Can't I just get a pelvic exam over the phone?

June 7, 2011 6:13 PM

Advice needed on: birth control; gynecologists; and confronting the first two as a sexual abuse survivor. Therapist and gyno recommendations in the Seattle area also sought.

I am a 22 year old female currently in a new relationship with my boyfriend of a few weeks. I am not, and have never been, on any type of birth control. We are sporadically using condoms, and more frequently having unprotected sex (though he does withdraw before ejaculating). We do not want to get pregnant, so obviously this is a situation that needs to be rectified by finding a BC option that works for us (which condoms don't seem to be).

This situation is a little complicated for me. I have never had a pelvic exam or been to a gynecologist. I survived a significant amount of sexual abuse as a child and teenager, and I do not want anyone, other than my current partner, touching me. I'm afraid of going to the gynecologist. I am afraid of the exam itself, and more over, afraid I won't be able to get through the exam; that is, I will have a panic attack, be crying, or getting sick during it (I have done all three of these things on a few occasions in the past in really evocative situations). I have a few light scars above my pubis bone and one inside of my leg, which aren't a medical issue at this point, but I'm terrified there is something else wrong as a result of the abuse that they are going to tell me about. I don't have any symptoms or pain that actually suggest in reality there is, but my basic fear is that, after more or less accepting that I will always have certain reminders on my body, I will have another traumatizing experience learning all about other, more significant reminders inside my body. I also can't really talk to people about this, and I don't know how to talk to the doctor about it or how much I will need to disclose.

So I need help figuring out the best way to confront this issue. Beyond this, on a more pragmatic level, I don't know what to seek as far as birth control. I'm worried about side effects, mood swings, gaining weight, or loosing my libido. Can anyone recommend resources for sorting out what the best option is for me? And additionally, do I need to get a pelvic exam to start hormonal BC of some kind? (I realize I should get one regardless).

I was in therapy for a few months, and it was helpful, but I stopped going because... basically, I just did not like it. I addressed this problem in regards to the gynecologist with my therapist, and she was trying to tell me how I should use this as a healing and empowering experience, but she didn't give me much concrete advice on what to do.

Additionally, if anyone here has any recommendations for gynecologists that deal with these sorts of issues regularly in the Seattle area, that would be helpful. And also, based on the fact that I am terrified of the doctor, I should probably think about getting back into therapy... so recommendations for that would be great, too.

Thank you, mefites.

posted by anonymous to Human Relations (27 answers total)

If no one can provide you with a specific practitioner, I would suggest bringing your partner in to a nearby Planned Parenthood. Ask for a birth control consultation for the two of you. You can talk about the available options and whether (and how) to make a pelvic exam work. PP has seen it all.
posted by freshwater at 6:23 PM on June 7, 2011 [3 favorites]

First, condoms every single time! Then thirding PP. Or, if there is a nurse midwife practice in your area, they often provide other women's services in a relaxed yet empowering way.
posted by dawkins_7 at 6:27 PM on June 7, 2011

Would it help to see someone else having a pelvic exam first? If you don't have any friends who are the sort of people who'd be comfortable with someone sitting in on that, it might be close enough to sit in on your boyfriend getting an STD check. A benefit of doing that could be seeing what that particular doctor is like, and if they seem like someone who makes you more, or less, comfortable.
posted by Ashley801 at 6:38 PM on June 7, 2011

I find asking health/mental health professionals you already trust for referrals helpful. That's how I found the OBGYN I've been so happy with. It's also how I found a pulmonologist I was happy with. And a foot doctor, when I needed one, as well. My working theory is that people who are good tend to know who's good. Polling the office for who likes their doctor has not worked nearly as well.

If you made it through that kind of abuse, you much have developed some ability to dis-sociate just to stay sane. Now would be a good time to put it to positive use. This person is not attacking you, not out to get you or use you, and not, at least in theory, doing anything that you do not approve of. S/he is a doctor, checking the plumbing. It requires some level of discomfort, in an area that most people to not have permission to handle. But you are going to give that permission, and they are going to use that permission respectfully, while you do your best to think about other things.

Also, at *ANY* time in the process you can pull the plug --you will not be forced or required to do anything. If you are unable to remove your emotions from the process enough to complete the exam, you DO have the power and their permission to just say stop. Think about that. Think about it *really* hard. Because that is a huge part of why you do not need to react to this the way you would to assault, molestation, or any other abuse.
posted by Ys at 6:41 PM on June 7, 2011 [2 favorites]

OP, at the very least I can vouch for the kindness and easy-going attitude of the Planned Parenthood on Capitol Hill.

I've also reached out to a friend of mine who works at a midwifery clinic -- I'm hoping she might have some names of doctors who have experience with abuse victims/very nervous patients. I'll post back here if she can help me, or please feel free to MeMail me and I will keep you updated that way.

Also, please please please use condoms every time you have sex, at least until you're on another birth control method. Please please please please.
posted by palomar at 6:43 PM on June 7, 2011 [1 favorite]

you must have developed. not "much" have.
posted by Ys at 6:43 PM on June 7, 2011

I am going to point out that going to the gynecologist because you're pregnant is gonna be a whole lot more traumatizing and mandatory than it is right now while (hopefully) you're still not. So even if the condoms don't work for you, please stop with the pulling out, or just stick to oral or something until you get this taken care of, please?

I also recommend going to Planned Parenthood, who by virtue of being PP is probably guaranteed to have nice people, or getting recommendations from your friends.
posted by jenfullmoon at 7:02 PM on June 7, 2011 [4 favorites]

Would it be helpful to make a couple appointments with an OB-Gyn to "talk" before actually getting a pelvic exam? I think that any OB-Gyn worth seeing will be very understanding if you went in, explained your history of sexual abuse and said that you would like to see her (and I am assuming you would probably be more comfortable with a woman than a man, but that may not be the case) a couple of times before getting the exam. The doctor may or may not be willing to give you hormonal birth control without a pap and a pelvic, though. In the meantime, of course, use condoms because the pulling out method is a recipe for pregnancy.
posted by teamnap at 7:15 PM on June 7, 2011 [1 favorite]

First of all, pap tests, pelvic exams, and clinical breast exams have no medical relationship with birth control prescriptions even though they are often done at the same time in the US. The only medical test needed for a birth control prescription is a blood pressure check. So if you are specifically worried about a pelvic exam or pap test, there's actually no reason to have those just to get a birth control prescription. Any provider who requires a pap test or pelvic exam for birth control is manipulative and paternalistic, and not someone you want to see. Pelvic exams are about as relevant to the pill as cholesterol checks are--which is to say, not at all.

Your best bet for a provider is probably either PP or a nurse midwife. If there's a Feminist Women's Health Center in your area, try them too--I know for a fact that the one in my city does not require pelvic exams for birth control.

(Also, withdrawal is as effective as other barrier methods when done correctly.)
posted by Violet Hour at 7:34 PM on June 7, 2011 [4 favorites]

If you've also been a sporadic condom user with other sex partners, or your abuser had an STI and you did not get followup care to test for it, you could be at risk for more than pregnancy. I'm not trying to scare you even more, but you don't want your current consensual, healthy sexual relationship potentially marred by transmitting a disease. Regular pelvic exams are the name of the game for sexually active women, so its not like birth control is the only reason you'll ever need one. You're going to need them for the rest of your sex-having life and beyond, so it's best to reframe it as just that: something responsible people do, like going to the dentist and getting oil changes. Of course it's going to be hard at first but it's something you need to get used to and will get used to, with time and patient doctors.

As for hormonal BC, there are several varieties and I've been on the whole spectrum. There are pills, patches, shots, rings and implants. Some were great, some sucked. A copper IUD sounds like it would be distressing for you, but if you could handle the insertion you'd be baby proof for ten years, and no hormones. I encourage you to do a little of your own reading on legitimate websites like Planned Parenthood and Mayo Clinic. Every single BC method out there has shady stories of horrid side effects somewhere on the internet and you should pretty much ignore those or you'll drive yourself crazy. You have options and many people have to try a few before they find one they like.

Here are a few questions to ask about a prospective doc to see if they will provide a good pelvic exam and be helpful with birth control:

- do they talk through what they're doing? some do this, like they say "now I'm going to take a swab" or whatever before they do it. this makes it so there are no surprises and you feel more in control
- do they warm things up? this is like the "only green M&Ms in the dressing room" of OBGYNs. If they care enough to not use icy cold lube directly on the bits, they're going to take their time with you and listen in general
- are they the sort to push a particular brand of BC pills on all their patients or do they have some patients on less common BC like IUDs, Depo, diaphragms, etc? do they have time to do a detailed interview with you about your preferences to recommend something more likely to work for you? what BC do the docs and nurses at the practice personally use?
- will they schedule extra time for your appointment? you might need it and not feeling rushed will make it go much better
posted by slow graffiti at 7:39 PM on June 7, 2011

slow graffiti, you don't need a pelvic exam to be screened for the standard STIs. Urinalysis and blood tests are just as accurate while being less invasive. She could also self-swab.
posted by Violet Hour at 7:46 PM on June 7, 2011

If there's a Feminist Women's Health Center in your area, try them too

Not quite the same but I received excellent feminist women's health care at the 45th St Clinic in Wallingford. I was given my own speculum to take home and generally felt that they were very woman- and health-positive. They also do mental health there and work with a lot of homeless youth. I suspect they would be very open to birth control without a pelvic or at least having a long talk about it and your concerns before doing anything. They also operate on sliding scale if that is a concern you have.
posted by jessamyn at 7:51 PM on June 7, 2011

Yes, you can probably get BC from a general practitioner without a pelvic. And yes, it's absolutely going to be more upsetting to start on your ob/gyn career when you're pregnant.

Two concrete suggests:

1. You can take someone with you. I've never had a doctor object to this. You can take your boyfriend or a female friend as moral support. You can also ask for a nurse to hold your hand during the procedure if you'd rather go alone.

2. You will not be the first woman the doctor has ever seen who finds a pelvic exam traumatic. It is okay if you cry. Or vomit. Or have a panic attack. Or whatever. If you can, tell the doctor at the beginning of the appointment a little about your history and that you are SUPER SCARED. Most are very sympathetic. If it's appropriate/safe for you, you may be able to have your GP (or the ob/gyn, if you do a pre-appointment with talking) give you an Rx for Xanax or similar to take just before the exam.

You can memail me for a bit more info if you'd like.
posted by Eyebrows McGee at 7:52 PM on June 7, 2011 [1 favorite]

Does it help you any with the discomfort of seeing the doctor for a pelvic exam to know that in most practices, a female nurse will remain in the room during the exam? The nurse wouldn't necessarily need to know your specific circumstance, but just that this is your first exam and you are anxious.
posted by tamitang at 7:52 PM on June 7, 2011

Call your local Planned Parenthood and ask about a HOPE (Hormonal Option without Pelvic Exam) appointment. That was how I started on HBC (I went with NuvaRing at that appointment) -- and then, after I met the ARNP, I decided I was comfortable enough with her to go back and get the pelvic exam a couple of weeks later. At the HOPE appointment, she did a health history, talked to me about the different options and wrote me a script for NuvaRing. (They also sold me NuvaRings there for less than what my insurance copay was.) She encouraged me to come back for a full exam but was very respectful about it. The HOPE appointment was a good experience for me. I hope it is for you too, if that's the way you decide to go.
posted by whatideserve at 8:03 PM on June 7, 2011 [4 favorites]

Some practical things come to mind:

1. Tell the doctor upfront that you are a survivor of abuse. This is usually part of the intake form--be honest about it. You don't have to detail the abuse, just say you were sexually abused and explain whatever you think is relevant to the doctor when you are in the exam room. The gynecologist knows that this is an invasive and anxiety-producing experience even for women with no history of abuse, and will be sensitive to that, but letting her know will help set everyone's expectations.

2. Would it be helpful if you had a female gynecologist examining you? If you are especially nervous, they can bring a nurse in to hold your hand. Or if you have a trusted friend (or even your boyfriend, although that could be awkward), they would allow that too. A good gynecologist will tell you exactly what she is doing before she does it so even if it is uncomfortable, you won't be surprised. It isn't a fun experience, but it only lasts a few minutes. It's okay to cry, if you have to, or say "ouch" or ask her to stop. She will stop.

3. If there is a local sexual abuse survivor's network in your area, they may be able to provide you with referrals to gynecologists who specialize in the care of survivors of abuse. If not, I think Planned Parenthood is a great option. They see everything under the sun and won't judge.

As for your fear of learning that something else is wrong with you: Of course you worry about that--I sure would. But.... assuming you don't have any concrete symptoms, I think if you feel all right, you are almost certainly all right. They may find some benign stuff incidentally--a yeast infection, or a cyst, things almost all women have from time to time--but odds are good that there's nothing left over frm the abuse to worry about. And maybe that would be a reassuring thing to hear from a doctor--to have confirmation that you've healed.

Would it help to have a step-by-step understanding of the process? Memail me and I'll tell you.

Good luck. Please, please be more diligent about birth control while you're working yourself up to this. Getting accidentally pregnant is probably the worst possible introduction to your first pelvic exam.
posted by thinkingwoman at 8:19 PM on June 7, 2011 [3 favorites]

Oh, by the way, I have twice stopped pelvic exams midway through because of pain, and the doctor didn't hate me forever. She stopped immediately, gave me time to collect myself, and asked if I wanted to try again.

Also, if you can't handle the speculum, which is definitely the least fun part of it, you might ask if a smaller pediatric speculum is available. It means they don't get quite as good a look at you, but they can at least get in for the pap smear. If you don't have symptoms to begin with, this is probably a reasonable compromise.
posted by thinkingwoman at 8:26 PM on June 7, 2011 [1 favorite]

I'm going to try not to address the fact that you aren't using birth control.

I'm very happy with my OB/GYN Kelley Hanrahan. She has been exceptionally accommodating to my concerns, for instance pain (yes, there are topical analgesics available for pelvic exams – even if it's just irrational fear of pain), and others that are not relevant to this discussion, etc. You may have to schedule a couple of months ahead to get an annual exam with her, unless you ask to be notified of cancellations.

Meanwhile, follow the suggestions of others above and get on birth control now or use a condom every single time.
posted by halogen at 8:37 PM on June 7, 2011

Mod note: this is not an argument about birth control and not a forum for getting in arguments - please MeMail people if you want to talk with them directly, thank you.
posted by jessamyn (staff) at 9:09 PM on June 7, 2011

Where I am (New Mexico) we seem to not have all that many gynos; so a lot of us get general pelvic exams done by our GPs. If you have a GP that you like you might look into doing that. (If not, ignore this.)
posted by NoraReed at 9:48 PM on June 7, 2011

The King County Sexual Assault Resource Center is going to be able to help you with the kind of referral you're asking for. And I don't know if the therapist you saw specialized in abuse, but KCSARC can likely assist you in finding someone that will be able to give you concrete suggestions.

There are national hotlines as well (1-800-656-HOPE, for example) that might be able to make referrals, but KCSARC is local, and will know local resources.

Good luck!
posted by Gorgik at 9:57 PM on June 7, 2011

Bring your partner with you. I think if comes with you and holds your hand you will be able to get through it.
posted by bananafish at 11:55 PM on June 7, 2011

Agree with bananafish; bring your partner with you. Although not a survivor of sexual abuse, I am incredibly anxious about doctors, so I put off getting my yearly exam for... over ten years. But this year, I finally pushed myself to do it, and saw Dr. Miller in Ballard, who was perfect for an anxious patient like myself. She has a calm, comforting bedside manner, and patiently talked me through the entire process. She was very compassionate, and never made me feel rushed. I feel -- no, I know -- I can see her next year for my exam, no problem. Good luck to you!
posted by polyester.lumberjack at 1:41 AM on June 8, 2011

Good for you - you are super-brave and super-responsible for taking charge of your sexual, reproductive and mental health. Anonymous you may be, but I'm proud of you nonetheless.

I n-th the Planned Parenthood recommendation. Finding centres near you.

As well, Harborview Medical Centre has a specialty centre that will, I am sure, be able to recommend excellent psych folks and excellent gynecologists.

About the disclosure piece: in order to get a GYN with specific training in working with survivors of sexual assault, you will have to ask for one. But Planned Parenthood lets you make appointments online, and the software lets you provide information about yourself, your needs for that appointment and your general health, which provides you an alternative to talking aloud about it, if that's a particular challenge for you. Or you can have your partner explain and make the appointment for you.

I don't know how much you know about what actually happens during the exam, but this is a very simple illustrated guide. I know you're considerably older than the intended audience, but it can be hard to absorb information under stress, and so I thought maybe it would be more accessible and so easier to use to prepare yourself. Being prepared is key to feeling in control of this situation.
posted by gingerest at 1:48 AM on June 8, 2011

Just jumping in to nth talking to the person performing the exam before anything starts (in a separate appointment if you'd like) and explaining your history and that you are super scared. I hope sharing the following is helpful to you, OP: I, too, have severe pelvic pain problems and a lot of fear and terror associated with going to the gyno. I, too, avoid it, but I have done the exam several times, and I lived through it. When I go to the gyno, I cry and tremble and generally freak out. The practitioner always just tries to make everything go as fast as possible and communicates with me about everything she's doing the whole time. I mean, it's not my favorite thing to do by any stretch, but I do get through it and you will, too.

It helps me to:

1. NOT hold back any tears or shakes or other symptoms/discharge from feeling fear or anxiety

2. practice deep breathing during the exam, remind myself that the dr is there to help me, not hurt me, etc

3. have something lined up to do afterwards that I really like, like going out for a huge slice of cake or whatever

4. remember you can stop at any time. Just say to stop. It's a totally safe environment. I've never had to stop a regular pelvic exam, but one time I tried to be fitted for a diaphragm and the pain was so bad that we couldn't finish the fitting. It was no big deal, I just told my doctor we had to stop and she said no problem, let's just come up with some other option for you.

I've not tried having anyone go with me into the exam room or having a nurse hold my hand, but I think either or both of those things could potentially be helpful.

Good luck with this.
posted by pupstocks at 6:49 PM on June 8, 2011 [1 favorite]

I know a great therapist, but it feels odd to put her name and number out here in public. Could you e-mail or Me-mail me, and I'll send it to you? Or, I don't know, e-mail a mod and ask them to ask me for you, if that feels more secure?
posted by The corpse in the library at 1:56 PM on June 9, 2011

1. I would recommend you to find a pediatric gynecologist who'd be willing to see you, given the circumstances. Many of them have seen childhood sexual abuse, and are gentle practitioners with such cases.

If that's not possible,

2. Can you get recommendations from friends for gynecologists they've found to be empathetic and gentle?
3. Would it help you to have a friend there with you? If so, can you ask the front desk if they permit that?
4. You would probably benefit from prolonged exposure or trauma focused CBT, specifically, so if you were to find another therapist, I would recommend seeking that out specifically.
posted by namesarehard at 2:32 PM on June 10, 2011