"A Trip to the Gynecologist"

TMI Alert; read at your own risk

 by L. Lisa Lawrence

(author holds copyright on all material.  Permission granted to link to original pages, please use contact link on webpage for any requests for reprinting or publishing)

Today was my “42,000 Mile Check Up” (I coined the term “40,000 mile check up” when I turned 40 and decided to have the full cardio/blood/etc… work up), which roughly translates to my “annual check up and “female” exam”

Women know how much we look forward [insert sarcasm here] to these check ups. Men have no clue; but like childbirth, PMS, migraines and menstrual cramps, is something they will remain blissfully unable to experience. Most of us would rather have a root canal.

Before you even get to the physical discomfort, you have to answer all the “personal” questions about your lifestyle, behaviors, risk factors, etc (gotta update every few years)… which when you have a good relationship with a doctor that has as sick a sense of humor as you do, is pretty darn funny; but I know it makes a lot of people uncomfortable, especially when they’re honest (it IS important).

So you get asked questions like, “Are you sexually active? (to which I of course answered, “recently?” and then burst out laughing (she knows how picky I am). “Do you have sex with men, women or both”? (I actually wish I could be sexually attracted to women; they’re easier to understand, but the though of… bleck… As my lesbian friend Janice says, “Honey you can’t help being straight, you were born that way) “Do you engage in oral sex?” (same answer as the general sex question, and then some bad jokes from both of us about “as needed”) "Do you engage in anal sex" (EEEWWW, not only unhealthy and a good way to spread fecal bacteria to other orifices, but... oh never mind... NO", “Do you use IV drugs, other drugs, smoke, etc…? (I’m so boring… no) “How many sexual partners have you had?” (not as boring, but not slutty either) which also lead to more jokes, and the list goes on… I can’t imagine what it’s like for a woman that’s more shy and inhibited to answer those questions, especially if it’s a male doctor or one she doesn’t know well.

First, you have to pee in a cup. I KNOW I’m not pregnant, because I haven’t been having sex lately and have had menstrual periods since the last time I did; I don’t believe in “immaculate conception” so what’s the point? I also know that I don’t have a UTI because I’m not in chronic pain and peeing every 10 minutes… Well the point is (after following all the clinical “cleaning” procedures for a “clean catch”) making a woman who doesn’t have to pee and even if she did, who’s urethra is clenched in the closed position from the freezing temperatures and request for a command performance in the bathroom, squat, stop her urine mid-flow, then place the cup under the stream and re-start it without peeing on your hands, legs, the floor our your pants. Good thing I have strong thighs and keigel muscles, that’s all I can say…

All doctor’s offices are cold, freezing cold. It’s some sort of sick rule they abide by.

So you’re put in this freezing cold exam room and given a paper gown to put on; or in the case of my doctor, a cape and a paper towel as a lap drape. You’re allowed to keep your socks on if your lucky.

Finally, when you’re cold enough, the doctor comes in and whatever shred of dignity you managed to salvage when putting on the gown is tossed out the window. You have to scoot your butt to the edge of the table until you are certain that you’re going to land on the floor, and then the “stirrups” (another thing men don’t usually get to experience) are pulled out [I did have the pleasure of watching my ex-husband put his feet in stirrups for his vasectomy, which is actually a pretty cool/interesting procedure for a medical geek like myself to watch] but I digress…

So there you are, your cold naked butt hanging off the edge of the table, in a freezing cold room, your feet in the air, being held in place by cold metal stirrups [presumably, so that you can keep your legs spread in the air, but I think it’s so that you can’t kick the doctor]

Since the room is so cold that your arm veins constrict and can’t be found, this is the time that the doctor decides to do a blood draw. so that gravity can help. Now I know my veins. I know they can be felt and not seen (and that they roll and need to be stabilized by finger pressure at the bottom of the vein as the needle is inserted upwards). As a field medic working in a helicopter in the dark, that’s how I started IVs. Doctors in a clinical setting want to SEE the veins (the good ones are deeper), so she goes for a tiny vein with a 22 gauge butterfly, which although appropriate for that size vein, makes the actual drawing of blood extremely slow, so the experience lasts a good long time and the thing has to be wiggled around in an attempt to increase the flow. (Isn’t this fun!?)

Next, a cold metal device called a speculum is inserted in a place that I’m sure you can figure out the anatomically correct name of.  Now, a reasonable person would think that this device would spread things horizontally. Nope, it’s twisted in all it’s freezing, stainless steel glory to open things up vertically [after years of subjecting myself to this procedure, I discovered it assisting in an exam, during my clinical rotation in the emergency room] I’m sorry, that’s not meant to open that way. Yikes. Of course, we’re told to “relax” during this completely unnatural process.

The instrument never quite warms up and neither does the cold glob of lubricant they use to make the insertion “easier”. While the cold air is rushing in, the doctor takes a good look to make certain that things look right (no signs of swelling, infection, trauma, odd odor, discharge, etc…)  My doctor uses a Petzl headlamp to (as she likes to joke) “go spelunking.” At least I get a good laugh when I go in there. (Did I mention that you’re told to “relax” during this procedure?)

Then, the pap smear starts, while we are still trying to “breathe” and “relax” our way though the instruments manipulation of an area that’s not meant to be in that position. Many of us were lead to believe, when we were younger (and dumber), that a cotton swab would be gently brushed across our cervix and then put on a slide for examination in the lab (doesn’t that sound kind and gentle?). I’ve seen the tool that’s used. It’s some sort of mutant pipe cleaner with a twisted metal core holding a cone shaped, spiraling pattern of stiff, nylon, toothbrush like bristles that stick straight out, which is not gently brushed across the cervix, but is inserted INTO it, in order to get a sample of “endometrial” cells. Yes, that’s right… It goes right for the entrance to the uterus. And whomever declared that there are no nerve endings in the cervix, does not have one. I’d like to find that guy and explain (and demonstrate for him) how a long swab inserted into the urethra of a male to check for Chlamydia doesn’t hurt… (Just relax buddy, you don’t have nerve endings in there)

Then the speculum is removed and things snap back into place (well, they kind of slop and gurgle since they’ve been slathered in cold lubricant making you feel slimy)… Then the pelvic exam starts. This involves one hand on the outside of the abdomen and two or three fingers pressing on the inside (oh yes, and the doctor forgets to warn you about the next cold glob of lubricant (as if you don’t already feel slimy enough) on the cold latex glove headed your way, until after they nearly have to pry you off the ceiling from the cold shock) of the uterus so that the uterine wall and the ovaries can be felt to make certain that there is no swelling, pain, cysts or tumors. I for one, am not big on having my ovaries squeezed. (Did I mention that you’re told to “relax” during this procedure?)

Once that’s over, you get the “breast exam”. We’re talking serious poking and prodding in order to detect “unusual masses”. (Did I mention that you’re told to “relax” during this procedure?) Ouch.

Now don’t get me wrong. I have a great doctor and we actually laugh and joke a lot during this procedure. The fact that she’s a woman helps a lot too. I don’t care how empathetic or well trained a man is, he doesn’t belong poking around down there (unless of course, it’s for mutual recreation purposes) because he does NOT know how it feels.

So, I know that everything is in “good working order” and “looks like it should”. The cells they so brutally scraped from the inside of my cervix will be sent to a lab, stained, and examined under a microscope and I’ll be told that I’m “good for another year”

Oh yeah, now that I’m 42, they want a baseline mammogram… THAT’s going to be an adventure in it’s self.

When I was a kid, I at least got a lollipop. Now I just get a bill and maybe a sample of Diflucan…


Now… Don’t get me wrong after this “tongue in cheek” depiction of what I did after work today.

Annual exams are important, and should NOT be missed. A woman I know, who works on the Pine Ridge Indian Reservation told me many years ago, that “Women don’t understand how important these exams are, until they miss a few and then discover a problem when it’s too late.”

The fact is that cervical cancer is very common and has a nearly 100% cure rate if caught early. It’s not so good if it’s not caught early.

I had a really nasty scare about 10 years ago. I had missed a few exams because I didn’t have health insurance, and working for the Park Service, wasn’t near a Planned Parenthood clinic (which works on a sliding scale to provide live saving health care to all women, especially those on fixed/low incomes)

So I went in after having some spotting between periods, and my pap smear came back ASCUS (atypical squamus cells of undetermined significance) They went through all the typical treatments to rule things out. They treated me for infection (since I didn’t have one, it didn’t help) and ran through several other protocols. Finally, it came down to the cervical biopsy. This is when I really wanted to kill the guy that said there were no nerve endings in the cervix. Try having pieces of it ripped out pal… It hurts. I remember laying on the table in the Planned Parenthood Clinic in Glenwood Springs Colorado (Grand Junction was too redneck conservative at the time to allow one there) My friend Karen from Aspen went in with me, told me dirty jokes and held my hand. I used to give her injections when chemotherapy from her breast cancer lowered her white blood cell count to dangerous levels. That’s what friends do, they see each other through such things. She also saw me through the cryo-surgery I later had to have.

It was a year and a half before I was allowed to go back to once a year pap smears (from the quarterly ones required in someone who’s had a bad pap smear) and I don’t ever want to go through that again. Not the hassle and discomfort, or the fear and dread of what the test results might be, and that you might have to go through it all again.

I’ve been fine for 10 years and no longer stress over waiting or results to come back.

I should not have skipped the pap-smears and will never again. If you (or a loved one) can’t afford them, go to Planned Parenthood; it can mean your life.


(author holds copyright on all material.  Permission granted to link to original pages, please use contact link on webpage for any requests for reprinting or publishing)

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