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Pelvic Exams: Not Just For Straight Girls

Nothing quite strikes the stomach as the utterance of the words “pelvic exam”. For those of us that have sex with women, thoughts of insensitive health professionals and judgmental questioning are enough to deter us from making an appointment. Couple that with the stereotype that a woman only needs to get a pelvic exam if she has sex with men, and it suddenly becomes very difficult to find a lesbian with a gynecologist. Unfortunately, with rising rates of diseases such as cervical cancer for which early detection is key, it is important for all women to get annual pelvic exams.
One of the ways to get more comfortable with the pelvic exam is to know what is going to happen before you even get to your appointment. The basic pelvic exam begins like most other visits to the doctor, with a quick chat with the nurse or medical assistant about what any particular issues you would like to discuss with the doctor, the date of your last menstrual period, etc. Blood pressure, height, weight, and temperature are all taken after which you are given a fashionable paper gown and told that the doctor or nurse practitioner will be in to see you in a few moments. You will need to take off all of your clothes (you can leave your socks on as those hard floors get mighty cold) before you put your gown on. Ideally you would have met the doctor or nurse practitioner before you were dressed up in a piece of paper but unfortunately, it does not always happen.
When the practitioner enters (knocking first, of course), they will greet you, ask you a few questions, then move on to the exam. This is where my favorite questions usually pop up, “Are you sexually active?” and “What type of birth control do you use?” Now a sensible person would not miss a beat when I answer that yes, I am sexually active and no, I do not need to use birth control as I only have sex with women. Unfortunately, I have had the extreme pleasure of dealing with the one who missed the sensitivity training. A band of crickets began to chirp as she stared back at me blinking, mouth slightly open. Do not fret, though, I have had wonderful people do my exams since then. Remember, you always have the option to leave. There are numerous doctors and nurse practitioners to pick from so you can always choose someone else if a doctor is being inappropriate or making you feel uncomfortable.
Even though they are not part of the pelvic region, your breasts are examined during your visit. While you are laying back on the examination table, the practitioner will do a simple breast exam for you to check for lumps or discharge. If you are not familiar with doing self-breast exams at home, your practitioner can tell you how to do it every month for yourself.
Now it is time to scoot on down into the fancy footrests or stirrups for the Pap Smear. The point of the Pap Smear is merely to check for abnormal cervical cells. This is where the speculum is introduced. While many women may believe that a speculum is a type of torture device, it is actually a tool used to hold the vaginal canal open so the practitioner can see your cervix. If you would like to see your cervix, you can ask your practitioner to hold up a mirror for you. They have mirrors in the office for just such an occasion. The practitioner will check out your vulva and the surrounding areas for coloring, discharge, and anything that does not seem normal for you. Then they will lube you up and slowly insert the speculum into your vagina. In a perfect world, the speculums would be self-heating. In reality, prepare yourself for a slight chill. Sometimes someone takes pity on you and warms it up in their hands first. Once the speculum is inserted (don’t worry, only the thin beak-like section is inserted), the practitioner, slowly uses the handle to push it open just enough for them to get a clear view of your cervix. They take a couple swabs of the cervical cells, place the cells on a lens to send to the lab, and slowly take out the speculum. If you ask to be tested for certain sexually transmitted infections as well, they will do an extra swab at this point. It only takes about a minute from start to finish. The vagina is one big muscle so the more you breathe and relax, the easier it will be for you and the practitioner. It should not hurt so if you find it really uncomfortable, take some deep breaths and relax your muscles.
The last part of the exam is the bimanual exam. All that means is that the practitioner uses their hands to examine you. With gloved hands, they will insert two fingers from one hand into your vagina until they are touching your cervix. Gently, they will jiggle your cervix a little so that, with their other hand on your belly, they can feel your uterus. They are checking for size, tenderness, and anything else that does not feel normal for you. This allows them to feel for your ovaries as well. It takes less than a minute to complete. After the bimanual exam, any last discussions will happen and then the practitioner will leave you to get dressed. Congratulations, you are done!
The whole exam takes about five minutes. The rest of the appointment time is spent discussing things with your practitioner and taking your clothes on and off. It is a lot of worry for just a few minutes. According to the National Women’s Health Information Center, lesbians may be at a higher risk for cancers such as uterine, breast, cervical, endometrial, and ovarian because many of us do not go in for our annual pelvic and pap for early detection and prevention .
If you are familiar with what to expect during the exam and are still apprehensive about going, bringing a friend, family member, or partner in with you for support can help ease anxiety about the exam as well as provide an advocate for you. Another way to become more comfortable with the exam is to ask a friend, family member or partner if you may accompany them to their next exam so that you can see someone else go through it first. If it is your first exam, tell your doctor or nurse practitioner beforehand. They may go more slowly and explain more about what they are doing than with someone who has had an exam twenty times before.
Ultimately, no one has the right to make you feel uncomfortable and humiliated in a medical exam. There are numerous wonderful providers, many of them lesbians themselves. If you are unsure about someone and do not want to wait until the exam to find out if they are homophobic, call their office and either speak with them directly or with their staff. If you do not like how they are answering your questions, find a different practitioner. If insurance and money are the barriers, there are clinics that offer free or low-cost pelvic exams and pap smears to women who do not have medical insurance.
Women should begin having annual exams once they turn eighteen or when they first become sexually active, whichever comes first. For those that fall into at least one of those categories and get their exams annually, keep it up. For those that fall into at least one of those categories and have not ever had a pelvic exam and Pap or have allowed several years to float by since the last one, make an appointment. Just remember, you could spend a lot of time worrying and putting it off or you could take control of your health and spend a few minutes once a year getting your exam.


Guidelines for Gynecological Visits

1. You do not have to have anyone in the room that you do not want there. This means that if you want a female doctor, you cannot be forced to see a man, and vice versa. You also do not have to agree to have a specific person assisting the doctor or clinician. You can refuse to have any particular person in the room for any reason.

2. None of the clinic staff should be present while you are undressing or while you’re putting your clothes back on.

3. You may watch what is happening through a mirror, if you want to, and you are not required to keep a sheet over your legs so that you cannot see what is happening.

4. Anyone who touches your genitals must wear gloves. If you are allergic to latex, you need to inform the clinician so that they can use latex-free gloves.

5. You may ask the clinician to tell you exactly what he or she is doing throughout the exam. If it is your first visit, the clinician must do this.

6. You are free to ask questions at any time.

7. The staff must do any tests on you that you ask for, as long as they are capable of performing these tests.

8. You may bring a family member, partner, or friend to support you during the exam.

9. You do not have to do anything you don’t want to do.

10. You deserve to be listened to, and are free to tell the staff what would make you most comfortable. (i.e. you can ask that they take more time, go more slowly, stop to allow you to relax, etc.)

11. You can stop the exam at any time.

12. If at any time the staff does anything that makes you uncomfortable, you can leave.

 
 

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