Read My Lips: The Importance Of Being (Gynecologically) Earnest

Today, Clare Allen writes in Guardian that she’s never going to have another Pap smear done, cancer be damned, because she found her last one so traumatic. You see, she suffers from mental illness.

Allen, who hadn’t had a Pap smear in 10 years despite the urging of her regular doctor, scheduled an exam following the death of British reality TV star Jade Goody from cervical cancer. Although she finds Pap smears traumatic, when meeting her gynecologist and nurse for the first time, she failed to reveal her mental illness or that she finds the experience trauma-inducing.

The nurse was a perfectly kind and decent woman. The doctor she went off, mid-process, to fetch was probably more or less human too – by that point my judgment was somewhat impaired – but neither appeared to have even the most basic comprehension of my position.

“Why are you so upset?” asked the doctor, laughing, presumably in some misguided attempt to lighten the atmosphere. Lying naked from the waist down on a couch with my legs in the air didn’t strike me as the most appropriate time to discuss it. “None of us like it,” she told me, smiling. “But it’s not as bad as going to the dentist.” By the time I left, I was in such a state I cannot even remember going home.

Well, to be frank, of course he lacked comprehension of her position — because she didn’t tell him anything about what her position was. He and his nurse were facing a person who, for very legitimate but undisclosed reasons, was having a severe emotional reaction to a routine medical exam.

Allen says that a short conversation before or after the exam might have helped — although, by her own admission, she was so upset by the end of it that she doesn’t remember getting home. And, yes, some doctors can lack bedside manners, or patients can be stacked too close together to allow for conversation, or the patient’s own demeanor might lead them to believe that she doesn’t wish to engage in conversation. But, at the end of the day, when you’re visiting a doctor for the first time, or have relevant medical information of which they are unaware, information that wouldn’t come up on a checklist screening (like mental illness or a history of assault) but can affect the exam or its results, the full responsibility doesn’t lie with the gynecologist. If you wouldn’t go to your therapist and keep quiet about it, you shouldn’t keep it from your regular doctor or your gynecologist, either.

I’m not going to pretend it’s fun to tell a relative stranger, health professional or not, that you’ve been raped or have a history of mental illness that predisposes you to find certain medical procedures or examinations traumatic. It’s not. I never thought to inform my doctors until graduate school, actually, when, due to switch in my birth control prescription, I ended up with a yeast and a bacterial infection (nasty, I know). The doctor at student health services was, let’s say, far from experienced in the art of giving a pelvic exam and, in an effort to preserve the sanctity of his specimens, shoved the speculum in me without any lubrication. When the examination was over, I sat up, looked him in the eye and told him that before he shoved a speculum in another woman without lubrication and told her to relax, he’d damn well better think to ask if she had a history of sexual assault.

Recently, when I went for my 6-month follow-up exam to my rape kit (and my annual Pap smear), I explained to my doctor — who has always been extremely efficient but with whom I lacked a certain rapport — that I’d been sexually assaulted since my last visit. And suddenly, the experience of the exam changed. She was kind, thoughtful, and empathetic — and she spent more time talking me through the (very gentle) pelvic exam than she had in the past. I imagine that most medical professionals – particularly gynecologists – would do the same if they could, if only given the right information.