A few months ago, I wrote about my first (attempted) Pap smear after sexual assault. In short, an already difficult experience was made worse by a GP’s refusal to honor promised accommodations.
Because I am in a low-risk category, I can opt out of Pap smears altogether. In fact, one GP in the UK has written about her reasons for doing so (actually, screening in general). Her argument boils down to:
- Screening tests everyone
- Not everyone is equally at risk
- Tests are faulty
- False positives result in unnecessary additional treatment, which comes with side effects
- Even when accurate, many tests can’t distinguish between harmless abnormalities and actual cancer risk
For me, though, Pap smears mean taking back control of my life, not limiting medical risk. I was told that I couldn’t/shouldn’t have them by someone I thought I trusted, and I complied. Just as I complied with the loss of freedom, meaningful employment, friends, and everything else that was taken away from me. I let someone else make decisions for me. I thought she truly had my best interest at heart.
I’m fortunate enough to now receive care from a doctor who specializes in psychosexual health. (I didn’t even know there was such a thing!) For a month before the first appointment, I literally made myself sick with worry. I couldn’t sleep, couldn’t eat, couldn’t work, and couldn’t do anything besides take my puppy for endless walks.
If the gynecologist’s job was to help me overcome sexual trauma to have a Pap smear, wouldn’t she (reasonably) expect me to talk about it? Just the thought of talking about it kept me awake at night.
One (accidental) mention of the traumatic incident (in a different context) rendered me almost completely non-functioning for over a week. I spent each day looking at the time and calculating how many minutes and hours were left until I could safely go home with the possibility of going to sleep. As long as I stayed outside, and as long as I kept walking with my puppy, I could dull the fears to a constant, painful ache. At home, the terror consumed me.
It’s been a relentless cycle of mutually exclusive, competing demands.
- I don’t have to have a Pap smear. I’m about as low-risk as possible.
- I was told I couldn’t have one. If I don’t, I let her win.
- A man made me terrified to let anyone touch me. As long as I can’t have a Pap smear, he wins.
- I can’t let anyone touch me. Pap smears involve touch.
- A doctor’s touch is clinical, so it can’t hurt me. But the doctor who attempted the exam (five times, without consent) did hurt me.
My brain doesn’t know where to settle, so it spins constantly. I want the power to have a Pap smear, but I’m terrified of the actual exam.
I’ve been put in a position of helplessness, powerlessness, dependency, and vulnerability. So, the way to take power back…is to lie flat on my back, half-naked, with a stranger inspecting my genitals?
But that’s not quite it, though.
It’s about choice.
My body, my life, my rules.
I’ve been incredibly lucky in this gynecologist. (Full disclosure: I’d never visited a gynecologist before. So I, honestly, expected the worst.) I’m very appreciative of the NHS providing services like this, as I hadn’t known they existed.
I walked into my first appointment expecting a cursory interrogation followed by instructions to strip for the exam. Instead, almost immediately I was promised “no touching” and “talking only.”
That one promise changed the entire experience from nightmare into an embarrassing but tolerable medical experience.
I answered lots of questions, including ones that didn’t seem relevant. It helped, though, because questions about the sexual assault were also brief and matter-of-fact. I’d been afraid I couldn’t talk about it, or that being pressured to talk about it would precipitate another weeks-long crisis.
Instead, we ended with the decision to make another appointment.
The next one was even better. I knew what to expect, and (again) was able to say I couldn’t tolerate any touching. In fact, the response was, “Actually, I wasn’t sure you were ready for an exam yet.” (Not the real thing, obviously, but a teeny-tiny step in a pretend exam.)
What an amazing experience!
I’m not saying I’m ready for the exam, or I expect/hope to be any time soon. But just being able to go into a doctor’s office, state my personal boundaries/limits for the visit, and to have them respected…most importantly, to still be able to receive medical care…wow!
This is why the Pap smear is important to me.
If I’d never been told I shouldn’t/couldn’t do it, and if my power had never been taken away, I wouldn’t care one way or the other. I’d put it off because it’s embarrassing and unpleasant, but I’d probably get it done because small preventative steps can save a lot of expensive medical bills later on.
But I was, and it was, so I need this. I need to be able to visit a medical professional, discuss my care, and find a reasonable solution that will respect my limitations while still accomplishing the objective.
The second visit hit on my favorite coping strategy–intellectualization. If I can transform an experience into a chance to learn something new, I can cope. As long as I’m able to learn, fears stay manageable.
And learn I did! I’ve spent a great deal of time, since the visit, looking up information, articles, and videos online. Some very kind and patient medical friends have answered questions, and I’ve gotten to feel a tiny bit like a medical student.
Want to know what I’ve learned? These points helped me, so maybe they will help you as well.
+ Contrary to popular belief/practice, you don’t have to be naked below the waist. Wearing a long, loose skirt is a great way to feel less exposed, and it doesn’t interfere with the exam.
+ A great deal of pain/discomfort/exam failure (i.e., having to make multiple attempts) stems from improper speculum technique. Since the speculum is straight and the vagina is not, inserting it the wrong way can result in both pain and failure to find the cervix.
+ Using a larger speculum is not always necessary if the first attempt fails. (This was the cause of huge distress for me, as the GP insisted on switching to a bigger speculum without giving me a chance to process the increased emotional panic.) If you get the wrong angle, a bigger instrument won’t help.
+ You insert the speculum sideways and rotate it after it’s inserted. Why? That reduces the risk of pinching skin tissue on the way in.
+ You do not need a longer/bigger speculum if the patient lies on her side, contrary to what my GP tried to tell me. It’s slightly more fiddly for the examiner, but the process remains the same.
+ It’s possible to insert the speculum yourself, similar to inserting a tampon. You don’t have to lie on your back to do this.
+ It may be possible to use water-based lubricant on the speculum (to make insertion easier), depending on the criteria of the lab. Some places say no lubricant at all, but some will allow as long as it’s not oil-based.
For me, the biggest epiphany surrounded pain. Yes, of course pain is increased when we’re tense, but that wasn’t enough explanation. Since “just relax!” has been a favorite way to dismiss my real concerns about most things in life (including situations with training my puppy), it didn’t help to know that I should relax.
Here’s what did help:
As nerdy as it sounds, taking a little model of the female reproductive organs and showing the angled pathway the speculum has to enter. Recognizing that a Pap smear doesn’t have to hurt if it’s conducted properly.
Discussing techniques for using a speculum.
And discussing why opening it hurts so much. If it’s not in the correct location, and sometimes even if it is, it can pinch tissue. The blades of the speculum open to push the vagina walls (sorry, my non-technical term) outward to give room for swabbing the cervix.
It works on the principle of holding your eyelids open so an optometrist can examine your pupils. It’s awkward and uncomfortable, and it forces your body into a position that doesn’t feel right.
Only it’s a lot less scary when thinking about eyes instead of a cervix!
I learned, also, that the pain of a Pap smear isn’t necessarily a bad thing.
The vagina has a circular, strong muscle that contracts in response to fear.
If you’re scared (especially while a foreign object tries to intrude), our lovely, intelligent, and wonderful bodies decide to protect us. Keep us safe. Keep the intruder out.
In other words, Pap smears hurt so freaking much because my body said no.
When I couldn’t say no, my vagina said it for me.
Thank you, body.
Thank you for instinctively protecting me when I needed it.
Okay, so it hurt like nobody’s business, I nearly fainted from the pain, and I honestly felt as if I would die…
But the speculum didn’t hurt because it was a horrible, evil awful instrument of torture.
It hurt because the GP didn’t use it properly, and my body said no.
So, today, I’m not ready for a Pap smear. I haven’t so much as unlaced a shoe in my doctor’s office, and I’m not sure I’ll be able to do so any time soon.
However, I’m excited to learn.
Excited to tackle this problem in the way I know best–studying it obsessively until I can become a lay expert.
I’ve found so little information like this as I’ve prepared myself to try a Pap smear again, and I wanted to document my journey for anyone out there who may also be searching. I may never be able to have a Pap smear, and I may not be able to any non-emergency medical exam again…but at least now I’ve got a chance.
Three months ago, the experience with the GP made me wish I could die. The doctor I’m currently seeing says that it was yet another sexual assault. It brought flashbacks, nightmares, terror, and depression so severe that some days I couldn’t manage anything besides feeding and walking my dog.
Right now, I can’t manage a Pap smear.
And that’s okay.
Thank you, body, for trying to protect me.
Just like my puppy will learn to trust when people are worthy of her trust (and I will always, always instantly remove her from any situation in which she may be mistreated), my body will learn to trust people who have earned it.
Thank you, body, for saying no.
I absolutely, positively, adamantly refuse to force my puppy to do anything that breaches our trust. If I don’t want her picked up, she better not be picked up. If I don’t want her fed treats, she better not be fed treats. Anyone who is incapable of respecting my dog’s boundaries will instantly get booted from her life. No second chances. (It only took one second to nearly kill her, and we’re still reeling from the aftereffects.)
If I wouldn’t force my puppy, why would I force my body?
Thank you, Ladybug, for teaching me about consent.
I protect my little dog from everything in the entire world, and I lay my life on the line to protect her. I will give up anything for her. No one will ever be allowed near her unless they consistently demonstrate that they will respect her and my boundaries.
If I can protect my dog, I can protect myself.
And I’m lucky enough to have a gynecologist to help me.
Will I be able to do the actual Pap smear eventually?
That’s not what this is about.