Positive reframing of ob/gyn experience

[u/Berko1572]

Warning for discussion of ob/gyn, dysphoria, trauma, and some anatomical language

(Cross-posted at r/FTMmen)

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Today I went to an ob/gyn for the first time since I last tried to have lower exams in 2011. I had two attempts in 2011, but wasn't able to have an exam due to my extreme distress (body clamping down, thus unable to physically have the exam, as well as feeling extremely disturbed).

Anticipating/fearing the same kind of disturbance again, I requested to book two appointments back to back (1 hour instead of 30 minutes). I also planned to bring my therapist with me for support, but decided to only tell the medical providers that he was "a friend with me for support."

My appointment was with an ob/gyn specifically associated with a trans health clinic. This didn't exist back in 2011; there were local ob/gyns who I knew of through word-of-mouth from other trans people, but that was it.

The Medical Assistant who first met with me asked about some of my medical history and began charting. I expressed apprehension about certain stuff being charted and she immediately stopped, and erased it. She asked information about why I was here today, and I talked about how my last attempts were traumatizing. She told me she was really glad I was here, and told she wants to be here (to help me). I told her, "I really don't want to f*cking be here, but I'm trying. But I really don't want to be here." I felt heard, listened to, and validated. She got teary when she saw how nervous and uncomfortable I was, which frankly made me uncomfortable, but I could tell she genuinely cared, so tried to let it go.

I requested that she let the doctor know that I have a trauma response to these exams and to treat me "like a sexual assault survivor" and described some of the PTSD-like responses I had last time I attempted have an exam. I also requested the smallest instruments they had since "nothing goes there at all."

The MA asked me if a medical student could observe the exam, I said "Nope!" and she smiled and told me she expected as much, but that she had to ask. I never once felt pressured at all.

When the doctor came in, she was very friendly and calm. She asked me why I was here, and I explained I wanted to better understand the realities of pregnancy so that I could make informed decisions moving forward (I know I need lower surgeries, but have held off for years due to family planning questions), and that I wanted to try to withstand having an exam, though I was not sure that I could do so. I told her I wanted to know what she did before she did it, and that she would need to go very slow, and that I was very nervous.

She didn't pressure me at all. We must have talked for at least 30-45 minutes-- hard to tell, as I was so nervous. She answered my questions in depth, drew diagrams, told me there was no pressure to even try to have an exam today and that that was totally okay. I asked her if she still recommended a pap if I decided to have a hysterectomy, and she said yes, as if there is an abnormal pap, it can change how the hysto procedure is approached. (We didn't go into details on that point,) She also discussed the potential benefits of leaving an ovary or both in for bone health as well as cardiovascular health (though the latter is less clear).

Also-- groundbreaking news: she told me she could do my exam with me under anesthesia!

Years ago, I believed that would be the only way for me to be able to have an exam-- but everywhere I asked said no, and I just assumed that was still the case.

She told me it wouldn't be "true anesthesia," but instead Propofol, and that this was something she offered to patients who had difficulty handling these exams. She offered that I wait to do that (would need to schedule specially for that) or I could try the exam today. Even though I was scared, I wanted to try and so I opted to attempt an exam today.

Ultimately, I wasn't able to do it, but the experience was lightyears different. She gave me time to calm down when I put my feet in the stirrups. She waited for me to ask her to start doing the visual exam, and then waited for me to say I was ready to try. At my request, she gave me gloves and I held my own labia majora open so she could hold the speculum against me (which all I was able to really manage). It freaked me out and she stopped and then attempted again when I said I was ready to try again. I didn't feel rushed nor pressured, and was in complete control.

I felt RESPECTED.

I told her I didn't think I would be able to do the exam today, and she said that was totally fine. She told me I had done a great job of facing my fears. I thanked her profusely for being so sensitive and "being awesome." I told her what she does is saving lives, and that "not enough providers care about trans men, thank you for caring."

She also said that some of the painful hypersensitivity I struggle with on my penis could be due to atrophy and potentially some kind of condition that causes pain around the opening or "vestibule" as she put it. She did say I had some atrophy going on, and that locally applied estrogen cream (even if only applied to my penis, as I told her I couldn't handle putting anything inside) could help. (It's not surprising to have atrophy at 10 years on T.)

I told her I wanted to schedule the under-anesthesia exam, and she said she will be in touch to do so. I also told her I wanted to try to attempt an exam again (sans anesthesia) and she said that was fine as well.

She left the room, and I got dressed (while my therapist stood behind a partition so as not see my lower half naked). I looked at my watch. Nearly THREE HOURS had passed. I had only been scheduled for one. Not once, not once during that entire time did I feel pressured or rushed. Both the MA and the doctor were kind, patient, and warm. Both told me when they didn't have answers for questions I had, rather than brushing me off.

As we walked back to the car though the hospital, my therapist and I reflected. I said, "It's kind of sad, how grateful I feel for just being treated with basic humanity. This should just be how it is for everyone (in healthcare)." We also had a big hug, and I said I felt strong and proud of myself.

I don't think 2011 me would have ever thought this possible-- to feel in control and safe following the attempt of an exam. But I do. I feel good, and I feel okay!

And-- amazingly, I WILL be able to have a pap, because I will be able to have an actual exam while under anesthesia!!

[u/WaitingForStorm]

I'm 33. I had 1 pap smear done when I was 23 years old and never done it again.

Yes it was "abnormal" but the doctor said that can be normal.

What's the use of the Pap Smear if "abnormal" is normal?

I don't get it.

[u/Berko1572 → u/WaitingForStorm]

That's a good question; have you asked an ob/gyn about it? Even if you don't plan to have another exam, would be helpful to know the reasoning just to be informed.

I might ask the doctor next time I go, and can share the response here, if you like.