Pap Smears I Have Known

Mollyblessingway 027

Photo by Karen Orozco, Portraits and Paws Photography

Your body is your own. This may seem obvious. But to inhabit your physical self fully, with no apology, is a true act of power.”

–Camille Maurine (Meditation Secrets for Women)

“I used to have fantasies…about women in a state of revolution. I saw them getting up out of their beds and refusing the knife, refusing to be tied down, refusing to submit…Women’s health care will not improve until women reject the present system and begin instead to develop less destructive means of creating and maintaining a state of wellness.”

Dr. Michelle Harrison (A Woman in Residence)

One afternoon at the skating rink for homeschool playgroup, a few of my friends sit in a hard plastic booth and the conversation turns to pap smears and pelvic exams. Later, I read Michele Freyhauf’s post about her hysterectomy experience and the skating rink pap smear stories come back to me with vivid clarity.  Being a woman is such an embodied experience and we have so many stories to tell through and of our bodies. During my conversation with my friends, I warn them: watch for my new one-woman show…Pap Smears I Have Known. At the time, several other friends are preparing for a local production of the Vagina Monologues and I have a vision: The Pap Smear Diaries. But, really, how often do we have a chance to tell our Pap smear stories, our pelvic exam stories? Where are they in our culture and do they matter?

Three experiences come to mind as I talk with my friends…

1999. I am married, twenty years old, and a graduate student. I go to the student health center for my annual exam. As I walk up to the door and place my hand on the handle, I feel this intense, visceral reaction in my body of wanting to run away. For a few moments, I can’t open the door, instead I think only of fleeing. The thought comes to me: I’m going in here to volunteer to be assaulted. Having to undergo a routine pelvic exam and pap smear as a condition of having access to birth control pills feels like a routine humiliation, like a ritual of physical invasion and “punishment” designed to shame young women who dare to have sex.

This is MY BODY.

2003. In my Type-A way, I head to a doctor for a “preconception visit” before my husband and I begin to try to conceive our first baby. This appointment is at a birth center in which you wear flowery housegowns instead of paper dresses. When the doctor touches me (she asks permission first), I flinch and recoil slightly. She looks at me with surprise: “haven’t you ever had a pap smear before?” I am intensely embarrassed because I know what she is thinking: she is thinking I must have been sexually abused and she is probably writing that on my chart right now. I haven’t been sexually abused, though I’ve spent my formative late teens and early twenties working in domestic violence and sexual assault centers. I’m not sure why this feels so embarrassing to me, and I also still wonder, isn’t it actually more normal to flinch when a stranger pushes their hand into your body than to be totally cool with it? Later at this birth center, I give birth to my first son. In what will eventually be six pregnancies, I only experience a single pelvic exam ever while pregnant, during his birth immediately before pushing. This is good. I prefer hands kept outside my body. After his birth, clots form in my uterus and prevent it from clamping down properly. The doctor does a manual exploration of my uterus to remove the clots. I scream out at first with the pain of this invasion and then hum my Woman Am I blessingway chant in order to cope.

This is MY UTERUS. March 2014 082

2009. My third baby has died unexpectedly during my second trimester. I give birth to him at home alone with just my husband. The baby’s birth is surprisingly peaceful and empowering, but then the clots come, eventually the size of grapefruits. When I become unable to distinguish whether I am fainting from the unbelievable sight of so much blood or dying from the loss of it, I ask to go to the emergency room. The ER doctor tries to examine me to see if I am hemorrhaging, but she only has a child-sized speculum. She is unable to get her hand inside me because of the clots in the way. She puts the miniature speculum in over and over and it keeps flopping out because it is too small for me. I have never been so miserable. “This wouldn’t hurt so much if you’d stop moving around so much,” she says in an irritated voice. When she leaves the room, she leaves bloody handprints streaked along the sides of the bed and my blood in a puddle on the floor.

This is MY BLOOD. 

“…no woman is powerful, no woman has ‘come a long way baby’ when she’s made into medical mincemeat when giving birth. No woman is powerful when she lies on her back and flops her knees open for stranger’s fingers and casual observation.”

Leilah McCracken, Resexualizing Childbirth, quoted in Birthdance, Earthdance, master’s thesis by Nané Jordan (p. 58)

This February, I attend the local production of The Vagina Monologues performed by several of my friends before an encouragingly full theater in our small Midwestern town. One of them delivers a powerful portrayal of “My Angry Vagina.”  She is amazing and intense and angry as she stomps across the stage:

“…why the steel stirrups, the mean cold duck lips they shove inside you? What’s that? My vagina’s angry about those visits…Don’t you hate that? ‘Scoot down. Relax your vagina.’ Why? So you can shove mean cold duck lips inside it. I don’t think so.  Why can’t they find some nice delicious purple velvet and wrap it around me, lay me down on some feathery cotton spread, put on some nice friendly pink or blue gloves, and rest my feet in some fur covered stirrups?”

During my pregnancy with my daughter three years ago, I buy urinalysis strips on the internet and keep track of the protein, sugar, and leukocytes level in my urine. I monitor my blood pressure in the pharmacy section of the grocery store. I buy a Doppler and check her heartbeat myself. When I find myself continually worried about what I will do if she is not breathing at birth, I travel to a city several hours away and become certified in neonatal resuscitation. I buy a neonatal resuscitation bag and show my husband and mother how to use it. After she is March 2014 116born, breathing well, in wild, sweet relief into my own hands in my living room, I drink liquid chlorophyll to rebuild my blood supply and I ingest my own placenta dehydrated in little capsules prepared by my doula.

An acquaintance comes to me complaining that her insurance company does not cover her prenatal visits and she is tired of paying more than $100 for a five minute visit while they check her urine and the baby’s heartbeat. I feel a little nervous about it, but I pass her my Doppler and my leftover urinalysis test strips on the front porch of my little UU church. Later, she tells me how empowering it is to take care of these responsibilities herself, rather than going to the doctor for something she is perfectly capable of doing. Another friend borrows my Doppler several times to check heartbeats for other friends—sometimes with good news and sometimes with bad news—and in January of this year I have the honor and privilege of finding my brother and sister-in-law’s first baby’s heartbeat for the first time.

My friend asks to borrow my neonatal resuscitation equipment in case she needs it for a birth she is attending (it has already been to several other friends’ houses during their births). I tell her, “I love black-market health care,” and pass it to her furtively at the bowling alley.

Later, I reflect that it isn’t black-market healthcare that I love, it is women taking care of each other and themselves. I love empowered self-care. I love feminist healthcare, though it has yet to exist on a systemic level in this country, and I love the possibility and potential found in taking the care of our bodies into our own hands whenever we can.

I have yet to invest in any speculums, but maybe I should. And, purple velvet.

This post was previously published on Feminism and Religion.

One thought on “Pap Smears I Have Known

  1. I stumbled upon your website and this article caught my eye. Your comments are very interesting.
    There seems to be an attitude in the medical world that because women can/may have children, we should just accept invasive tests, we sometimes read that women “need to get used” to these exams.
    It’s for our own good etc. In fact, almost all of these procedures and tests are unnecessary and simply expose us to risk. Sadly, many women don’t take the time to do some research (or don’t have the time) or don’t suspect they’re being misled and don’t get to the evidence.
    The routine pelvic exam is not recommended at all at any age in an asymptomatic woman, it was scrapped in Australia many years ago. If a doctor suggested such a thing, I’d leave assuming she was incompetent and I’d probably report her, she needs a refresher.
    Every screening test/exam exposes us to risk and that’s why the law and decent ethical standards says it’s our choice, our informed consent is a requirement for all screening. IMO, women have been denied not only informed consent, but even consent itself. (you need a pap test, breast and pelvic exam if you want the Pill – not true, your medical history and a BPT are the only clinical requirements)
    I know medical coercion around the Pill is still a problem in the States and Canada.

    Pap testing – has been horribly overdone resulting in huge levels of excess biopsies and potentially harmful over-treatment. The States and Australia probably lead the world when it comes to over-screening. Here in Australia the lifetime risk of cc is 0.65%, it was always a fairly rare cancer, the lifetime risk of colposcopy/biopsy is a huge and hidden 77%.
    Over-treatment can damage the cervix and lead to infertility, miscarriages, high risk pregnancy, premature babies, the need for c-sections and cervical cerclage etc.
    It should be a scandal that so many women have been negatively impacted by this testing, to help so few…and it was mostly unnecessary, we should have followed the evidence and put women first. (ahead of vested interests who make a fortune from excess)

    The Finns have had since the 1960s (so this is not new evidence) a 7 pap test program, 5 yearly from 30 to 60, they have both the lowest rates of cc in the world and refer FAR fewer women for colposcopy/biopsy/over-treatment. (fewer false positives)
    The Dutch had the same program but will shortly scrap their 7 pap test programs and offer instead 5 HPV primary tests or self-test with the Delphi Screener at ages 30,35,40,50 and 60 and ONLY the roughly 5% who are HPV+ will be offered a 5 yearly pap test. (until they clear the virus)
    This saves more lives and takes most women out of pap testing and harms way. Those HPV- and no longer sexually active or confidently monogamous may choose to stop all further testing.

    Routine breast exams: no evidence of benefit, but they lead to excess biopsies
    Mammograms – please do your research, the Nordic Cochrane Institute have an excellent summary of REAL information on their website. It’s concerning, about 50% of screen detected breast cancers are over-diagnosed and any benefit of screening is wiped away by those who die from heart attacks and lung cancer after treatments. The NCI is an independent, not for profit, highly regarded, medical research group.

    The routine rectal, recto-vaginal, visual inspection of the genitalia, TVU are also, not recommended and simply expose you to risk.

    I rejected pap testing many years ago, as a low risk woman I was content with my near zero risk of cc rather than the MUCH higher risk of a false positive and over-treatment. I’m not prepared to accept much risk at all to screen for a rare event. I now understand I’d be HPV-, not at risk, and cannot benefit from pap testing. More recently (when I turned 50) I declined mammograms.

    I value my health, quality of life and my bodily autonomy, I so agree with you, our body, our choice. I also, believe the best decisions are informed decisions, my GP respects my right to choose and has simply made a note on my file. Women cannot trust the official discourse on screening, we need to tread carefully, these “simple” tests can and do harm lots of women, they may even take our life.
    I know childbirth can be a traumatic experience, some of the Birth Trauma website accounts are the stuff of nightmares. More needs to be done to provide women with respectful, low/no intervention options.

    Best Wishes
    Elizabeth

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