Invasive Testing

A trans man’s first pap smear is a traumatizing experience.

You’re pulling some sort of stirrup thing out of the examination table. My feet go in there? Okay, I can do this, this is fine. Just ten minutes ago we were talking about extracting my ovaries. This is nothing. There’s a sheet over my legs and everything. My endocrinologist recommended you specially—said you were “professional.” I guess cold and terse are professional.

What’s that thing? It looks like the edge of a giant blue butt plug. Must be the speculum. Do you really think that’s going to fit? I’ve never been able to get more than a finger in without searing pain and you’re just shoving—

Oh god oh god oh god it’s not working it hurts oh god why don’t you stop stop stop stop it it won’t work STOP IT

My face is contorting in ways I never knew it was capable of. My hands are claws, grasping at air, desperately seeking something to grab, like old soldiers who bit leather belts or bullets. I need that control, that escape, but I can’t reach anything from here. I could ask but I’m so scared of looking weaker than I already do. It’s a goddamn pap smear, not a war wound; the only thing I’ve been fighting is my own body.

You’re giving up. You’re finally giving in to what the rest of us learned in preschool—you can’t shove a thick cylinder into a tiny hole that has become near microscopic out of stress. There’s a smaller speculum and that hurts too but it’s okay, I can do this, I’ve had three surgeries and a battery of nerve tests and this is supposed to be routine.

Now you’re holding up a pair of what might be scissors, except that they’re as long as my forearm and they’re headed under the sheet. What are those? You didn’t tell me about those! “I just have to clean up a bit.”

You are not cleaning up. You are taking your sweet time scraping away at my insides. I can’t hold back the screaming any longer. Downgrading it to a high-pitched moan is about the best I can manage. And you want me to control my breathing so I don’t pass out. That’s nice. Maybe if you FUCKING TOLD ME WHAT YOU WERE DOING I COULD CALM THE FUCK DOWN. Maybe your fucking failure of a fucking medical school (where you clearly skipped all the fucking lessons on what a fucking bedside manner is) explained that hyperventilation is a perfectly rational thing for your body to try when it is being threatened. More air means more gas to get the fuck out of there. And you, sir, are most DEFINITELY threatening my body right now.

Allow me to put this in perspective for you. After more than two years on testosterone I start bleeding again. I go see my endocrinologist, worrying that I might have cancer. He sends me to see you. I have never had an internal genital examination before, and now you want me to undergo a pap smear and an endometrial biopsy in the same visit. Do you know why I haven’t had a pap smear before? I’m not stupid. I know I should be getting them. But my vagina brings me a great deal of physical and psychological pain, and I have been—correctly, it seems—reluctant to trust a strange physician with those particular agonies.

So when you finally take the scissors monster out and piss around for a few minutes readying the q-tip from hell that you need to check my uterus for cancerous cells, please excuse me while I make a scene of myself.

And now without any warning whatsoever I can feel something indescribably wrong. At some point the probe must have gone in and now it is wiggling around in an organ that has never felt the sensation of touch before. It’s not cold but my teeth chatter fast and loud enough that I worry I’ll damage them.

Finally it’s over. It’s all out of me. I sit up, perfectly composed, and tell you that I feel just fine. Yes, I’ll be back in two weeks for my test results. Yes, I’ll fetch some ibuprofen right away. Thank you for your service.

When I stagger out to the front desk to schedule my follow-up appointment I am shaking badly. So badly, in fact, that I’m sure half the waiting room thinks I’m a junkie. My face is a jack o’ lantern grin of agony.

I am in a great deal of physical pain. My insides are cramping up. Worse, I feel violated. I cannot think of a better word than that. A part of my body that disgusts me has been probed without any care for my well-being. I cry myself to sleep that night, reliving every second.

On top of it all, I am ashamed. I screamed. I cried. I shook like a leaf. I am afraid of sex now. I want to curl up into a ball and squeeze the lingering cramping out of my body by sheer force of will. I can’t stand having such a strong reaction to such a simple test. I bet that I’ll be mentioned as an example of a terrible patient who couldn’t suck it up and act like an adult. “I had this patient today, a man, and he made quite the scene in my office. I’ve had patients giving birth who raised less of a stink than he did! I stayed out of pediatrics for a reason.”

My partner tells me not to blame myself, that I should raise a formal complaint, that my doctor was completely unprofessional. Still, though, I can’t shake the shame of breaking down during a routine procedure that so many coast through every day.

But routines are not always routine.

 

Read more on Health, Psych & Addiction and Cancer.

Image of gynecologist cabinet courtesy of Shutterstock

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About Tobias

Tobias is a young man fresh out of college with all the loans and uncertainty you'd expect. He is working on promoting his college to GLBT students, and hopes to enroll in a PhD program for philosophy. In his spare time he cooks, dances, and cuddles his sizable collection of stuffed animals.

Comments

  1. Still, though, I can’t shake the shame of breaking down during a routine procedure that so many coast through every day.
    it is routine for others as their vaginas are larger, can expand more and are less sensitive. you should feel no shame that yours is different

    complain to your endocrinologist about the behaviour of this pap doctor that he recommended. your endocrinologist needs to know what happened, so he can investigate further

  2. I’m somsorry you went through that. It’s a good example of why I prefer female gynecologists. Fortunately I’ve never had an experience this horrible, but female doctor are almost always gentler and kinder when doing ob-gyn exams. I remember getting my first pap smear, at age 17, with my mom’s male ob-gyn. He didn’t explain anything and stuck a freezing cold metal speculum in me with no warning. The next time, I saw a female doctor at the student health center in college. She warmed the speculum in hot water, and told me everything she was going to do before she did it.

    • I imagine that doctors who have had to undergo a procedure before are generally more careful when performing it on others. (I collapsed in relief when a different doctor I saw told me he had the same elbow problems that I was having, so he knew that I would be fine.) Then again, I’ve heard plenty of stories of terrible female gynecologists, so empathy only extends so far.

      Thank you for the consolation.

  3. I am so sorry that you had this experience. So very sorry.

    You did nothing to cause or deserve this. For instance, internal size does not guarantee positive genital examinations; my canal is way wider than yours and I have had some completely awful pap tests and speculum fails (by asshats of varying genders). A shitty exam is NOT the fault of the patient, the patient’s anatomy, or the gender identity of the patient/practitioner – a shitty is exam is entirely the responsibility of the clinician(s) performing the exam.

    As someone who has also had an endometrial biopsy, please let me offer you further condolences. They are just ridiculously tough to get through! I had a roomful of respectful, queer, trans-friendly clinicians and my support person, and I felt safe in their care, and/but STILL I vocalized loudly, shook, hyperventilated and alternately held my breath until I saw everything through a blue veil. My clinicians gently laughed (good-naturedly, to let me know it was NORMAL to vocalize!) when I had said the F-word more than twenty times in one minute; I, too, was feeling self-conscious because of all the pregnant people around who might hear me through the walls and think, “gee, how come someone’s having a baby in HERE?” So I had very good Without a supportive environment? Anyone of any gender(s) would be hard-pressed to not swear like a sailor, cry like a fountain, and/or implode from the intensity of the tenaculum (that long thing that looked like scissors), the rotating brush thing, and the experience itself.

    You deserve and deserved way better than that which you received in this instance. The feelings you share are real and if you feel like seeking additional support for your experience, The Network/La Red is a LGBTQQIAAKPetc-centric organization that centers the experience of people of color and seeks to end partner violence in our communities – BUT they also seek to end sexual violence and assault. If you visit http://www.tnlr.org you can find their hotline number, from which you could choose to ask for specific referrals relevant to you. And, of course, you could also choose to just talk.

  4. I have no idea how to reply to this but to just say I hope gyno’s learn to do the procedure better and inform their patients. It sounds very troubling. So sorry you went through such an experience.

  5. Peter Houlihan says:

    I’ve always wondered about this. Is there no way they could give women something to help them loosen up? Or would that make the pap smear not work?

    • Having the speculum inserted is not actually painful for most wmen tho it can be painful for some who have small or tight vaginas, in which case the doctor needs to be slow and gentle. Anxiety can also make the vagina tighten up. However, the vagina itself is very stretchy and the speculum isn’t really that wide. Probably the biggest complaint women have is that the speculum is cold although these days they tend to be plastic instead of metal. The pap smear itself can cause a sudden sharp pain as the doctor scrapes the cervix.

      Women who have a really bad reaction to the exam or a lot of anxiety could ask for a Valium first.

    • I haven’t the foggiest idea about the medication, but last time I checked I was a man.

      • Maybe he should say people with vaginas/etc? Is that technically correct? (I have no idea how to word it politely, I am trying real hard). Or maybe just people who need to see a gyno?

        • Just consider how you’d phrase any given sentence when talking about a medical specialty that’s not assumed to be gendered. “Patients should try to relax when getting a shot, since tensing up can make it hurt more.” Perfectly natural and easy to apply to pap smears: “Patients should try to relax their vaginas when getting a pap smear, since tensing up can make it hurt more.”

          In some cases it makes more sense to emphasize ownership of a body part, like with abortion. I cry a little every time someone writes about how abortion is a “women’s issue,” because it’s really not. If we’re talking about “issue” as being synonymous with anyone who can become pregnant at some point in their life (not that that’s a perfect way of looking at it), then the relevant characteristic is not whether you are a woman, but whether you have certain anatomy working in a certain way. There are plenty of women who don’t meet those qualifications, and some men who do. To account for that nuance I usually write in “people who can become pregnant.”

          • Would it be safe to say a female sex problem vs a woman/girl/female gender problem? A gyno visit is something my male body doesn’t need so I’ve always thought of it as a female body problem, not neccessarily a woman’s problem after I learned about trans. I guess “People with a uterus/etc” works.

      • Sorry for the wording, it’s a little difficult to talk about vaginas without mentioning women but I’ll try to be more careful

  6. At the age of 49, I must have had about 20 of them. Even with a moderate sized vagina, it always hurts. The speculum is always too big and, if I have an idiot doctor (male OR female), they always try first to wedge the bugger in for five minutes – like there’s some kind of fucking prize for using the biggest size – before reluctantly resorting to a smaller one. And, as you so rightly point out, the swabbing thing, which you’d think would be so innocuous, still makes me want to crawl out of my skin.

    My nastiest exam was, some might say ironically, by a lesbian gynecologist in San Francisco. And, before you ask, I surmised she was a lesbian because she was wearing a t-shirt that said “Proud to be a Dyke”. Initially, I found the T-Shirt a comfort. Later, not so much.

    My most comfortable exam was, again you might say ironically, performed by a male, gay, doctor who wasn’t even a gynecologist, in Singapore. And before you ask, I knew he was gay because his partner referred me to him. He used a metal speculum; he ran it under warm water first, and then he lubed it up like there was no tomorrow. He narrated exactly what he was doing every step of the way and kept asking me to let him know if I felt any discomfort.

    My theory is that ownership of the specific organ doesn’t give anyone any particular compassion for the organs of others. In fact, perhaps its very unfamiliarity is what caused the doctor in Singapore to tread lightly.

    The blessings of age are that you get a lot more protective of your body and a lot shier about how you demand people treat it. Now, when I feel like someone’s being unnecessarily rough down there, I get up on my elbows, glower at them and shout: “Hey, that’s my CUNT your ripping apart, not a fucking car tire. Try a little gentleness, it doesn’t cost you anything.”

    Invariably, it all goes pretty smoothly after that.

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