When I was a kid, I liked going to the doctor. I didn’t like the tongue depressor (quick gag reflex and a near-phobia of vomiting) nor did I care for shots (for my booster shot at age five, four grown men had to hold me down so the nurse could give me one shot), but the waiting rooms were fun, and the medicines tasted good, and I got to be the center of attention for a few minutes.
Then I turned eighteen and decided to go on birth control, and had my first pelvic exam.
I’ll not mince words: I hate PAP and pelvic exams. And when I say I hate them, I mean I’m terrified of them. I find them utterly dehumanizing. I had two okay exams, one with a certified nurse midwife in private practice and one with a male OB at a Planned Parenthood. But aside from those two okay ones, I’ve had doctors leave me splay-legged and half-naked for minutes at a time because they forgot something across the room or out in the hall or somewhere. And then there’s the thing where the nurse sets everything up and I don’t even see the doctor doing the exam until my feet are up in the stirrups. And the awesomest: Three times I’ve had doctors surprise me with a rectal exam. Even if you like people to jump out from behind furniture and throw confetti—which I don’t—this isn’t generally a fun kind of surprise. (Surprise!)
But even though I hated pelvic exams, I got them like a good girl, every year from the time I turned eighteen, because they can detect cancer and keep me from dying.
And then I found out that maybe they don’t. From the NY Times, June 30, 2014:
“The reviewers said that they could not even locate studies that had assessed whether routine pelvic exams of asymptomatic women could reduce death or disease from ovarian and other cancers, or benefit women with common benign conditions such as pelvic inflammatory disease, fibroids or warts.”
Nope, American doctors have been putting me through a yearly humiliating exam for two decades and there’s not even any evidence supporting the practice. I have to wonder: What else are my doctors doing that’s not supported by actual evidence?
Oh! I know of another one! When I was in labor with my daughter, I had my nether regions probed by literally a dozen people, most of whom didn’t even bother to introduce themselves first, much less offer me any scientific explanation for what they were doing.
My husband could have diseases that need humiliating examinations to detect, but no one’s hounding him to bare his bottom to a stranger once a year. I wonder why that is? (That’s sarcasm. I know why that is. It’s because he’s a man and he gets to maintain his bodily integrity when there’s no reason not to.)
I’ve recently read a blog post about how doctors are bullied by their patients. I don’t doubt that this happens, but I have trouble feeling sympathy. In the doctor/patient relationship, who has the power? Nine out of ten times, I’m betting it’s the person who’s fully clothed. When I fight past the embarrassment of saying out loud that I’m having excruciating menstrual pain every month and my doctor says, “For just one or two days? I have patients who are in pain for one or two weeks around their periods,” and then he changes the subject, who’s being bullied?
So I’ve decided to opt out. Twenty years of paying someone to treat me like I’m not there is enough. If I didn’t need my thyroid prescription refilled, I wouldn’t go to the doctor at all. The least I can do is keep my pants on when I go.
Imperfect Happiness 
I probably could have written this exact post myself. While preventive medicine has a point and I am sure it occasionally saves lives, doctors have lost our trust and for good reasons. It’s hard to believe that they do what they do exclusively for our health, when we know what role money plays in the way their businesses are set up. I’m sorry. It’s just hard to believe in their good intentions anymore. I’d rather trust the cues of my body and go get checked when I feel something might be wrong rather than subjecting myself to poking and prodding for reasons that are about to change every few years with new research. I mean, clearly, annual pelvic exams were “saving lives” just until recently. I don’t know. Our bodies are our own and we take whatever decisions we’re comfortable with regarding our health. And nobody should make us feel guilty about that. I guess that’s where I stand.
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“Our bodies are our own and we take whatever decisions we’re comfortable with regarding our health. And nobody should make us feel guilty about that.”
There’s so much gray area in medicine, and many (perhaps most; I’ve not counted) physicians I’ve met act like it’s all stark black and white. When medical professionals use guilt and scare tactics—rather than citing scientific evidence—to try and get me to agree with their recommendations, I get suspicious. It seems to me that if the scientific support for a course of action is strong enough, that should convince me. If my doctor doesn’t tell me his or her evidence-based reasons, that evidence either doesn’t exist, or the doctors themselves don’t know about it and are just operating on a hunch or personal preference. Either way, it makes as much sense for me to make a contrary decision (after my scientist spouse does a search for relevant studies on PubMed) as it does for me to take the doctor’s advice.
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I have avoided seeing doctors after a number of them, regardless of why I went in, would PUSH for some screening (many of which I was outside the guidelines for), or would “inform” me that I had “Syndrome X” with none but one of the symptoms, being assured that “yes I would” have them, unless I agreed to go on some (then) patented medications AND eat only the protein powder that I bought from the practice. RED FLAG. I remember the people who died while dieting on that “protein powder” in the 1970s. I was assured that because it was supplemented with 4 vitamins, that it was “entirely different”. I declined to go on a medication with cardiac risks to lower my blood sugar that was running in the 50s then.
While all of this high pressure sales was going on, those 6 cost-effective minutes to evaluate the condition which brought me in were up. To actually have them examined would require another appointment, and more waiting. In the mean time, the condition would have cleared up or gotten much worse. 3 of these “sales” appointments landed me in the hospital with pneumonia once – and asked, “Why didn’t you come to see us sooner?” I DID! I had been in 4 times in the preceeding month, and in all cases the appointments for the breathing issues were derailed into sales.
I had one doctor who sold personal information to the highest bidder, so I had people making claims against my insurance, and me for procedures I never had or needed in places I’ve never been. It destroyed my credit rating for about 20 years. She was also doing some other things, including medical abuse and financial abuse of the disabled. She might be eligible for parole in the 24th century.
I could tell more stories that I have personally been involved in, or observed through friends and family. Personal information abounds, and security of that information is almost nonexistent – both paper and electronic records.
So, I’m quite distrusting of the whole medical profession.
At least when I had a serious problem, the doctor I went to mostly worked to treat that problem. Sure, it was suggested for me to go on a blood pressure lowering medication with a diastolic blood pressure of 54, but I could and did refuse that. I still don’t trust the whole industry.
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You should check out my post on PAPs if you have not already, since you have my bullying post linked here. https://doctorly.wordpress.com/2014/11/13/yes-vagina-there-is-a-santa-clause/ I should clarify something you said, though. People often don’t understand that PAPs are NOT pelvic exams. So when the guidelines changed on PAPs and we were no longer officially going to hell if we didn’t do them every dang year, a lot of doctors said, “Well fine, you don’t have to get the PAP itself every year, but you should still get a pelvic exam every year.” What this latest thing on pelvic exams says is that they really are not necessary just for screening purposes. I applaud this! PAPs still are but they are every 3 to 5 years, not yearly anymore unless you have precancerous cells or HPV detected. Many women do not understand that I cannot see their ovaries or their uterus during a pelvic. Sometimes I can feel them if the patients are super thin, but let’s be honest…. I am not even that skinny! I am so sorry you have had miserable experiences during your exams. No one should have to suffer through that! 🙂
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I do recognize the difference between PAPs and pelvics, but to be honest, they both involve taking my pants off and putting my feet in stirrups, so they kind of fall into the same category for me, experience-wise.
Thanks for linking to your post about PAPs. I hadn’t seen that one and quite liked it. It reminded me of my friend’s experience with her (female) OB, who commented unfavorably on my friend’s pubic hair during a cervical check late in my friend’s pregnancy.
(Incidentally, I intended to keep this post as a draft until I’d slept on it (and perhaps never publish it at all), and I have no idea who hit “publish.” I blame my children because they’re asleep now and can’t defend themselves.)
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It is actually a good thing to talk about and I am so glad you did hit publish!
Your friend’s OB should be slapped. Or worse. That is appalling.
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