How to go to the gyno without breaking down (trans)

[LopezMonty]

I guess background information is in order.

1. I'm transmasculine. (Might be relevant, but I'm also like 90% sure I'm gay).
2. I'm nearly 18 and have never been to the gynecologist. Doctors recommend going between the ages of 13 and 15, but I've been putting it off for years. My parents have been fairly understanding, but the expectation/requirement that I'll go once I reach 18 still stands.
3. I've briefly talked about it with primary care doctors in the past, but those conversations were brief and not very helpful.

When it comes to my sexual healthcare, I've only really had two different responses/types of doctors (regardless of whether I was out or not).
The first would place a rather uncomfortable focus on my fertility, and stress gynecological care in the frame of fertility. Because of course I, a literal teenager who is openly mentally distraught at the thought, would willingly get pregnant!
The second would say things along the lines of "everyone's afraid of going to the gynecologist and everyone thinks it hurts, so you just have to suck it up".

I suppose, on top of the fear of dysphoria caused by gynecological care, I'm also afraid of pregnancy. I mean, for years, I've had vivid nightmares about getting pregnant.
I don't think I'll be sexually active anytime soon. I'm too insecure to try.

But bringing up sexual activity just makes this more complicated. Since I see myself only really having sex with men, I would be at higher risk for things like HIV, right? But there's the possibility that, because of my sex, no doctor would prescribe me PreP or other HIV-preventative stuff.

I know that if I don't go, I'll be risking my health and cervical cancer and all of that. And it's stupid, but my mind just keeps going, "well, I'd rather die!" "I'd rather die from cancer alone than be routinely humiliated and dehumanized by doctors."
But it's not like it's only gynecologists that have/could humiliated me. I know I'm supposed to trust doctors. But I'm still afraid of them more than anything else.

And the other patients! I can only imagine what the other patients would say about me if I stepped foot into a gynecologist office.
The further my transition goes, the worse this problem will get.
I feel like I'm never going to escape the pain and humiliation medical systems have caused me. And going to the gynecologist is just another step on a never-ending journey of pain.

So, I guess what I'm really asking is: how do I force myself to go through with this? How do I get through it without breaking down and embarrassing myself?

[Heather]

Hey there, LopezMonty. As an agender person, I can relate to a lot of this. Going through trying to get care for menopause as a non-cishet woman has been my most recent bunch of super-not-fun experiences with the giant UGH that is being in a body that so many people just presume is the body of someone with feminine gender and female sex, and continue to act like it, even when you correct them.

My best advice for you is to see if you can't find a trans-health-specific provider for all of your sexual/reproductive healthcare. By all means, you can still get care at most OB/GYN offices, and sometimes that care will even come from someone who knows how to be inclusive, and from a clinic that doesn't misgender you from the front or create dysphoric feelings just by stepping in the door. Spain is pretty decent when it comes to trans health: would you like some help trying to find specifically trans-serving healthcare providers for this?

We can still talk about how to manage this and other kinds of care when you can't get trans-specific care, but if you can, I personally don't see any reason to put yourself through experiences where people aren't trans-inclusive or at least trans-literate, you know?

[LopezMonty]

I think I'll be able to see a doctor who will be inclusive and trans-literate. Spain is, thankfully, a good place to be for trans healthcare.

I think part of it is my mind struggling from going from a very not-affirming area (Georgia, USA) to Spain. Even though my environment has changed and a whole year has already passed, I'm still paranoid--even though I shouldn't be.

I guess I just need help adjusting my expectations? I suppose I know the basics of what happens. It's the pap smear that causes me the most anxiety. I don't really know if there even is a way to mentally prepare myself for that. And there's always the likely possibility that I'll break down either way, whether I'm mentally prepared or not.

All I can really hope for is an understanding doctor and that it will be quick. Damn it, why are all these exams so damn invasive?
Well, hopefully I'll be able to get top surgery before I need to get breast exams done. Though honestly, that sounds less violating than a pap smear.

So, I guess I'm just asking: how does someone mentally prepare themselves for invasive gynecological exams? I know I can just look it up, but all the advice I find applies to cis women and girls...

[char]

Hi LopezMonty! While I haven't been able to seek a gynecologist myself, I can definitely relate to your worry and frustration over being treated disrespectfully by health professionals, including being misgendered. It's unfortunate that it happens, even if we had expected it to occur going in (such as going to a health professional in a generally conservative area). But as Heather said, if you're able to go to a trans-inclusive clinic, then your worries can at least lessen a bit. With this clinic in mind, have you been able to check out the testimonies from other folks who sought help there? Or, at least, the experience of Spanish trans folks seeking healthcare that is trans-inclusive? I think doing those could help you manage your expectations on the location/country-specific context side.

As for Pap smear, I know that it can be daunting for lots of people. We have an article explaining how it works; and the good news is, you have the right to ask your doctor not to do it. The decision on doing a Pap smear (and pelvic exams in general, since Pap smear is just one type of pelvic exam) lies on your doctor and you. Further, pelvic exams are done only if you've reported having issues with your vulva and vagina, such as pain or sores, and that you consent to it. We have some articles that discuss pelvic exams in detail:
- Pelvic Exams: A Modern Guide
- Do you need a pelvic exam? Maybe... or maybe not.
- Your First Gynecologist Visit - in case you need a refresher. These are gender-inclusive pieces, just so you know you don't need to steel yourself before reading them in that way.

How do you feel after reading all this? We can help you with forming the words to say to your doctor, if you'd like.