issues with pelvic exam, etc

[dana]

tw for mention of assault i guess. also sorry this is really long.

I'm 19 years old and I've been to the gynecologist twice- the first was when I was 17 or so with a doctor who specialized in teens, and performed an external and breast exam. I had a lot of anxiety about this exam but it was ultimately tolerable and acceptable. That doctor moved away though, so now I go to my mom's gynecologist, and it would be inconvenient to try and change to another one (setting aside the impossibility of having that conversation with my mom). She's an older woman and it isn't that I don't like or trust her, but I've been having a lot of anxieties about the process. I have been to see her once, when I was 18, and it was terrible- I had to wait an hour, and got incredibly anxious during that time. While I was filling out the paperwork, my sister, who was with me, was peering over my shoulder, so I wasn't able to indicate that I am a survivor of assault. This is hard enough for me to write down without someone looking- I absolutely could not say it out loud to a stranger. When I got into the exam room, she was nice enough, and performed an external and breast exam. Again, uncomfortable but tolerable. I have extremely painful periods and possibly endometriosis, so I had been on birth control. There were issues with me taking the pill, so at this appointment I was switching to the ring. She explained to me how to insert it and had me put it in, and then, without giving me time to brace myself, stuck her finger inside to check that I had done it correctly. NOT GREAT! It was physically uncomfortable and extremely upsetting to me. Whatever, though. When I left I found that they had informed my sister about my new prescription, which I also felt uncomfortable with bc I am an adult and they shouldn't be talking to other people about my stuff.

It was implied to me that in the future I would have to start having pelvic exams when I come in. I absolutely do not want this. Without being too graphic, I really don't fit more than a single finger without pain. I don't think anything's medically wrong, I just don't have a lot of sex and the sex I do have is rarely penetrative. Either way, I know it would be a LOT of pain. Also, as mentioned, I am a survivor of assault. I have a really complicated relationship with sex and consent and frankly don't like those parts of my body being looked at or touched at all in a medical setting. I can tolerate the external and breast exams, but fear of the pelvic exam has kept me from returning to the gynecologist, at the cost of my birth control prescription. I ran out of rings months ago, my periods are excruciating, and I'm mildly worried about it affecting my future reproductive health. I know logically that it's important to get pelvic exams so I can be screened for cancer, etc and checked for other issues, but as is I'm terrified of it. I don't think I could get through it without at the least taking, like, a xanax, and that presents a lot of issues in itself. I guess my question is: would it be ridiculous for me to not consent to a pelvic exam? Would the doctors be able to refuse me birth control if I did not consent to a pelvic exam? If so, does anyone have advice for easing anxiety and pain surrounding it?

Sorry if this is too long and, like, incoherent. I just really don't have anyone to talk to about it.

[Siân]

hi dana,

I'm sorry that you've had such unpleasant experiences at the gynecologist so far. It's pretty unprofessional for them to do an internal exam without saying what they're doing first, of course it was upsetting. And you're right that your prescription is your business not anyone else's.

In answer to your questions, I don't think it's ridiculous to refuse consent for an exam if you're uncomfortable with that doctor on a given day. I don't, however, know what impact that might have on your access to birth control (I will ask if any of our US based volunteers know). It might also create problems down the line for other healthcare e.g. treatment for endometriosis, so probably best to work out what you would need to feel ok about a pelvic exam.

You mentioned that it would be tough to change doctors, but may be worth looking into - if you need to speak to your mum about it for transport or health insurance reasons, you're not obliged to go into details of why. You could even present it as "I'm trying to practice accessing healthcare myself, for when I need to be able to later". What do you think?

In the meantime though, if you've got an appointment coming up there are some things that you could try to make it less intense. What can you take to the waiting room to do some self-care if there is a long wait again? Maybe a book, some music or drawing? When filling out the forms, maybe ask anyone with you for some privacy? You mentioned not being able to talk about the assault upfront, what if you wrote a note before you left home to give your doctor with something like "I am a survivor of sexual assault. I need you to....[explain everything you're going to do before you do it] [give me the opportunity to say yes or no before touching my body] [respect my right to confidentiality and not share information, including about prescriptions, with my family] [anything else that would make you feel more comfortable]". Do any of these sound like they might help? Do you have any ideas of your own?

[dana]

Hi Siân, thanks for getting back to me so quickly.

Ideally I think I would change doctors, but I'm concerned about both discussing it with my mother, and the process of finding one. I don't really know how one shops for gynecologists and the last thing I want is to visit another doctor and find out it's a poor fit. As I get older some of the other barriers are starting to fade- I'm learning to drive, I carry an insurance card, and I have dealt with doctor's appointments on my own before- but at the end of the day, my parents still pay for insurance & medical treatment, and I'm worried they won't accept a vague explanation.

I had not thought of writing a note and I might do that! It would definitely be easier if I could have something I had written out beforehand and wasn't put on the spot for. Thanks also for your suggestions of what to ask for. I definitely think "give me the opportunity to say yes or no before touching my body" is really important and not something I would have really known how to articulate.

[Siân]

I'm glad the note idea feels good to you!

Ok, so it seems like we have two separate things here 1) talking to your parents and 2) choosing a doctor.

1) You can keep it simple, for example "Dr XYZ made me feel uncomfortable and so I did some research and got a recommendation for Dr ABC". You're not obliged to go into any more detail than that. You have mentioned here and elsewhere though that not speaking to your parents about this is becoming a barrier to accessing things you need phyasical- and mental-health-wise. What makes you hold back? Do you think either/both of them would be supportive if you did speak to them?

2) Looking for a doctor is a bit like choosing a restaurant - you look at their websites, check out any reviews you can find and ask people you trust for recommendations. You could try calling a local LGBT centre or rape crisis centre and ask if they have any recommendations, ask any friends or family members you feel comfortable with who their gynecologist is and what their experience has been like and read around online.

This article has some good ideas around finding a new doctor and scheduling a low-stakes appointment first, and there are some great links at the bottom.
I want to avoid abuse triggers and flashbacks, but I really should go to see a GYN...

Does any of this sound like something you might do?