Most women I know hate pap smears. They're uncomfortable, awkward, and pretty much ruin any decent day. Before I had Crackle, I used to joke that I was the only woman on earth who didn't mind them at all. I seriously looked into becoming an educator on how to give a good one. I'd had a few bad experiences with doctors and paps - like the guy who joked about my vagina's size, the doctor who refused to allow a nurse in, against the law, and then gave me a pap that was so painful I cried for half an hour - but I was over all that. Right?
And I was. Until the pregnancy and delivery with Crackle. In BC, most family doctors don't do deliveries. They can't afford the insurance, and don't like the hours. Can't blame 'em. So the first thing a woman does is looks for a doctor or midwife. I chose a doctor. Got one whose office I could walk to. First appointment, he wants to do a pelvic. First appointment. Ew. So I agreed, because why piss off the new doctor, right? But first I asked if he'd do it in the side-lying position. He said, "We only do that for rape victims." I stared at him. He stared back. So I said, "Okay, but can we do it that way please? I find it more comfortable." Again, he says, "That's for rape victims." Now, remember, this shit-for-brains knew me for all of 10 minutes before this. So I said, "And how do you figure out who those are?" He kinda gaped at me, and said, "I mean, in immediate trauma situations." I said, "So, next day, next week, you're out of luck? Why?" He said, "Well, if you really want that..." And I did. And he agreed. And it was okay, but I'm sure he muttered something under his breath when he was doing his thing, and it has bugged me ever since. Did I smell? Did I have a dingleberry? Did I remind him of his ex? Did he disapprove of the configuration of my pubes? WHAT WAS HE MUTTERING?! Anyway, I basically let that go, but it bugged me, and it sometimes still does.
The delivery though. Jesus. Q. It was one clusterfuck after another. Most of it is a haze of pain and misery, but one thing stands out (and my husband remembers this too): A man I had never seen in my life, walked into my room, snapped on a glove, and had two fingers in my vagina before I could say hello. He said, "You're at about 4cm" and walked out. I turned to the nurse and said, "Who was that?" She said, "The doctor". I said, "Well, I was hoping it wasn't an orderly, but maybe suggest he introduce himself before jamming his fingers into a patient's vagina?" I was so calm. I don't know how I was so calm.
So that sorta ended my trust. I utterly refused to allow the doctors to do any pelvic exams during my pregnancy with Pop. And ooooh, they do NOT like that. They bullied and badgered and nagged. They pushed me past my limit a few times. One doctor refused to treat me because I wouldn't let him do a pelvic (which, btw, are unnecessary during pregnancy). A nurse said, "Oh, we'll just see about that!" when I told her no. I laughed and said, "Listen lady, unless you guys plan to hold me down and rape me with your speculum, it's not happening." She still argued. Suffice it to say, I won that argument. Another time, a lab tech informed me she needed to do a transvaginal ultrasound because "the doctor needs the head size, and I can't get it at this angle." I told her the doctor could either get it another day or do without (because I was having a c-section anyway). She literally said, "You have no choice. The doctor ordered this." I said, "Excuse me, but this is my body, and I damn well do have a choice. And I choose NO." Like the nurse, she said, "We'll see about that!" Then she stomped out. Came back a long time later, which was really shitty of her because I was on a metal table, and said, "I guess you're in luck. The doctor says you don't have to have one." I said, "That's not luck. I wasn't having it, regardless of what he said." She glared at me and said, "That's not how it works." I said, "Wanna bet?"
So after Pop, it took me... erm... 7 years to have another. 7 years. I finally did it, and it was okay-ish. I cried. He asked if I was okay - and did it nicely. So I told him everything. He said he was sorry. Fine. Then a few months later, he referred me to a specialist for something. And the specialist sprang a pelvic on me. No warning. No mention of it on the phone when they booked the appointment. No mention of it in the referral letter. Just "Okay, now go in the room, take off your pants, and sit on the table with the "blanket" (read: thin paper towel) over you. What?! So of course, I looked around frantically for wipes, trying to clean up a bit (because omg, what was he muttering?!) and then did it. And then I cried again. And this time, the doc said "What are you crying for?" and I stared at him. He said, "Well, it didn't hurt, did it?" I said no, and he said, "I didn't think so." And then he got up and left. He just fucking left me there crying. So I got dressed and I left, and there's no way I'm going back, despite the fact that I really need more testing and that the issue is still a serious issue. But the further testing is worse, more invasive, and no. I would literally rather risk death.
Why? Why? My Mom asks me, as she's been through so much shit from so many doctors I can't even begin to tell her stories. Why would I be so scared? Why would I refuse to look after myself? Is it spite? Or just pure cowardice? No. It's pretty simple: I'm so fucking angry with myself for allowing the doctors to treat me so badly, that my body is going into defence mode to protect itself now. It's like an overactive immune system. I'm so livid that I didn't protect myself before, that I'm overprotecting myself now, at the ironic risk of killing myself. Now even when I recognise the need for the tests, I can't get my body's defense system to back down enough for me to not panic. It's protecting me because it doesn't trust me. And I don't blame it. I have bowed to the authority of doctors too many times.
So here's my bullet point list of dos and don'ts for docs:
- Do NOT do a pelvic or pap the first time you meet a patient unless there are extenuating circumstances.
- Do NOT comment on the size of her vagina - small or large.
- Do NOT comment on her pubic hair or lack thereof.
- Do ask her if she's scared. If so, give her lots of time.
- Do ask if there's a way to help her be more comfortable. A real blanket would be great.
- Do put a funny poster on the ceiling.
- Do NOT assume a woman isn't an assault survivor just because she hasn't told you about it.
- Do warm the speculum.
- Do check the temperature of the speculum! (One idiot student put it on sterilize instead of warm, and burnt my labia. She did not apologise. She did yell at me for screaming.)
- Do explain what you're doing, and what she might feel. Do not use words like "minor" or "a little bit", because you really don't know how she'll feel it. What is minor to most might be incredibly painful to this patient. If you must qualify it, say, "Most people..." and "usually" or "sometimes".
- Don't mutter things under your breath and refuse to answer when she asks you to repeat it.
- If she's crying, don't assume it's because you did something she doesn't like. ASK. But be kind about it. If it hurt, that's not a shot at your technique (but you should ask yourself if it can use work). If she's suffering from old trauma, that's not about you either. Unless you're an asshole. it's not about you.
And as I'm typing, the doctor's office called again. She forgot she called here already, didn't mark it down, and called again. I reminded her that she already called this morning. She apologized and then said, "Oh, but there's no appointment!" *sigh*