Yo, Doctors: Pelvic Exams Shouldn’t Be Quickies
A few months ago I woke up in the middle of the night with intense pain on the right side of my abdomen. I then had diarrhea and threw up twice. The pain in my side was like nothing I’d ever experienced. I could barely breathe or talk. I thought my appendix had burst. My girlfriend bundled me up and took me to the ER. At the hospital, I lay on a bed contorted and vomiting until I got a morphine drip that blissfully took the pain away.
While I was there I was given a blood test, a urinalysis, and unbeknownst to me, a pregnancy test. I only learned about the pregnancy test later when my new doctor, looking at my hospital file, puzzled over why the hospital would give a lesbian a pregnancy test.
Because of my symptoms, one of the first questions I was asked at the ER was whether I was sexually active, and whether I could be pregnant. I said yes to the first question, and explained that I’m only sexually active with women (see the sexy and concerned looking woman holding my hand and getting me another vomit container?). So no, there is no chance that I’m pregnant.
I was reminded of another time at a different ER, four years earlier, when my sexual orientation also felt invisible. I was fifteen and went to the emergency room for a yeast infection. It wasn’t an emergency; I was just taken there because I didn’t have a gynecologist.
The intake woman took my vitals and asked me some questions, including “Are you sexually active?” I told her, “Yes.” I was a little excited and nervous saying it. I’d had sex with a girl for the first time a month before. Even though I was out to almost everyone at that time, I hadn’t told anyone about this sexual experience. It was exhilarating getting to finally tell someone I’d had sex. Then the woman asked, “What form of birth control do you use?”
Surprised and uncertain, I hesitated. I hadn’t expected this was the direction she was going and the presumptive way she asked about birth control made it clear she didn’t have much experience with queer people. The whole scene — sharing I was sexually active, having vaginal symptoms I felt self-conscious about and being confronted with a heterocentric nurse — was just too much. I didn’t even consider coming out to her. I still wanted to show I was sexually responsible though, so I looked her right in the eye and boldly said, “Condoms.” She wasn’t impressed. She asked if I’d had a pap smear, and when I said no, she frowned and said I should start having them regularly. It occurs to me now that I likely picked up that yeast infection from my first sexual encounter. Some lesbian safer sex tips then would have been helpful.
The ER doctor who saw me this time thought I had a UTI and a kidney stone, but wasn’t certain. He said I needed an IVP scan in a few days to see if I had a stone and told me to check in with radiology two days before my scan. I’d need to pick up a “kit,” whatever that might be, along with instructions for how to prepare.
When I arrived at radiology the next Tuesday, the woman behind the counter explained I’d have to fast the whole day before my procedure Thursday morning. She then handed me my “kit” which turned out to be three tiny pills in blister packs stapled to an index card. I had been expecting something more elaborate, along the lines of a bento box. She said I had to take the pills the same day as my fast and suggested I “might want to stay close to home.” I had no idea what she meant and thought she was just saying some friendly platitude. I started to leave, but luckily my girlfriend was there and interjected, “you mean her bowels are going to be emptied?” “Hm?” I was suddenly paying attention. The receptionist lady looked uncomfortable but nodded and offered another euphemism: the pills would “clean me out.” I now had the unsettling picture that these pills would give me uncontrollable diarrhea.
Concerned, I called my dad who is a doctor and found out it was a high dose of a common over-the-counter laxative called Dulcolax. With some trepidation I took the pills and spent the next 18 hours fasting, prepared for the sudden and violent evacuation of my entire intestinal tract. However, nothing happened. By the time I left for my IVP scan I hadn’t had any sort of bowel movement. I think it made me constipated.
Back at the hospital again, the IVP turned out to be both unpleasant and pointless. The radiology tech, Bob, was obnoxious from the start. In the waiting room he was rude to my girlfriend when I asked if she could come in with me, and he was condescending about my youth during the entire procedure.
I told him as soon as we got into the exam room that I hadn’t had a bowel movement. I knew now the whole point of my “kit” was to clear out my intestines so my urinary system would be visible. The intestines are in front of the kidneys, bladder and ureters, so fecal matter would obscure the images they were trying to get. Bob did preliminary scans and I overheard him say to his assistant that there was “a lot of fecal matter,” and implied I hadn’t done the kit properly. I told him I had taken the “kit,” it just hadn’t done anything, but he went ahead with the IVP anyway.
The procedure involved Bob positioning my body in various chiropractic-like positions. He’d then go into a little studio on the side of the room, and instruct me to hold my breath while he took the image. I can’t imagine someone being worse at this than he was. He’d leave me in a fetal position with my arm at a weird angle, fiddle around with his dials and knobs and then out of nowhere shout, “Now!” That was my cue to hold perfectly still in my hospital gown and not breathe for fifteen seconds until he came back to put me into another uncomfortable pose.
It turned out the results were practically useless, and that the technicians should have rescheduled the scan when they realized my intestines hadn’t been emptied. The only thing the scans showed was that my right ureter (the side I was having pain on) was draining more slowly than the left one. The whole point of the IVP was to confirm or rule out the possibility of a kidney stone, but the results were inconclusive. I still didn’t know what was causing my pain.
The next doctor I saw was referred to me by the hospital and had an office with gigantic biblical passages on the walls and stuffed bunnies on every surface. I wanted to leave as soon as I walked in. I wasn’t only worried about homophobia; the place felt incredibly creepy. The waiting room was deserted, the décor was from the fifties and the receptionists looked sick and depressed.
I stayed anyway; I was scared. I needed help and didn’t feel like I could leave. I’d been having to take painkillers continuously to stave off the intense abdominal pain. On the opposite coast my Jewish mother was convinced I had terminal cancer and both of my parents were angry about the incompetence of the IVP techs and the fact that I didn’t have a diagnosis yet. Also, I wasn’t positive, but I was pretty sure that I’d seen a little blood when I’d wiped my butt the previous morning.
When the doctor came into the waiting room to get me I felt momentarily relieved. She looked and spoke like a normal, educated doctor, and a little later her reaction to my sexual orientation was professional. In her office she had me lie down and applied some pressure to my abdomen. She felt a small lump that she thought might be an ovarian cyst. Then she said she wanted to do a vaginal exam and within seconds she had yanked out the stirrups on her table, fished out her antique looking speculum, told me to take off my pants and left the room.
My exam room had one tiny window that was completely blocked by at least a dozen stuffed animals. There was dollhouse wallpaper on the walls, a yellowed linoleum floor, a stack of some of the most sexist children’s books I’d ever seen (a la Barbie Teaches Her Young Sister To Distrust Her Intuition) and the speculum she’d taken out truly looked like it was some nineteenth century abortion device. She’d also taken out a generic tube of very cold, cheap, glycerin-based lube. Sugar and vaginas don’t mix.
Non-arousal and fingers being inserted into your body don’t mix either.
I know some women find pelvic exams uneventful, but they tend to make me say “ow” and “stop.” So I’ve gotten into the habit of telling my doctor beforehand that I usually find the whole procedure painful, so please go very slowly and listen to me. This doctor did neither. I wanted to get dressed and leave as soon as I saw her response to my “go slow” preamble. She made a face that was supposed to be comforting but looked deranged, and in a grotesque baby voice said she’d “use the smaller speculum and be gentle.” I didn’t trust her. One second in and I told her it hurt. Another few seconds and I told her to stop. This wasn’t right. Her technique was the dangerous nonsense medical schools seem to teach -- plunge in, turn your head away from the patient, feel around hurriedly to get the information you need, pull out.
My voice got quieter and quieter. She ignored me and kept telling me to breathe. It hurt. I kept saying it hurt, but her response was to thrust around more quickly, keep her head 90 degrees away from me, and tell me to breathe. I didn’t know what to do. I don’t know if I said stop again. I started thinking it would be over soon and if she stopped now, I’d just have to let someone else put a speculum in later. When she was finished she said it probably hurt because she was applying pressure near the cyst: I had a cyst. She made no acknowledgment of what had actually just happened to me.
I was silent as she wrote out an order for a CAT scan at the hospital. The doctor’s receptionist started firing off information: that I’d have the CAT scan the next morning at 8 am, that I needed to go to the hospital that afternoon to pick up my “prep.” I just wanted to get out of there as quickly as possible.
In a daze I went directly to the hospital. At Radiology for the third time, the receptionist handed me two huge 450 ml containers of this chalky banana flavored Barium Sulfate beverage that could have passed as semen. She said I’d have to drink all of it and fast at specific times in the next 24 hours so that my organs would be visible during the scan. I asked if it was vegan and she didn’t know. By the time I got back to the car I was crying. My girlfriend said, “We don’t have to go through with this. We can find you another doctor. You were just raped. You don’t have to follow a doctor’s orders.” I called and canceled my appointment for the CAT scan and we went home. My vagina still hurt. I took a shower, wrapped myself in a blanket and we spent the evening watching movies.
I called a bunch of gynecologists the next day. I called my local LGBT center and asked if they had any recommendations, but the only gynecologist they had in their file required a referral, which I didn’t know how to get.
I ended up getting an appointment with another OB/GYN later in the week, Dr. K. Her receptionist sounded nice and from googling her I learned that she was in her late-twenties, was from the northeast like me, had cool hair and was an “avid reader, gardener and knitter.” Good enough.
In person, I liked her. Her office was clean and modern without being too sterile, and she was smart and seemed responsible. After getting her up to date, she said she’d have to do a pelvic exam. I told her that I’d had a scary, painful, rape-like pelvic exam earlier in the week and she assured me she’d go slow and listen to me. I’d give her exam a B. She wasn’t as tuned in as a person should be when poking into someone else’s vagina and she also used crappy lube, but overall the exam was okay and during it, I basically trusted her.
When the vaginal exam was over Dr. K said she wanted to insert her finger into my anus. Earlier I had mentioned my concern about rectal bleeding and she wanted to investigate. She followed this news with a sheepish, “Sorry.” I appreciated her sensitivity to causing me pain, but her whole approach suggested she was no anal expert. She obviously couldn’t imagine inserting her finger without it being very uncomfortable.
Since my night at the ER, when I got a prescription for anti-nausea medicine that was in suppository form, my relationship with my anus had been getting better and better. For the first time in my life I was easily putting objects into my anus. It was empowering. I think anal sex is really hot, but thus far my experience has mostly been in my imagination. I hold a lot tension in my anus so anal sex hasn’t always been comfortable. Now, after hours of practice in front of a mirror, I was sliding in waxy bullet sized medicine with ease. Even though I was apprehensive, I felt more prepared to receive Dr. K’s finger then I ever would have before.
She told me to turn over on the table. As I did, I asked, “How much of your finger will you be putting in?” She paused in a way that seemed to indicate she thought it was sort of a weird question. I thought it was a perfectly reasonable question and was surprised she hadn’t given me more information since she was already lubed up and heading toward my butt. “About half,” she said. OK. She started applying pressure. I tried to relax and push out like I’d learned to do, but she was going too fast and I couldn’t relax. The fluorescent lights were harsh and she seemed to be in a rush. More pressure from her finger. She didn’t check in. I was feeling panicky but still tried to relax. She gave the instruction to bear down like I was having a bowel movement. There was a tearing feeling. In. Oh my god. It hurt. “Relax,” she said. Out. Crap! While I lay there quivering she rubbed her finger on some special paper to see if there was any blood. There wasn’t.
This is what has become obvious to me: The physician’s apparent mandate — “to complete intimate examinations as quickly and impersonally as possible” — is incompatible with avoiding pain. There’s no getting around it: putting your finger in someone’s vagina or anus is intimate. It’s absurd that doctors don’t take more time to get a patient properly prepared for a rectal or vaginal exam. Just because you’re not having a sexual relationship with your doctor doesn’t make some of the principles of healthy sexuality any less relevant: communication, education and going at the right speed.
It should not be the sole burden of the patient to ensure their physical and emotional safety.
It’s difficult to advocate for yourself when you have a frightening medical condition and are relying on “experts” for help. We look to doctors as role models for how we should relate to and protect our bodies. They are the middlemen in the absence of patients’ knowledge of their own bodies. We suppose them to be experts at increasing our health, eliminating our pain, and alleviating our fear with accurate information. But while doctors might be experts when it comes to reading x-rays, palpating fallopian tubes, and analyzing urine samples, they are not always expert at promoting healthy relations between patients and their bodies. Doctors are in an authority position and play a major role in defining the sexual ethics of a society. Their duty should be to demonstrate sex-positivity and respect for bodies.
After the examination Dr. K told me I almost certainly had a cyst on my right ovary.
She explained that normally each month ovaries grow tiny cysts to hold the eggs. The tiny cyst sac breaks open to release the egg when its mature, and then the sac is supposed to dissolve. However, sometimes the sac doesn’t dissolve, and instead grows or becomes filled with fluid, which can be extremely painful. She said it was most likely benign and would go away on its own, but explained the steps I would go through if it happened to be cancerous. The next step, Dr. K said, was to get an Ultrasound. Dr. K thought the previous doctor’s recommendation of a CAT scan was not appropriate. So, yay, I wouldn’t have to drink the 900 ml of banana Barium Sulfate that went along with it.
An ultrasound is that procedure you see in movies where they put a pad thing on a pregnant woman’s tummy and on a monitor you see the fetus. My Ultrasound would be a transvaginal ultrasound, which meant that in addition to having the thing on my tummy, a “wand” would be placed in my vagina. I asked how large “the wand” would be, and she said about the width of two fingers and it would have to stay inside me for “a while.” Oh, and beforehand I’d have to drink 40 oz of water and not pee for the hour and a half before my ultrasound.
My girlfriend had the good idea that since the doctors weren’t doing anything to make inserting the ultrasound equipment easier, I should warm up beforehand — i.e., sit around for a while with a dildo in my vagina. The morning of my ultrasound I spent an hour, half-asleep, watching Star Trek Voyager and methodically working my way up to bigger dildos. I also called the hospital and made sure I wasn’t getting Bob the radiology tech again.
We got to the hospital early and when the radiology tech came out I immediately felt thankful. She was quiet and self-possessed and smiled at my girlfriend and me. She led me back to a room that felt more like a massage therapist’s than a hospital. The lights were dim and it was nice and warm. When I was lying back I felt like I was in good hands. First she did the external part of the ultrasound, which just involved running the pad over my lubed abdomen. She turned the audio on and explained that the rhythmic sound I was hearing was blood rushing through my veins. I asked what we were seeing on the monitor and she pointed out my full bladder and uterus. She took screen shots from various angles and then after a few minutes said I could empty my bladder in the bathroom before it was time for the wand.
The wand attachment was a little slimmer than I’d expected. For most of the length it was probably under an inch in diameter; its widest point at the bulbous head was maybe an inch and a quarter. It was quite long, with a big handle grip and a coiled cord connecting it to the computer. As I was getting settled back in the chair with a sheet around my waist, I said, “Can you please go slowly? My last few gynecological exams have really hurt.”
She looked sympathetic and said, “You know, you could put it in yourself if you want,” and offered me the wand. I wanted to hug her. What sanity.
The apparatus looked sort of unwieldy though so I decided to let her put it in. She looked at me the whole time, checking in with her eyes. I’d nod and she’d go further. Once it was in, it felt, well, good. Like how having something in your vagina should feel.
The machine was set up so that she was seated right next to me. She had her wand arm sort of resting against my leg and it was very comforting. The monitor was next to my head, and she’d move the wand around slightly and then tap some keys. She said she didn’t see a cyst on either of my ovaries. Her opinion was that, from the fluid she observed in my uterus, the cyst had ruptured. She also said she wasn’t a doctor, so not to take it as the final word. When she was done taking her readings, I removed the wand myself. When I got back out to the waiting room, the first thing I said to my partner was, “I just had the best transvaginal ultrasound.”
A week later my new doctor (a grade A pelvic examiner) Dr. C confirmed that the ovarian cyst was gone. It had ruptured, as most of them do, and so that was the end of my medical saga.
My experiences are probably very common. Doctors are people, and people, to varying degrees, have similar shame and fear-filled sexual upbringings. There’s no quick solution to that. Unfortunately, comprehensive sexuality education in medical schools is still rare. Doctors’ own internalized beliefs and wounding gets passed on to their patients.
It’s tragic that doctors don’t have a greater comfort with sexuality because they’re in a position to do such good. Instead of reinforcing negative messages about sexuality, they have countless occasions to counteract them. A pelvic exam is a an opportunity for women to be supported in deciding how someone else touches her body; a rectal exam is an opportunity to make it clear that any pain is not okay; a doctor’s office should be an effortless place to be out about your sexuality. Those sorts of approaches heal trauma.