that makes you feel more comfortable, and having an extra blanket over you during your pelvic if you like. You might also see if she'd be willing to give you a fully-dressed walk through of an exam first: having you sit in the stirrups with your pants on, for instance. From the sounds of things, she is ready to adapt to your needs in whatever ways she can.
One other suggestion I have is that you can get yourself a speculum at any medical supply center and try a self-exam first so that you have a better idea of what to expect very viscerally. Here's a great set of instructions on how to do that if you want to try: http://www.fwhc.org/health/selfcare.htm
I'd also suggest, if you're not already, that you consider seeing someone about your more general social anxieties, like the issues with people sitting next to you, or parents touching your shoulder. That's pretty extreme anxiety, and it's bound to get in the way of more in your life than just your reproductive health. Getting a therapist to help you cope with that anxiety will not only help with this exam, but with everything else.
But for now, I'd say to just suck it up and go get that exam. If you can go to the dentist, you can do this, seriously. More waiting = more panic and worry. If you feel depressed afterwards, you feel depressed afterwards, but for most women, taking charge of their reproductive health is empowering, not depressing. Have your boyfriend or another friend agree to be around afterwards for you to provide any extra support you need, or arrange to do something right afterwards you know is a comfort for you. But I think that the positives far outweigh the possible negatives here. Getting that exam not only nets you important health benefits and protections, it also gives you a victory in dealing with this phobia, and taking care of yourself.