The exam table. The stirrups. The papery surgical sheets waiting to be draped. The bright unforgiving lights. The instruments neatly lined up waiting to be employed. The faces of strangers about to look at a part of your body that, perhaps, you haven't ever even looked at yourself. Many women will know exactly what’s coming next.
The contraction, the sharp inhale & holding of breath, the closing of eyes, the cold, possibly irritating, lubricant, the uninvited & perhaps unwelcome penetration that I certainly never feel fully prepared for, the pain, the sound & feel of the speculum being cranked wide open and how that jangles my nervous system. The paint on the ceiling, as if nothing had ever been more interesting to my eyes before. My cervix then appears in all its moist rosy glory to the complete stranger whose face is now between my thighs. I can’t look her in the eye, (I will refuse male staff) usually there’d at least be some kissing before someone is so ‘up close and personal’ with my genitals!
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The entrance to my womb, the holy of my lady hollies, awaits examination, poking & prodding, also possibly some snipping or scraping, but definitely lots of scrutiny. No, it’s no fun, and no laughing matter either, really, but sometimes laughing about it makes it a little bit easier to deal with.
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It’s my least favourite few days of the year, the lead up to my annual colposcopy &/or pelvic exam. I feel every muscle tighten with each passing day as it approaches, as the sensations of old trauma resurface yet again.
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It’s necessary, however. I’ve had treatment for pre-cancerous cells which is why (at time of writing) I attend annually. Like 80% of sexually active adults in my part of the world I have HPV so I’m at risk for cervical & other cancers though that risk is significantly lessened now given my age, though I will continue to be tested until aged 65, I was told at my last exam.
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The responsible, adult & grown up thing to do is to care for this aspect of my reproductive and sexual health. The fact that I work professionally in the field of sexuality, & have done for over 3 decades including several years as a sexual assault counsellor, makes it doubly important that I model responsible behaviour, but my anxiety deepens daily as the appointment approaches. For many women it's a stressful experience & I'm far from alone in that. Studies are clear, approximately 1/2 of sexual assault survivors will not attend for cervical smear tests for years, perhaps decades, on end, & if we consider that 1 in 4 women are sexual assault survivors that's a lot of women missing out on essential health care. Unfortunately, this will inevitably result in cases of cervical cancer being missed & perhaps result in the deaths of those women.
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Like an estimated 1 in 4 women, I am a survivor of several forms of sexual assault, including as a child, and I know that I am far from alone in having this trauma revisit me, to some degree, each time I climb onto and lie down on that exam table spreading my legs wide by placing my heels in those stirrups. Frankly, it’s emotionally excruciating, even if only for a split second, each & every time, and I've done a lot of work on this in myself as well as professionally supporting women who've been sexually assaulted on a weekly basis. But these experiences embed themselves deeply in our minds as well as in the memory of our flesh, bones, muscle & nervous system. For many women, it doesn't help that this is the same position they were sexually assaulted in. The body remembers even if the mind doesn't.
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Screening is far from perfect and ‘catches’ only 12 out of every 20 potential cases of cervical cancer, however that is 12 out of 20 that, if they hadn’t gone for screening, may have been missed altogether and research tells us that approximately 50% of women who’ve experienced sexual violence do not attend for cervical smears; this is something I cannot neglect & an aspect of female reproductive & sexual health that I feel a duty to support & encourage other women to take seriously.
This is Laura Brennan, a young Irish woman who died as a result of cervical cancer in March of 2019, aged just 26. Read more about Laura here.
I want you, Woman, to live, to not only survive but to thrive & cervical cancer is a real threat to that for many women. Below are some things you could consider to make this essential part of your female reproductive healthcare easier, to support you to feel more in control of it if, like me, it's a deeply unpleasant experience & if even the thought of it is enough to make you want to ignore it.
If the process gives you no anxiety at all, that's really great, and I want to encourage you to continue reading & share the article, as what's below may be of benefit to someone else if not you.
BEFORE YOUR APPOINTMENT
1. Ask for a clinician of your choosing in terms of sex.
Regardless of what anyone says, it’s your body, your choice, always & in every situation in which you are capable of giving consent. You owe no one an explanation nor an apology as to your reasons for insisting on a clinician or practitioner of a particular sex for this most intimate of exams. If your request is refused, or if you turn up on the day & a clinician of the sex other than the one you've requested is undertaking the exam you (in my opinion) are within your rights to refuse the appointment. Legislatively in some countries this may not be the case, in which case I would strongly urge you to seek out a different clinic, to reschedule your appointment etc.
2. If you attend the same clinic regularly, ask for a clinician you have a relationship with, one you trust, ask that your next appointment be with the same person if possible & when the appointment notification comes call the clinic to see who the clinician is expected to be & ask for it to be changed if necessary.
Again, no apology nor explanation should be required, but, it will be really helpful for clinic staff to have more information about just how anxious the experience makes you feel & why - they want you to be comfortable & relaxed in order to get a good sample, they likely have your best interests at heart so help them by giving them any relevant information.
3. If you want & if it's possible, ask for an appointment for the sole purpose of talking about the procedure before actually having it. If this isn't possible, which it may not be due to staffing issues, ask to speak to a member of staff on the phone before your appointment if you have questions or concerns.
4. If you feel it would be helpful, bring a friend, ensure they’re available before confirming your appointment.
You could ask them to drive you to & from the clinic, especially if it's a colposcopy or treatment, and maybe to go somewhere afterwards to debrief, to talk about how it was & share your thoughts & feelings.
Be clear with your friend what exactly it is you need from them, ie: do you need them to come into the exam room with you? do you need them to advocate & speak on your behalf with the clinician in case you freeze? (a common response to trauma being triggered)
Do you need them to hold your hand, to speak to you while the procedure is happening? What do you want them not to do?
Carefully consider how much support you need from this person & ask for it, clearly, ask them to repeat back to you exactly what they understand it is you need from them to ensure they've understood.
The idea of putting so much effort into this one exam is so that it is a positive experience & one that makes future appointments feel less scary.
5. Consider what you're going to wear so that you'll be at your most comfortable, many women like to wear a skirt so that there's some cover of the body & removal of a few items of clothing as possible. Also, warm socks, perhaps over the knee, can be helpful - keep them on during the exam to keep your feet warm. Wearing flat shoes, maybe heavy boots, can also help to feel more 'grounded'. Most clinics will provide free sanitary towels in case of any post-procedure bleeding or spotting but consider bringing your own if that makes you feel more comfortable.
The idea of putting so much effort into this one exam is so that it is a positive experience & one that makes future appointments feel less scary.
5. Consider what you're going to wear so that you'll be at your most comfortable, many women like to wear a skirt so that there's some cover of the body & removal of a few items of clothing as possible. Also, warm socks, perhaps over the knee, can be helpful - keep them on during the exam to keep your feet warm. Wearing flat shoes, maybe heavy boots, can also help to feel more 'grounded'. Most clinics will provide free sanitary towels in case of any post-procedure bleeding or spotting but consider bringing your own if that makes you feel more comfortable.
6. Plan what you’re going to do afterwards. I usually bleed a little and am in some pain so I prefer to have someone drive me straight home so I can go to bed for a few hours but you may prefer a walk in a park or on a beach, to go for coffee, or go back to work, it's entirely up to you but planning the rest of your day to factor in being gentle with yourself will help.
Also, if you want to move your appointment so you can have better after-care, ie: going straight home & to bed instead of going back to work, then maybe ask for an appointment at the end of or after your working day, if that's easier.
7. If you experience bleeding & pain, ensure that you bring pads together with pain relief, I take pain relief about 20 -30 minutes before the appointment time to minimise any possible pain - just paracetamol, & I tell the nurse I've taken it. I would suggest, though it's entirely up to you & what works for you, that tampons & menstrual cups be avoided in this instance & for a couple of days afterwards. Many clinics provide free pads, if yours doesn't you could ask them to.
DURING YOUR APPOINTMENT
1. Explain to your clinician how you wish to approach the exam, yes, they are the clinician & they have a job to do, but it is your body. Your consent, comfort & intimate care should not be sacrificed for anyone else's schedule.
Perhaps, you would like them to explain exactly what they are doing and why, before they do anything & to get your verbal consent before proceeding.
Tell them, if you do, that you want them to seek your explicit consent before touching your genitals or inserting anything inside you, ie: ''I'm going to touch your thigh with my hand now, is that OK?'' and they wait for an express ''yes'', or ''I'm going to insert the speculum now, is that OK?'', again, they wait for an explicit ''yes''.
Explain you want this to be a collaborative process not something that is being done to you and you have no power to control.
You could ask if you can insert the speculum yourself, I do sometimes & then the clinician jiggles it around after I've inserted it to get a good position for her.
2. You shouldn’t have to, but unfortunately there are a lot of things in life that should be different to how they are, you may need to clearly speak your fears, concerns & negative previous experiences to your clinician.
2. You shouldn’t have to, but unfortunately there are a lot of things in life that should be different to how they are, you may need to clearly speak your fears, concerns & negative previous experiences to your clinician.
Prefacing your desires for a discussion about consent with the reasons why you want it may help your clinician understand why the pelvic exam needs to happen this way. Clinicians are trained in these issues in most countries, however, like any job we can become complacent & forget, clinicians have bad days & feel ill, they are not perfect. The daily tasks of our job can become somewhat clinical, it can be helpful to be reminded of the responsibility that comes with the fact that there is a real human being with real & difficult experiences lying vulnerable & exposed on the table.
3. You have the right to say ‘’no’’ or ‘’stop’’ to any clinician conducting the exam or any staff member being present in the room for any reason.
This makes you a woman taking charge of her own healthcare, including her mental health, a woman asserting her boundaries, and this is something to be respected & honoured, this does not make you a ''difficult patient'' nor an ''obstreperous woman''! No one has a right to touch you without your consent if you are in a position to give it or refuse it, even if they are a doctor or nurse - your body, your choice, always & in every circumstance.
3. You have the right to say ‘’no’’ or ‘’stop’’ to any clinician conducting the exam or any staff member being present in the room for any reason.
This makes you a woman taking charge of her own healthcare, including her mental health, a woman asserting her boundaries, and this is something to be respected & honoured, this does not make you a ''difficult patient'' nor an ''obstreperous woman''! No one has a right to touch you without your consent if you are in a position to give it or refuse it, even if they are a doctor or nurse - your body, your choice, always & in every circumstance.
4. You have the right to ask for the language of your choice to be used. You can ask for it but, of course, no one can or should be compelled to use any particular words or language. There is a current trend, in some countries, of calling women ''cervix owners'', for example. If this is offensive to you, as it is to many women, particularly women who've had 'issues' with their cervix, then ask for the language of your choosing to be used or not used, as is appropriate. Again, if you've brought a companion with you ask this person to help advocate on your behalf in this regard, if necessary.
5. Remember, it's OK not to feel OK & to say so.
AFTER YOUR APPOINTMENT
If the procedure was challenging, difficult, painful, and you feel in need of support seek out a professional service or a professionally trained & qualified practitioner either in-person or online to support you afterwards, you deserve that. It's important that any negative experience be dealt with promptly so it doesn't prevent you from taking care of this aspect of your health in the future like it, unfortunately, does for many women. Of course if a clinician acts inappropriately then the patient complaints procedure needs to be sought.
*** If you would like my support before your appointment, to coach you in terms of what you choose to say & how to approach the appointment in a way that works for you, or afterwards if it was difficult & challenging, please feel free to email info@bethwallace.org to book an online appointment.
Last updated: 19/10/22
