Your vagina is NOT a crystal ball. OR: What your doctor really can't tell just by looking.

MMkay, so I'm 21, being doing all the right things with yearly exams, getting the tests I need, etc. I just read an article about how the vagina does not substantially change after intercourse, but the first time I had a pelvic exam my doctor said "you're lucky you're getting this done here, a lot of college clinics don't have virgin equipment." What? If there's no substantial change (which I am FAR more inclined to believe) then this makes absolutely no sense. I would ask what she meant, but her practice has moved and I see a different doctor now. UNRELATED question that I always wanted to ask her but was too afraid to- I was sexually abused when I was little, and raped when I was 16. That for me also confuses the whole issue of what she said- first of all, I wasn't a virgin, and secondly, (my real question) how was it possible she thought I was a virgin, as my guess would be there would also be some kind of signs of past trauma? As a note, I'm in counseling and doing pretty well but I'm scared to ask because of the oh-man-if-my-doctor-was-right-then-maybe-I'm-overreacting/wrong problem... I'm usually pretty good at trusting myself on this issue, but this is one place I'm always afraid to go because it would be so concrete. (I also just moved for grad school and am seeing someone new and feel comfortable, but I will make a point to ask her too.)
CJ replies:

Dear Scarleteener, congratulations on being such an active participant in your own health care, and for doing your best to take care of both your physical and emotional well-being. That can be hard to do, particularly when life and school get crazy (as they tend to). I'm hoping that the gynecologist you see now is someone who makes you feel more comfortable, and with whom you are can openly discuss your sexual health and related questions.

Let's give your previous doctor the benefit of the doubt (which she may or may not deserve) and say that she was just trying to break the ice a little bit, make a joke that would help you feel more comfortable or less awkward before your exam. OK, benefit of doubt given. To be honest, I think she missed the mark pretty hardcore with that comment. Sure, maybe that visit to the gynecologist was memorable, but certainly not for the comfort you felt, care you received, or the rapport you had with your doctor. That said, there is no such thing as "virgin equipment". There are different sized specula (that's sort of a funny plural for speculum, but there you have it) that can be used for different sized genitals, but genital size or tone is not 100% correlated to what you have or have not done sexually. People are diverse. Bodies are diverse. Vulvas and vaginas and clitorises are delightfully diverse, too.

There is a lot of sexual mythology, as well as history tied up in the concept of the word "virgin". If you're up for an interesting little lesson about that, please click on over to the article Magical Cups, Bloody Brides: Virginity in Context to check it out. We like to toss around the word "virgin" and the idea of virginity as if we all know exactly what it means, but people have vastly different ideas about definitions. Some folks will say that being a virgin means you haven't ever had vaginal intercourse...but what about someone who has not had that type of intercourse but has plenty of oral sex and some anal sex? Are they still a virgin? What about a woman who is only attracted to people with vaginas and does not have that type of intercourse but engages in other sexual activities? What about queer, cisgender men who are partners, neither of whom have a vagina and yet they still have sex. What, as you brought up, would this concept of virginity say about people who have experienced rape or other coerced/forced sexual activity but have not chosen to have whatever kind of sex because they wanted to? The concept of virginity is pretty loaded, and leaves a lot of questions unanswered.

You get to decide, personally, whether you feel that experiencing sexual assault puts you into the not-a-virgin category, based on how you define it. It sounds from your question as if you believe that because you were assaulted, you were no longer a virgin (and, thus, how could your doctor think that you are?). That is ok if you want to believe that--we each form our own sexual values and definitions--but another thought to consider, if you're still working through this in your head, is that sexual assault is not actually about sex; it is about power and control. So some sexual assault survivors will decide that since their assault was not really about sex, it did not impact their self-definition of virgin or virginity (if they identified with that term prior to being assaulted).

Indeed, virginity is more a cultural and socially-constructed concept than a medical concept.

So what, then, inspired your doctor's comment? I'm not really sure. But I highly doubt that it helped open up communication lines. Being able to have open and honest discussions with your doctor about your sexual history is hugely important. First of all, sexuality is an integral part of our overall health and well-being, on physical and emotional levels. Although doctors, nurse practitioners, physician assistants, and other medical professionals almost invariably do not get enough training about sexuality and sexual health issues, they absolutely need to be able to have those conversations with patients, and we also need to get used to the idea that it's ok to ask--and ok to tell--about sexuality, sexual behavior, and sexual concerns with our providers.

Knowing whether or not someone is a "virgin"--by whatever definition you and your provider are using--is less important, in my mind, than knowing what sexual risks you've had. In other words, what have you been doing, with whom, with which body parts, and which fluids were involved. Not a terribly glamorous way of asking, but really that is what it comes down to. As patients and advocates for our own health and care, it's important to feel comfortable enough with your provider so that you can tell him or her about your whole sexual history, including things that were consensual and non-consensual. Your doctor can help welcome your stories and experiences by asking open-ended questions and not assuming that he or she knows what you might be into sexually, or knows what you've experienced just based on the way you look, how old you are, or how you're dressed. Your provider can also show that he or she is open to listening to you by explaining why he or she is asking the questions that he or she is asking about your sexual history.

(As an aside, if you are a young person who has never engaged in intercourse, oral sex, anal sex, or manual sex (fingering) and you do not have any concerns or issues around your period, there is a chance that your clinician might not even need to do an exam with a speculum at all. That is just one more reason to have open dialog with your provider about our reasons for coming in, as well as all of the sexual activities you've engaged in, so that he or she can assess what type of exam will best suit your needs and care for your health!)

Knowing this information helps your provider provide you with the best possible care. Of course this means physical care, like knowing what STIs you might have been at higher risk for contracting given your experiences, but I think that it also means providing you with the best emotional care that is possible. For someone who has experienced sexual assault in the past, even going to the gynecologist can feel scary. Certainly that is not the experience for everyone or every survivor of sexual violence, but some can find even annual exams to be threatening, overwhelming, or even retraumatizing. If you are comfortable in sharing your history with your clinician, then the clinician can help assure that he or she is making you as comfortable as possible during the exam, helping calm any anxiety or avoiding triggers for you.

But your clinician cannot necessarily know any of these things about you without having these important conversations with you.

Your vulva and vagina are not like a mystical crystal ball; one gaze upon them and a doctor does not know your complete past. Depending on how recently you were assaulted, and the nature of the assault, there may be trauma evident to your doctor upon examination...but your doctor will not necessarily know how that trauma came to happen. It's important to note that if you were assaulted, there may also NOT be evidence that is noticeable upon visual examination, which is why it's important to be open with your clinician about your assault if you are concerned about trauma or potential sexual health risks. When sexual assault survivors choose to have a specialized exam done after they are assaulted (typically done in an Emergency Department, often by specially trained doctors or nurses), different methods are used to examine you and check more carefully for any and all trauma that may be present. Not all signs of trauma will be immediately visible to the naked eye, and not all types of trauma will remain visible for that long.

I'm of the mind that while conversations with doctors can sometimes be challenging or feel a little awkward until you and your doctor have built a strong relationship, it's always easier to have them before your feet are in those stirrups and your doctor is physically doing your exam. You're in a pretty vulnerable position when you are mid-exam, so I can understand that you might not feel that right then is the moment to ask a question that has been on your mind or you've been worried about.

Your doctor cannot tell just by looking at you, or looking at your vulva and vagina, whether or not you are a virgin. He or she, under most circumstances, cannot tell just by examining you that you have been sexually assaulted. Perhaps most importantly, your doctor absolutely cannot tell just by looking at you or examining you how to best help YOU take care of your sexual health, or what information you came through that door hoping to get from them.

Communication is a two-way street, for sure. We need our medical providers to have the language and skills to speak with us about sex and sexuality, and we need to muster the energy to speak about our experiences so that our providers can be the most helpful to us. While it does not sound like your first gynecologist was a good fit for you, I'm hoping that the person you are seeing now provides a more open environment for you and you feel more comfortable asking questions of her or him. You should never feel silly coming to your provider with a might be hard to believe, but I promise that they've likely had that question before and they'll probably get it again. It is your body and so you have every right to ask the questions you want to ask. If you feel totally shut down by your provider and don't think that you can freely ask questions, I would say that's a definite sign that you may want to consider switching providers.

You mentioned that you usually trust your instincts, and from what you've written it seems like your instincts are pretty solid. You're obviously intelligent, thoughtful, and you care about your health and well-being. I think it's high time that you found a provider who cares about you in that same way, and who will meet your thoughtfulness and inquisitive nature with some accurate information that will help you to build your knowledge about your body, how it functions, and how you can be happy and healthy as a sexual being. If you've not yet found that provider, perhaps you can ask friends if any of them have gynecologists they particularly like, or you could try the local Planned Parenthood or women's health practice in your town to find someone who is a better fit for you!

Here is some additional reading that might be helpful and interesting for you to check out:

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