I swear I begged for it.

October 16, 2011 4:44 PM

I'm sporting some pretty awesome, consensually-obtained bruises in some choice places this week, which I certainly wasn't planning on showing to my doctor. Now I just realized I'm almost out of birth control and need to go for my annual women's health checkup to get more. Am I going to run into any problems? (NSFW)

So, I'm a submissive masochist and my sex life happily involves lots of fun pain play, especially impact play. I was caned hard on Friday night by a wonderful partner, and I'm black and blue all over. My butt and breasts are the most heavily bruised up, but the backs and insides of my thighs are also well marked.

Normally that would be all well and good, but I just realized I'm near the end of my pack of birth control pills and I don't have another one - that was the last pack in my year-long prescription. I always get my pap smear/STD tests/year's worth of birth control at the same time with an NP who I like very much. If I'd realized it was nearly speculum time I would have held off on the caning!

I want to get a new prescription by Thursday, and there's no way these bruises will be gone by then (although they won't look as scary as they do now). I've always tried to avoid letting any doctors see bruises like this, because I figure they just don't need that in their lives. But are there any more serious reasons to avoid it? Will my NP be obliged to do anything about it? Will it be noted on some sort of permanent record? Does it have legal implications? Insurance ones?

If it makes any difference: I'd be totally comfortable warning my NP before I undress that I'm bruised up because I'm a masochist who indulges in impact play. I'm not shy to come out as kinky to her and own the marks, if that will help avert any concerns of abuse.

I could go off birth control for a week or two until the bruises clear up, if I had a compelling reason to hide these marks from the NP. But I'd really rather not because I've been struggling to get my body used to continuous cycling (no periods) for almost a year now, and I don't want to set back the progress I feel like I've finally made in the last couple of months. I suppose another option would be to request a new birth control prescription without the rest of the annual exam, but I'm guessing they'll be reluctant.

This is in Pennsylvania and I'll be going to my university's generally excellent student health clinic.

posted by anonymous to health & fitness (26 answers total)

do not risk going off your birth control because of this.
either ask for a month long extension of your pack, or own it early. S/he may not believe you. They may believe you. They may or may not record this in your record. However, you are not doing anything illegal and the worst thing that may happen ifs that there is a note in your file.

this sounds much easier ot deal with than a fetus because you couldn't own up to your sex life.
posted by wocka wocka wocka at 4:46 PM on October 16, 2011 [3 favorites]

Just tell the truth. Doctors and nurses have seen it all.
posted by Perodicticus potto at 4:48 PM on October 16, 2011 [4 favorites]

Your NP doesn't need to physically examine you before prescribing birth control. You've been doing it all in one appointment for convenience, not because it's a medical necessity. Just tell him or her it's "not a good time" for a full physical, you just need a new prescription. Agree to book in for your check-up at a later date.
posted by embrangled at 4:50 PM on October 16, 2011 [20 favorites]

You could probably also call and ask for an refill, but mention that you're swamped and can't come in for a couple of weeks for the exam, if you don't feel like dealing with it. I've done that MANY times with birth control pills (I didn't realize I was out of refills and I WAS swamped, or going out of town) and it's totally not a big deal. Especially if you make the appointment while you're on the phone asking for the refill, so they know you're not trying to get out of it.
posted by Countess Sandwich at 4:51 PM on October 16, 2011 [25 favorites]

They aren't there to judge you. If they ask, tell them what happened. If you are too embarrassed, call in and ask for a month extension as you will "be out of town" until after thanksgiving. Make an appointment, and everything should be fine.
posted by TheBones at 4:53 PM on October 16, 2011

Agree with Countess Sandwich, my gyno or the nurse will prescribe another month or two of birth control as long as I have made an appointment within the next couple months.
posted by scrubbles at 4:55 PM on October 16, 2011 [3 favorites]

If you've seen the same NP a number of times, and she knows you, she'll be much more likely to take you at your word about the marks. I've had this come up before and my NP (at a generally excellent student health clinic in Pennsylvania...) only chuckled and said, "well, just play safe, ok?"
posted by miagaille at 4:56 PM on October 16, 2011 [1 favorite]

Just seconding that you can almost certainly get them to call in a refill if you make an appt at the same time.
posted by mercredi at 4:57 PM on October 16, 2011

Hey, I'm a med student in Philadelphia. Pennsylvania has mandatory reporting of child abuse, but if you are above the age of 18 there are no statutes mandating domestic violence reporting. This, from the AAOS whose logo looks like the Portal logo.

Pennsylvania
Training: HB 2268, passed in 1998, established the "Domestic Violence Health Care Response Act." This act prescribes how certain "medical advocacy project sites" will be chosen and that each will provide comprehensive training, universal screening and domestic violence educational materials.
Screening: Includes asking patients seeking medical treatment at a hospital, health center or clinic during the course of medical examinations or treatment about the possibility of domestic violence within their relationships, regardless of whether they are suspected to be victims of domestic violence.
Protocol: The medical advocacy projects shall develop and implement uniform multidisciplinary domestic violence policies and procedures which incorporate the roles and responsibilities of all staff who provide ervices or interact with victims of domestic violence, including the identification of victims of domestic violence through universal screening.
Mandatory Reporting: None

In all likelihood your NP is familiar with the existence of the culture, but you may also want to have some informational materials to provide her if you think she might balk-- there are actually quite a few journal articles out there on how to deal with kinky patients. Here's one. Here's a powerpoint.

Bottom line: you're looking, at worst, at a slightly awkward conversation.
posted by The White Hat at 4:59 PM on October 16, 2011 [3 favorites]

The gyno won't do an exam if you say you have your period. Tell the NP you are on it but still need the BC (yes, women CAN get pregnant at that point in their cycle; the nurse at my college said "meet my son" when someone asked that question).
posted by brujita at 5:05 PM on October 16, 2011 [1 favorite]

Your pharmacy should be able to call in and get a refill (in my experience anyway); just plan the appointment for later.

I wouldn't recommend going into your doctor with the bruises even if the law doesn't say they have to report it unless you know your doctor is kink-friendly.

I am not an expert on any of these things though. I just get a lot of prescriptions. :P
posted by NoraReed at 5:37 PM on October 16, 2011 [1 favorite]

If you're upfront and cheery, she won't care. I went into surgery with tons of bruises and have gone to multiple gyn exams with obvious bite marks. It's not ideal but nothing happened.
posted by the young rope-rider at 5:37 PM on October 16, 2011 [1 favorite]

Do you have children? I have an acquaintance who saw her doctor for an injury related to D/S play. The doctor saw her marks, didn't believe her 'play' explanation, and called child protective services - although there is no mandated reporting for domestic violence in my state, there is for child abuse, and the very high correlation between the two was enough to make her doctor make that call.

Dealing with CPS is a nightmare I wouldn't wish on my worst enemy - and dealing with CPS when you live a lifestyle that a hell of a lot of people just don't 'get' would be a hundred times worse. If you have kids, I'd skip this month and switch to condoms for a while.
posted by deadmessenger at 5:54 PM on October 16, 2011 [3 favorites]

Tell them that you're traveling and that you need a month's supply to tide you over until you can come in. My doctor does this for me all the time for meds that I have a long-standing prescription for. I don't really see an upside in having to deal with an (at best) awkward conversation - this is no one's business but your own.
posted by hapax_legomenon at 5:59 PM on October 16, 2011 [3 favorites]

Who cares if they're reluctant? Claim you have your period if you want an easy excuse. I don't see the potential for serious trouble, but medical stuff in the US is complicated and bad, and I wouldn't want to have this awkward conversation and risk having it noted in some way or even just creating potential awkwardness with my NP. The exam can happen another time, and unless you had a previous abnormal pap most medical authorities say you don't really need a smear every year anyway.
posted by crabintheocean at 6:07 PM on October 16, 2011

Call your GYN and tell her that you need a refill but can't get in for an exam before you run out. They will almost certainly call in a refill at your pharmacy assuming you make an appointment within a reasonable time.

Assuming you have been taking this pill with no ill effects, they shouldn't have a problem with this.
posted by thinkingwoman at 6:13 PM on October 16, 2011 [1 favorite]

"I'm not shy to come out as kinky to her and own the marks, if that will help avert any concerns of abuse."

You may well have a super kink-friendly NP who will totally get it, but to many people who don't get it and especially those who make moral judgements, your consent doesn't count and is actually just more evidence of how much you need help. Probably and hopefully not a factor in this situation, but a lesson I have unfortunately learned.
posted by crabintheocean at 6:13 PM on October 16, 2011 [2 favorites]

I graduate this year as an NP, I'm in my residency seeing lots of patients, and I've attended some great seminars about alternative communities, lifestyles, and families. The info I'm passing on is an explanation of general practices for primary care and patient history.

It is correct that a pelvic exam is not required to obtain a BC Rx. However, your office may have a policy that they do require an office visit (to minimally take a history and reconcile your medications. This is for your safety--to make sure nothing has changed that could make a hormonal contraceptive unsafe). Many offices, however, will forward you one pack in the event you make an appointment. Some won't, but it is not meant to inconvenience you financially or otherwise--there really are considerations to take into account, even if you've been on a Rx for some time. Technically, too, if you're taking packs continuously that are labeled for a break, you're taking it off label and so some office policies take that into account, as well.

Also, while any good provider will fully accept a reasonably safe and consensual lifestyle of any kind, they are required to chart physical findings. For example, on little ones, I have had to chart marks left by cultural healing practices that aren't truly causing harm, but redden the skin (poultices, for example). It would be the same with marks that the patient reported were from consensual play. A complete physical description of the marks would be charted, along with your report of their history. The reason? It is technically trauma and if there were complications or future inconsistencies that resulted in your harm and the provider had not charted on them, the provider would bear liability. Further, like a poster commented above, if there are children in your household and your report and the physical findings do not correlate, it would require investigation. Keep in mind, as well, that if the provider felt that your findings and history did not correlate even without other vulnerable members at home--they may determine that you are vulnerable. Their determination of correlation is just that--their own determination.

If you are uncomfortable having the injuries from your play charted on and want to wait to see your NP, you'll need to check in with their policies about Rx extension, or if they will accept a medication reconciliation interview in lieu of an exam for one month. Also, when you see her for your physical exam all healed up, that would be a great opportunity to let her know about your lifestyle if you don't mind it being a part of your history. This establishes precedence in your social history without record of current physical findings, so if you come in at some other time with marks from your play, your NP will likely be much more comfortable correlating them with your report of their history. And if your lifestyle preferences change, you'd want to tell her that, too, so that any future physical findings were not mistakenly attributed to a lifestyle when they were, in fact, injury that required attention. Also, it is your choice to say nothing and balance the issues and considerations on your own.

This is kind of long, I know, but I think it's important to know that alternative friendly providers have the same legal and ethical obligations as ones that would presume to judge or speculate--but the art of providing good care to someone involves transparency and balancing best practices with the individual patient sitting on your exam table.
posted by rumposinc at 6:18 PM on October 16, 2011 [12 favorites]

Not sure if this is a concern for you, but will the exam (in particular I'm thinking of the breast exam) be uncomfortable/painful for you if the bruises haven't healed? If it will be, I definitely second calling and asking for a month of pills and make your appointment for a month from now.

Also some arnica gel might help them heal a bit faster.
posted by pupstocks at 6:31 PM on October 16, 2011

Planned Parenthood offers their H.O.P.E program (Hormonal contraception without Pelvic Exam) at most of their offices, if you are fine with the option of not going to the student health clinic. They generally will work on a sliding scale, so if you're broke it should still be fine to go there.
posted by charmedimsure at 6:39 PM on October 16, 2011 [2 favorites]

Currently I'm not on a machine from which I can easily google this, but I specifically remember hearing that PA is a state where, legally, consensuality does not matter where physical evidence like this is observed by someone who feels the need to report it.

I'd suggest not assuming any given medical professional is kink-friendly, for your partner's sake if nothing else, without more research!
posted by kalapierson at 8:30 PM on October 16, 2011 [1 favorite]

I've been in a similar scenario twice.

Had to go to the ER for something viral--not bruise related!) after some rough sex. Another time had a gyn appointment. Both times the bruising was much less intense than usual, maybe only 5-10 bruises spread over my breasts/butt/thighs. Both the ER doctor and the NP gyn asked me about them and it was a conversation. Awkward but they believed me. (I also live in a larger city and think the providers may have been more likely to be exposed to the situation? Just with the assumed larger #/variety/turnover of patients?) FYI I'm a single lady with no kids.

That said, I've had bruising which I suspect is similar to what you're describing, and honestly I would go out of my way to not go to a doctor in that situation. The bruising/biting marks I've had in those two scenarios were more "standard" vanilla-ish, I think.

Many other folks have suggested just calling for a refill. You should be able to do this, no problem. I've had a new gyn office refill a bc scrip before I even had my first appt with them. Most dr's get how it's a big deal to go without it. Your pharmacist should just be able to call for the refill for you.
posted by manicure12 at 10:03 PM on October 16, 2011 [1 favorite]

***could be triggering for people fighting self-injury***

I don't want to be the bearer of bad news here, but doctors (at least some, haven't met them all so I don't feel comfortable say "all") DO judge you. I get mistreated at the hospital a lot because of really old "self-mutilation" scars... And these are scars I've applied topical shit to unrelentingly 'til they're almost gone.. I can imagine some doctors being very mean about your situation. But I really, really hope yours isn't. They shouldn't, under any circumstances, treat you differently for something you did for (to you) fun. What I did is because I really felt no other option and no control and no way to get out of a bad bad situation and felt THAT upset and trapped. Neither of these feelings should be punished. When I say punished, I mean back when I was still cutting, I had a gash where you could see my guts and bones and the ER turned me away, refusing to stitch it up. My girlfriend went to the Syracuse medical center once after having cut herself (this isn't something fun we do together or anything or, like, for attention, we just came from similar backgrounds which led to similar behaviors.) Anyways, the Syracuse medical center refused to give her numbing shots before they stitched her up because it was "her fault". Refusing to stitch me or numb her is like refusing to pump someone's stomach who has alcohol poisoning. They did that shit to themselves but they still get treatment. It's a widely-held prejudice, but i honestly don't know if it extends to sex stuff or if they would care about bruises. The doctor should (but may not) be understanding, but yeah, you're gonna have a hard time convincing them it's not abuse. Tread very lightly. Hopefully you won't have to convince a social worker that you love these fun sex games and it's not abuse (but like many have said, they might not care or it might not matter if it was consensual or not), but be prepared to do so.

I'd reschedule the appointment.
posted by jitterbug perfume at 1:56 AM on October 17, 2011

That said, I've had bruising which I suspect is similar to what you're describing, and honestly I would go out of my way to not go to a doctor in that situation.

I agree. My partner had to go to the ER once (for a totally unrelated issue) and the doctors freaked out over some pretty mild bruising, much less than what you describe. It was awkward and uncomfortable, she felt totally judged and isolated, and afterwards I realized I was extremely lucky that the police weren't called. Hopefully hers was an unusual case, but since getting a refill by phone is usually no big deal, I'd skip going in this month if you can.
posted by Forktine at 3:18 AM on October 17, 2011 [1 favorite]

Absolutely just go in, get your birth control, and be up front to your NP about your sex life.

You should be able to have a safe and trusting relationship with your care provider, so if you get any attitude about this, it's a good sign that you should seek someone else. Certainly if you ever needed to see a doctor about an accidental injury that you received during impact or other sexual play, it would be important to be able to talk about it frankly.

I've gone to practices with "GLBT Safe Space" stickers in each exam room, which certainly makes me feel more confident in talking to doctors about alternative lifestyle choices in general. If you need to find a new practice, looking for one that advertises being a safe space might be helpful.

(And of course, this might be a non-issue as you may not need the full exam right now anyway.)
posted by sonika at 8:21 AM on October 17, 2011

Just re-read and saw you'd be going to a university health clinic, which implies to me that you probably don't have a child, taking the issue of potential CPS reporting off the table.

University medical providers are more likely than those serving the general public to run be experienced with every single kind of sexuality related (for lack of better word) "issue." They're also very likely not to require exams for Rx refills - the only time I ever had to go in person to get Depo refills at my clinic in college was for my yearly Pap.
posted by sonika at 8:27 AM on October 17, 2011