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.

[LopezMonty]

After reading the articles, I know that an exam won’t necessarily happen the first time I see a gynecologist.

But I’m going to have to get an exam eventually. And now, I know the nature of those exams. The thought of anyone putting their fingers inside me, especially in my (ugh) vulva makes me feel panicky. The thought of a speculum exam and those awful stirrup tables is even worse.

And even without an exam, I’ll still have to talk about things that I’m deeply ashamed of and uncomfortable with. Even acknowledging that I have a vulva makes me feel like a freak. I feel like everyone is judging me (which is a delusion, obviously). Talking about things like pregnancy or birth control elicits the same response.

I just can’t get over the fact that, most likely, I’m going to have to deal with this shit for the rest of my life. No matter how fluent in Spanish I get, I don’t think I’ll get any better at talking about myself. Healthcare shouldn’t cause me pain or shame, but it does. The fact that I even need to see a gynecologist brings me shame. I don’t want to talk about my fertility any more, but every single step of my transition has brought it up. Like I’m a fucking incubator.

And it’s not like they can help me with my nightmares. That’s a psychological problem.

I guess I just don’t know what to say, at the end of the day. I have many questions, but I never get up the courage to ask. And my Spanish isn’t good enough yet to form those questions or respond to them.

Can you even ask questions about sex to a gynecologist? I’m not even heterosexual, so they probably can’t help me. (Unless me being attracted to guys is “straight with extra steps”. As if).

Everything feels…humiliating, when it comes to this kind of medical care.

[mikky]

It is really hard. And at times, dehumanizing. Being trans/queer can make medical environments, which can already be beyond challenging, even harder. I think like others have recommended, going to a trans inclusive/literate provider or practice is going to make a huge difference. I don’t want to pretend that trans people are never treated in humiliating ways in medical contexts. Working with folks who have navigated these topics with other trans people, though, means there should be some mitigation and prevention strategies in effect to make the experience better. At a trans and queer literate practice, I would hope that the doctors are not going to be completely fertility centric or make any exams more difficult than they need to be.

I go to the OBGYN a LOT. I noticed you said something about what other patients would think- there are all kinds of people in a waiting room at most OBGYN offices. Patients, parents, partners, friends. Typically when I am waiting, I am mostly focused on whatever is going on in my body or having a full bladder for an ultrasound, not trying to figure out who is a patient and who isn’t. There are a lot of people I perceive as men around.

Exams are usually pretty quick, and though it is by nature intrusive, most medical providers now have pretty good training around making them easier to navigate. Here’s how mine often go: The provider leaves the room after asking me if I would like a nurse or other “chaperone” in the room for the exam. I undress from the waist down and leave my socks on for comfort. I sit at the edge of the table (and I am alwayssss going to be asked to scoot down some more, no matter how far down I sit!) and cover my lap with a sheet. When the doctor comes in, they have me put my feet into the footrests, and adjust the sheet so they will be able to see what they need to. Then they tell me where they are putting their hands, what sensations or temperatures I can anticipate. . Because there is a sheet up, I feel a level of privacy or disconnection that feels helpful to me. Everything is deliberate and as quick as possible.

That is because a lot of people, cis and trans, find our reproductive health particularly sensitive, shameful, uncomfortable, or dehumanizing. A good provider will attend to their patients with a high degree of sensitivity and empathy.

You can absolutely ask a gynecologist about sex. Heterosexual or not. Again, the competency of a provider can range, but they should be able to address sex related questions. Are there questions you have right now? As you know, that’s what we are here for too!