Don’t Let it Happen to You: What You NEED to Know Before Visiting the Gynecologist
I am a grown woman. I am 23 years old. I’ve graduated from college. I pay my own rent, I have a Big-Girl job, and I do my own taxes. All signs point to the fact that I am a responsible adult and can make well-educated decisions and lead a productive life with little to fear. But why have I always been so afraid to visit the gynecologist?
Don’t get me wrong, I have visited the gynecologist at least once every year since I was 17, and several years I saw them a few times more. I only did it because I knew it was best for my health. I have never gotten over my first experience with a gynecological exam because it was truly traumatic.
In early December 2007, I was a high school senior. One night, around 12:30am, I woke up with a wrenching pain in my abdomen. I’d never been woken out of a dead sleep like that before, and gut-punching menstrual cramps were not foreign to me. I was in so much pain that tears started streaming down my cheeks from the sheer stress of it. I knew I needed to tell my parents. I couldn’t even roll over I was in so much pain, so I reached blindly for my phone and called them. They rushed from their room to mine and alternated rubbing the area that hurt, asking me how it felt, and giving me some Advil.
My dad was worried that because the pain was concentrated on my right side (though not exclusively) my appendix was going to blow and decided it was time I go to the hospital. My mom drove me and we arrived around 1:15am. Even though the Advil was starting to kick in, my core was so sore that I could barely shift my hips. They admitted me and set me up with an I.V. and fluids. In order to determine it was my appendix, they needed to prove that it wasn’t anything else, and so began the assorted tests, pokes, and prods.
After about the fourth test, it was 4:00am and my pain was still subsiding, but I was sore as hell and they hadn’t yet determined if it was my appendix. The on-call doctor double-checked my personal history and told my mom that she wanted to conduct a pelvic exam to rule out anything with my reproductive system. My mom consented, and they took me a few halls over to an exam room.
I’d never had a pelvic exam before. I didn’t even know what that was. I mean, I knew what sex was, I hadn’t done it, but I knew friends who had, but I didn’t know that a pelvic exam meant going “up there.”
The nurse who escorted me told me I could leave my panties on for the walk over. When the on-call doctor had me sit on the exam table and put my feet in the stirrups, she started laughing at me.
When I was in place the way she wanted, the doctor shoved the speculum so hard and so far inside me that she ripped my hymen. All my senses went black; there was never anything else but agony. I screamed and cried, begging her to stop, yelling “no” over and over again. But she kept going. Later, my mom told me she’d heard someone screaming; I was the only one in the E.R. that night.
When the doc finished, she pulled out the speculum and commenced a rough exam with her fingers, telling me I needed get used to this because you need these exams every year. Great, terrify me more, why don’t you?
The supervising nurse was kind to me and tried to wipe the tears from my face while she held my hand. The doctor finished and had me sit up. I sat on the very edge of my butt because I was in too much pain and too shaky to sit up all the way. The doc looked me over carefully: the tears and snot on my face, my sickened complexion, my blood-stained hospital gown. Then she lifted an eyebrow, snorted and said, “I kind of feel bad now,” and got up and left the room.
The nurse got me a new hospital gown and a pad to wear on my underwear before taking me back to my room. I collapsed in my bed and sobbed to my mother who panicked at my distress. I had to change the pad twice before I was discharged at 8:00am because the blood kept soaking them through and they didn’t want me to become infected.
After a C.T. scan a couple hours later, they determined that I had inflamed cysts on my ovaries. Not an ectopic pregnancy as the on-call doctor had thought. That doctor raped me with a speculum because she thought I was being dishonest about my sexual history. What’s more, a doctor is bound by the law to stop treatment when the patient asks. She did not stop any of the times when I begged her.
I was violated by that woman, that doctor, that person who was supposed to look out for me. The trauma still stays with me. Up until I was about 22, I cried at every gynecologist visit, no matter how kind or gentle they were to me. Every visit I could see the socks I was wearing when I was 17: mismatched with catchy stuff on the bottoms so you don’t slip, one white sock with cats and hearts, one blue sock with a smiling moon and stars. I used to love those socks. I didn’t realize how much it had affected me until I saw a therapist when I was 22 and it all erupted out of me.
I want to talk about this. I don’t want this experience to happen to any other girl or woman ever again. I want you to be prepared. I want you to demand respect from your care providers and most of all, I want you to make these visits a priority. I was violated and taken advantage of because I didn’t know my rights or what to expect.
As a disclaimer, I do not have a medical degree, I never went to medical school, and all of the information I am providing below I have obtained from my own gynecologist, the American College Obstetricians and Gyencologists, the Centers for Disease Control and Prevention, and Planned Parenthood. According to my research from these sources, this is what you need to know about going to see the gynecologist:
What is a gynecologist? Gynecology is a branch of medicine that is dedicated to the health of women, in particular, the health of their reproductive system. So, a gynecologist is a doctor who specializes in the health of women, particularly their reproductive health.
My reproductive health? You mean the health of my vagina and my uterus? Yes, but your reproductive system is so much more than those two parts. Let’s make a list: There’s the Bartholin’s glands, the cervix, the clitoris, the Fallopian tubes, the labium, the ovaries, the uterus, and, finally, the vagina.
Whoa, whoa, whoa. Hold on. What are all of these parts for? Well, above I listed them in alphabetical order, here, I will do my best to explain them in tract order from the inside of your body to the outside. Ovaries are two egg sacs in the average woman’s body that secrete estrogen and progesterone. The former being responsible for the appearance of secondary sex characteristics and maturation and maintenance of reproductive organs, while the latter prepares the uterus for pregnancy and the mammary gland for lactation; both hormones function together to promote menstrual cycle changes. Fallopian tubes are two fine tubes leading from the ovaries to the uterus, allowing the passage of egg(s). The uterus directs blood flow to the pelvis and external genitalia during sexual response and accepts a fertilized ovum when serving a reproductive function. The cervix serves as the opening between uterus and vagina and allows sperm and menstrual fluid to pass. The vagina is a cylindrical sex organ made of fibrous and muscular tissue that has functions in childbirth and sexual intercourse. The Bartholin’s glands are two glands near the opening of the vagina that secrete mucous for lubricant. The labium are the externally visible lips, and serve as protection for the clitoris and the openings of the vagina and urethra. The clitoris is the most sensitive sex organ and the primary source of sexual pleasure. The vulva, which I didn’t mention in our alphabetical list above, is the overall collection of external sex organs.
Okay, so now we’re all caught up with the biological apparatus of the average woman’s body.
Why do these parts need a specialized doctor to look after them? Your reproductive system is one of the most powerful and most vulnerable systems in your entire body. It determines your physiological sex and responds to your sexual attractions. It’s also centered around an orifice. Every orifice in your body is at risk, that’s how we get sick. The average baby is born perfectly healthy, but once they begin using their orifices, they are at greater risk for an unwanted microscopic problem to enter their bodies. We don’t touch our mouths after touching doorknobs or using the public restroom because we don’t want to bring in any dangerous germs. Stands to reason that we should have the same concerns about the opening to our reproductive system and these concerns should be managed by someone who specializes in the health and well-being of that system. You have a dentist for your mouth, you have a gynecologist for your reproductive system.
I keep hearing you say “reproductive system,” but I’m not planning to get pregnant and I’m not even sure I ever want to reproduce. Maybe so, however, the reproductive system’s name doesn’t depend on whether or not you actually reproduce. It’s name depends on the system’s abilities, and the fact that the average woman could procreate if she so chose. Whether or not you want children should not determine if you see a gynecologist. A gynecologist is responsible for the health of your reproductive system, whether or not reproduction is the goal.
You’re talking about orifices letting things in. I’m in a same-sex relationship and I’ve never had sex with penetration, do I still need to go to the gynecologist? Yes! An orifice is still an orifice. If there is a space for something to come in or something to come out, it has the potential to bring in something that is harmful, whether or not it’s sexually transmitted. It’s not about sexuality, it’s about sexual health. No matter how you do or do not choose to express yourself sexually, you are a sexual being and so this part of your health matters. And vaginal sex isn’t the only sex I’m talking about. If you’ve had oral and/or anal sex, with or without penetration, this rule still applies.
But I’ve never had sex. I don’t need to the see the gynecologist, do I? Actually, you should. Let alone whether or not you will reproduce, or have sex with penetration, it’s also not entirely about the act of having sex. Even if you aren’t having sex, problems can still arise. Abstinence (and I mean from everything: vaginal, anal, and oral), or even the fact that you might not have found the right time or person for that experience, might prevent STIs and HIV via a sexual encounter, but you can still have UTIs, yeast infections, cervical cancer, polycystic ovaries, HIV (be careful around the blood or needles of other people), etc. The list goes on an on. Remember how I said earlier that your body’s goal is to survive? That doesn’t mean it can prevent every problem from arising. When something becomes too major for your body’s immune system to handle, it will do it’s best to throw up warning signals for you to recognize and go to the doctor. Seeing a gynecologist regularly means that there is a better chance of these issues being caught early before things get out of control.
Okay, I hear you. When do I need to start going to the gynecologist and how often do I need to go after my first visit? The American College of Obstetricians and Gynecologists recommends that girls begin seeing a gynecologist between the ages of 13 and 15. They suggest that you begin going this early in life even if you aren’t having sex in order to build a relationship with your gynecologist over the years so they understand your health and what matters to you most when it comes to your health. See your gynecologist once annually. If you are a new patient, your gynecologist will talk to you in order to complete a detailed family history (of illnesses). At every visit, they will begin by weighing you and taking your blood pressure.
Other instances in which you should see your gynecologist aside from your annual visit are: if it has been three months or more since your last period; if you have stomach pain, fever, and strong smelling yellow/gray/green vaginal fluid (indicative of Pelvic Inflammatory Disease, a.k.a. P.I.D.); if you are having problems with your period such as heavy bleeding or bleeding that lasts much longer than unusual; you have not gotten your period by age 15 or within three years of your breasts starting to grow; if you’ve had your period for at least two years and it is still irregular or comes more than once per month; if you are having sex and have missed your period. You can also ask your gynecologist questions regarding cramps, acne, weight, depression, contraception, and STIs.
I’ve heard of pelvic exams and pap smears. Do I need one? It is recommended that you have your first pelvic exam and pap smear once you become sexually active (orally, vaginally, and/or anally) or at age 21, whichever comes first. After that first exam, you should see your gynecologist at least once a year. If you are sexually active, your gynecologist will recommend you be tested for STIs. If you consent, they will use the swab taken from your pap smear and run the extra screenings for STIs with that sample. These screenings can take several weeks to get the results, and your gynecologist will call you if tested positive for anything. If you do not hear anything after a few weeks go by, it is safe to assume that all of your STI tests came up clean. To be tested for HIV, you will need to request your gynecologist screen you for it and then submit to a blood test, in which your gynecologist will prick your finger for a blood sample; you can get the results within 10 minutes.
After you have had several clean exams a few years in a row, your gynecologist will often recommend that you only have a pelvic exam and pap smear once every two years, although you should continue going to visit your gynecologist once annually. If the results of your pelvic exam and pap smear come up abnormal or you are having menstrual or reproductive issues, you may need to have these exams more often than once per year.
Your care provider will also probably conduct a breast exam, where you lie back on the exam table and they lightly and strategically rub and press different parts of your breast tissue, neck, throat, and tongue with their fingertips for any signs of lumps or swollen lymph nodes. To check your breasts, your care provider is going off mostly feel and not sight, so if you would prefer they do this part of the exam with your dressing gown on, you may ask them to do so, and they should comply by leaving your dressing gown draped over your chest when conducting the exam.
What is a pelvic exam and a pap smear? Are they different? How are they performed? A pelvic exam involves the doctor visually examining your vulva and inserting a speculum in your vagina. A speculum is a metal instrument often referred to as “duck-lips” for its comical-looking apparatus; when inserted into the vagina, your gynecologist will squeeze the base of the instrument in order to widen the “duck-lips” and open your cervix for examination. Once your gynecologist removes the the speculum, they will insert two of their gloved fingers into your vagina, while placing their other hand on your pelvis, alternating between both ovaries. A pap smear takes place while the speculum is still in use. While the “duck-lips” are open, your gynecologist will insert a long Q-tip through them to take a quick swab of your open cervix and pick up some cells for screening, primarily for cervical cancer. This entire exam takes less than three minutes. I’m not going to lie to you, it can be uncomfortable the first few times, but if you have a gynecologist you trust and who really cares for your physical comfort and emotional well-being, they will be gentle and you will become accustomed to these exams. Both of these exams are performed with you lying on your back on the exam table with your feet in supportive stirrups and your buttocks inched up to the end of the table so your care provider can see.
Also, your care provider will provide you with a disposable (sometimes paper) dressing gown when you are first seated in the exam room. They may ask you to undress from your waist down before being seated on the exam table, or they may ask you to become completely naked. Either way, you have the dressing gown for modesty. When you put on the gown, wear it with the opening in the back, and it’s usually easiest to leave it untied if ties are provided. All personnel should leave the room while you are changing. They will give you plenty of time to get situated on the exam table; don’t worry about putting your feet in the provided supportive stirrups, they will instruct you when to do so during the exam. If someone tries to stay in the room while you change, demand that they leave and exit the premises as soon as you can. Also attempt to lodge an official complaint at the front desk if you feel safe enough in the environment to do so (if you want to take further action, consult local legal services for help and guidance).
How can I pay for my visits to the gynecologist? An annual visit to the gynecologist is considered a regular check-up by most insurers and it should be covered entirely under your insurance plan. If you do not have insurance, look into Planned Parenthood for their low-cost options when it comes to women’s (reproductive) healthcare. You are also allowed to pay out of pocket for a visit to the gynecologist, if needed.
Short of STIs, HIV, and cancer, how can seeing a gynecologist once a year help me in my day-to-day life? For starters, they can help you understand your body and how you can best care for it. They can also help you establish what is normal for your body, so if a problem arises you will be able to recognize it.
I’m afraid. I don’t blame you. I was afraid, too. I was afraid for a very long time. But don’t forget, your health is more important than your fear. If you are really nervous about an exam, ask a friend or family member to go with you to hold your hand. With or without someone from your personal life at the appointment, you should focus on your breathing; the deeper you breathe, the more relaxed your body will become. It might help to imagine relaxing your pelvic and vaginal muscles. Clenching won’t do anyone any good. It makes your doctor’s job harder and the exam longer. If you consciously think about releasing those muscles and think positively, your body will follow suit. Also, doing some research on different gynecologists in your area can help you make an educated decision about someone you want to be your attending doctor.
You mean I can choose my care provider? Absolutely. Google is a beautiful thing, with links to a large number of physician-reference sites. Before you begin your search, ask yourself questions about what gender you would prefer them to be if at all, how far you are willing to travel to see them, and what you are looking for in a doctor treating you at least once per year. If you have insurance, confine your search to practices that accept your insurance plan. If you do not have insurance, confine your search to Planned Parenthood or practices that provide their services on a sliding scale. Don’t be afraid to ask, either. If you find a practice or doctor that is everything you want but you can’t afford to use their services, call and ask if they make exceptions or if they can recommend a practice or a doctor who could accommodate you. Finally, to narrow your search, read as many reviews as you can find on those doctors. Make your decision from there and go with what feels right.
When I went in search of my current gynecologist, I researched for several weeks before I selected them. I knew I wanted a woman for my doctor, that just made me more comfortable. So, I began looking online for practices and doctors that accepted my insurance plan within 10 miles of where I live. I narrowed it down to three doctors and finally selected the one I see now based on her patients’ reviews. In light of my traumatic first experience with gynecology and pelvic exams, I looked specifically for someone whose patients thought they were warm, kind, gentle, easy to talk to, and trustworthy. After having my first appointment with her last month, I had the first comfortable gynecological exam in my life. It was as easy as lying on the couch. We talked about Harry Potter and my current love for “The Hunger Games.” I felt completely at ease, and it seemed like even before she started she had finished with my exam.
That is how your exams should be. Do not accept anything less from your care provider. As much as it is your responsibility to take care of your reproductive health with these annual visits, it is as much their privilege to serve you and your body. You don’t deserve to have a terrible experience or an unhealthy reproductive system.
Lastly, I am obligated to reiterate that I am not a licensed medical professional and the following is the standard disclaimer of liability pertaining to medical matters:
“The information contained in this article is for educational purposes only. This article does not and can not provide medical advice for any person which requires direct medical care. It should not be used as a substitute for medical care and advice of your physician. There may be variations on the treatment that your physician may recommend based on individual facts and circumstances. Medicine is a dynamic science and should be considered accordingly. All visitors must evaluate the information in this article for their own purposes. Never disregard professional medical advice, or delay in seeking it, because of something you have read in this article. Never rely on information in this article in place of seeking professional medical advice.”