Do I need to have a gynecologist appointment if (long-winded, slightly graphic context)

[vambrace]

I'm 22 (sorry if I'm a bit too old to be on this forum, but I know it can also be for young adults), and at an age where by now my doctor would usually schedule a gynecologist appointment. However, I really do not want to have one. I'm asexual and autistic, and the idea of anything penetrating me is such a terrifying sensory and general experience that my brain blue-screens rather than confront the possibility. I'm also agender and have dysphoria about my vagina if I have to think about it too deeply.

Which brings me to my question: do I have to have one? I have had one sexual experience, and it was something that most people wouldn't consider sex. I know this forum definitely would, but it makes it difficult when information about when you need to see a gynecologist is based around more conventional definitions and assumptions about sexual activity.

These are the (TMI, sorry) specifics of my situation: I fingered my partner directly (my fingers often have a ton of little cuts on them, if that makes the contact riskier). Because of my sensory issues, she fingered me, but only over my underwear. My partner had been sexually active before, and I don't think she got tested.

To make matters more complicated, this happened a couple years ago! I tried to explain the situation to my doctor at the time but I was super embarrassed by all the details and am not sure how clear I was. She assumed I would go on to be more sexually active, and I wasn't 21 yet, so she said it would be okay for us to put off the gyno appoint until I was. But now I'm 22 and have discovered I'm asexual and haven't had sex since. Because of my lack of experience, is it safe for me to just not have this appointment? Or are there health concerns from either this one event - or just from growing up - that require gynecologist appointments and I need to prepare to have one?

Thanks!

[Emily N]

Hi vambrace, you are very welcome to post here!

It is totally understandable to have anxiety surrounding gynecologist appointments and pelvic exams! I have a few articles I can share with you, and I’ll talk through my thoughts to hopefully address some of your concerns.
It is generally recommended that people with uteruses and periods visit a gynecologist or their doctor annually to discuss menstruation and general sexual health. You can take the process slowly and one step at a time - don’t feel pressure to jump directly to a pelvic exam. My hope is to let you know that you can ease into gynecologist appointments. If/when you go for the first time, you should feel that the decision to visit an OB/GYN is your own (not your doctor’s or Scarleteen’s or anyone else’s) and that you feel heard and respected by your doctor and your anxieties have been addressed.

There are many reasons why people visit OB/GYNs. You’re right that sex and sexual activity is one of them, but the majority of reasons for an OB/GYN visit are not related to sex - general health, menstrual cycles concerns, pelvic pain, questions about discharge, pap smears, and more! This article does a great job going through the details of what a first gynecologist visit can look like.

That all being said, I really recommend reading this article: “Do you need a pelvic exam? Maybe... or maybe not.” It sets up the importance of patient autonomy and sovereignty over decision making in medicine, and how to advocate for yourself with your doctor. It also says the pap smears are often over-prescribed.

Do you have a primary care doctor now that you would feel comfortable asking to learn more about gynecologist appointments? I wonder if it is possible to set up a consultation with an OB/GYN so you can talk through your concerns and questions about pelvic exams with them without the anxiety of a pelvic exam looming in the same visit. I can imagine it would also be helpful to build some trust and form a relationship with your gynecologist before having a more difficult appointment set up.

I feel like I wrote a lot of things down, but I just want to summarize to say that it definitely is nerve-wracking to think about setting up a gynecologist appointment, especially when there isn’t often a lot of transparency about what these appointments entail. The bottom line is that you should only make one if you want to. If you do decide to , you have the right to understand exactly what will happen during the appointment and feel that your concerns are being addressed. Do you have other questions I can help with?

(*Also, as a last side note - it doesn’t sound like your past sexual experience was high risk, but if you ever want to, most all STI testing can be done through a urine sample or blood work, and does not require a pelvic exam.)

[vambrace]

@Emily N - first of all thank you so much for this response!

Secondly, while all of this is incredibly helpful, I want to call particular attention to the suggestion to see a gynecologist and ease into the issue. For me, seeing a gyno was always framed as "for the sake of getting a pap smear", which I wrongly equated with it here. Regardless of if I have to get one in the future or not, I think interacting with the doctor myself in preparation would be really helpful for transparency and managing expectations.

I found the article really helpful for context, although I admittedly still find myself a little uncertain (or maybe disheartened) by the suggestion of having a pap smear every three years. But questions like "is that due to assumed sexual activity or inherent risk increasing with age?" (I feel like I've read both on my own research) probably would be best to have with an OB/GYN directly, in the way you've suggested here. I am going to be honest I would still rather avoid this as long as possible, but speaking with a doctor directly is probably my best bet for balancing that with my safety.

Thanks again!

[Mo]

I hope you're able to find a doctor who's willing to be transparent about what they recommend and why, and who's patient and respectful around your discomfort. Sometimes finding a new doctor you really click with can take some time, but hopefully you'll come across someone soon. I can certainly understand you wanting to put this off, but I do think that getting started on the process of finding someone you trust is a good idea whenever you can manage it.

[vambrace]

Thanj you! I really appreciate it.