You're Just A Fatty McFatterson Whining About Pain.
May 1, 2014 10:55 AM   Subscribe

Pap test anxiety! How do you cope with having to get a pap test and get the results you want out of the appointment when you have a history of really crappy dismissive doctors? (abuse/gender complications).

(Canadian small town so I have no choice about choosing the OB/GYN available)

I have been referred to an OB/GYN to find something that will completely stop my periods and seek out relief for mood swings. I have med resistance depression and am a child abuse victim as well as being gender fluid. My periods cause a lot of anxiety and are sometimes triggering for my PTSD (as well as my periods are just getting heavier and more painful as I get older).

My shrink told me to just get the shot. My GP doesn't want to do that because of it affecting my moods. He referred me to the OB/GYN to see about getting an abalation to help but reading up on that it seems to do nothing hormonally. I want to make the most of the appointment but am nervous about being dismissed if I reveal too much. As well as the idea of pap tests are triggering in themselves.

Over the years I have had my menstrual issues dismissed by various doctors because of my depression or being too fat. I have been told it is in my head. That it is a weight issue. That every woman feels pain and I should suck it up. That the woman doctor didn't have bad problems so certainly I am malingering when I say I am bent over in pain and bleeding through layers of clothes. I have had people shadowing the doctor invited in to take a look. And repeatedly been ignored about my actual problem and have the doctor harp on that I have lumpy breasts and mention them ten times in an appointment. Heck, once I got told off for leaving my clothes on the floor at a walk on clinic.

And this was before I had memories of abuse and was diagnosed with PTSD and figured out my gender issues.

How can I manage my anxiety at the appointment and not just be written off as a crazy whining woman? I have never met this doctor and have no other options but to see him.

Is an abalation the best choice in this situation (YNMD)? Are there other options I should bring up with him? Do I mention the abuse/gender or will that get me written off? The depression? Am I making a big deal out of nothing?
posted by kanata to Health & Fitness (17 answers total) 3 users marked this as a favorite
I recommend -- if possible -- doing a clothes-on, talking only appointment with the OB/GYN first. Talk through what's going on, see how you feel about him in conversation. If he is making you very uncomfortable, is dismissive, etc, then you don't have to go forward through the examination. You do have other options -- they're not great, they involve hard scheduling and traveling, but you are likely able to get to Vancouver or wherever where there are more options, and if this GYN won't be helpful anyway, then this isn't an option either.

But don't go in there assuming he'll be bad -- he might be great, lots of GYNs are! Let him tell you what kind he is.
posted by brainmouse at 11:10 AM on May 1, 2014 [2 favorites]

Could you ask your shrink or GP to talk to the ob-gyn about your medical history and the PTSD before your appt? The obgyn may take it more seriously coming from another doctor (which is shitty but what can you do).

Good luck.
posted by matildatakesovertheworld at 11:15 AM on May 1, 2014 [1 favorite]

Call the doctor's office and when you speak to the nurse or scheduler, say, "I am an abuse victim and I know I need to get this pap test -- I want to get it done -- but gynecological exams can be triggering of PTSD and trauma for me, and in the past I've had doctors really dismissive of my abuse and fear." Then talk to the person about your options. If it's just a scheduler you should probably ask if a nurse or the doctor can call you back, but if it's a nurse you should probably be able to have a conversation about it, where the nurse can reassure you that the doctor doesn't suck, that they'll make a note on your record, how they usually handle this sort of thing, etc. Two very common things are having the doctor prescribe a dose of Xanax or similar to be taken just before the appointment (which may or may not be appropriate for you depending on meds/depression/etc, but is an option), and having a nurse in to hold your hand during the exam and talk you through it if that will help you, which nurses actually do ALL THE TIME and is not even a little weird to ask for. (And in the U.S. it's usually a patient's right to have a second medical professional present during pelvic exams if they ask for it; I imagine it's the same in Canada.)

(You don't mention a romantic partner, but it's also pretty normal to have a romantic partner come with and stand up by your head and hold your hand during the exam, if you'd prefer that.)

When you go in for your appointment, remind the nurse or doctor, ideally before you take your clothes off (when they do blood pressure and whatnot) so you feel less vulnerable, that you're an abuse survivor and VERY ANXIOUS about this appointment.

I know nothing about your specifics, but I have friends who have had ablation help a lot for period pain (don't know about hormones/depression). Personally I would just be up front and say, "My shrink wants me to see if I can get [this shot], because my depression is really responsive to my hormones, and the periods alone cause me a lot of anxiety. My GP referred me here and talked about ablation. I talked to my shrink and my GP and read up a little bit, and I think I'd rather have the shot if that's appropriate?" Also your shrink should really be able to advocate for you with the ob/gyn if the ob/gyn isn't sure. ("Can I have my psychiatrist call you? Because he really felt the shot was important for my treatment.")

And, yeah, what brainmouse and matilda said.

("That the woman doctor didn't have bad problems so certainly I am malingering when I say I am bent over in pain and bleeding through layers of clothes." -- there is a small but definite subset of female ob/gyns who are ABSOLUTE SHIT about women with menstrual pain because THEY don't have menstrual pain and can't imagine other women do, you are not alone in this experience.)
posted by Eyebrows McGee at 11:16 AM on May 1, 2014 [10 favorites]

Do you have a close enough friend who can go with you, stay in the room with you, and advocate in case you freeze up? Or, as brainmouse suggested, have a clothes-on meeting and bring a friend to that?

Feel free to write out what you want to talk about before you go in. You are not going to be graded on your extemporaneous speaking. Do keep it efficient - stick to bullet points and decide with the doctor what needs to be discussed in more detail.

I would also suggest proposing to the doctor that you get the pap test and bloodwork first and have the more in-depth conversation after the results come back. What can and should be done for your best results is going to vary depending on your endocrinological situation. DO front-load the conversation about being a survivor of abuse and high-anxiety. But maybe have the conversation about ablation/whatever methodology the two of you end up deciding on after you've talked about thyroid etc.
posted by Lyn Never at 11:24 AM on May 1, 2014

I had to look for options on getting rid of periods as completely as possible. For several years I was on continuous birth control, then I switched to the "mini pill" as a test/precursor to getting the Mirena IUD. It hasn't 100% stopped everything, but OMG SO MUCH BETTER. It is a minimal amount of hormones (progesterone only), and lasts for 5 years. I didn't want to do the shot because if I reacted badly to it, I had no way to get it out of my system. I would caution away from the shot, as I have known a LOT of people who had extreme mood issues on it.

Regarding the doctor, I don't have much to add. I found that in small towns I got a lot more shit from my docs, and in the city I'm in now, mine has been awesome and not shaming and doesn't seem to care in the slightest about my genderqueer presentation. If at all possible, do the clothes-on visit, and if they seem concerning, try to go to a larger city.
posted by HermitDog at 11:24 AM on May 1, 2014 [1 favorite]

I'm also attempting to get rid of my periods, have had severe mood swings with hormones, and have tried several options -- crossing my fingers on the NuvaRing at the moment. There is no way I'd go for the shot first, just because there's no way to stop taking it if you react badly to it, you've just got to wait for it to wear out and that sounds awful.

This was really a red flag for me: "I am bent over in pain and bleeding through layers of clothes." Has anyone considered endometriosis might be an issue for you? You should not have life-stopping pain with periods -- it's just not normal, though doctors will sometimes wave it off as being dramatic or whatever.

Big hugs to you. Remember that you're doing this so you can get to the bottom of this and get some help. I hope this goes well for you.
posted by fiercecupcake at 11:52 AM on May 1, 2014

What about seeing a midwife? (Some are assholes, yeah.) I love the midwives I have seen and who delivered my kids. I would just never go to a male gynecologist (after a horrible experience.) I don't understand why most women do. I don't get it. If I don't have access to a midwife I would go to Planned Parenthood or to a female nurse practitioner who does gyn exams.
posted by cda at 12:01 PM on May 1, 2014 [1 favorite]

Others have offered great advice. I have had similar issues with getting pap smears done due a being raped as a teenager. I have found having the nurse stay in with me, away from the business end and hold my hand very helpful. I actually bought it up with the nurse that came in to take my details before hand and she arranged with the doctor to be there.

I do have to say I sympathize with you about how terribly dismissive US doctors seem to be as I have had several such visits since moving her to the US. The last was a visit where the doctor tried to fob me off with a non answer. I found snapping, could you try that again without the condescension very effective as I don't think he was used to people talking back.

Next time I go,I plan to do what others here have suggested and make clear to the doctor up front that I consider this a serious problem and I want a serious solution not a hand waving. A clothes on initial visit is a great idea so you can sit down and make sure you are clear on everything with the doctor and happy with them. No one is in a great state of mind after laying there with their feet in stirrups.
posted by wwax at 12:24 PM on May 1, 2014

I recommend doing some reading about endometriosis and ovarian cysts if you haven't already -- I, too, bled through my clothes for days and was told by a male doc that it was "just a heavy period."

I then went to the emergency room and expelled so much blood and tissue into a kidney dish that they had to check me out. If that's an option for you, do consider it -- you are likely to be taken seriously there.

If you aren't doing it already, keep a daily chart of your cycle and flow, including the days on which the pain/bleeding is worst. Use the 1-10 pain scale, where 1 is no pain and 10 is excruciating -- when I showed a newer ob/gyn that mine had been at 7-8 for a month, she got me in immediately for a scan that showed a ruptured ovarian cyst.
posted by vickyverky at 12:29 PM on May 1, 2014

If your location is the same as in your profile, I see you have a Planned Parenthood in your town. I'm hoping that's not where you've been treated so badly. If it isn't, I hope you can try to talk to someone there.
posted by vickyverky at 12:31 PM on May 1, 2014

There are many potential ways to try to avoid getting or lessen the heaviness of your periods using hormonal contraceptives aside from Depo Provera. You may want to start by trying something you can easily stop taking if you find it's giving you side effects. I would recommend going in with an open mind and asking your physician what options might be best for you.

I suspect they will not recommend ablation off the bat, because it is invasive and irreversible. You also cannot do it if you ever might want to bear children, although maybe that's not a concern. They will probably recommend trying some other things first and then discussing ablation if you find the other options aren't working for you.

As a physician I would absolutely respect it if you told me you had a history of abuse and struggled with pelvic exams. Most physicians have encountered women who have such issues before and should know how to deal with them in a courteous and accommodating way to minimize the stress - obviously not all do, based on what I've heard, but I definitely think you should be up front about it. Be sure to check up on the latest guidelines for Pap testing - new recommendations have decreased the frequency which most women need to get these tests done, depending on history of normal tests/if you are sexually active with new partners, etc.
posted by treehorn+bunny at 8:59 PM on May 1, 2014

Is it possible for you to ask your shrink to liaise directly with your GP, either by writing or phone call, and for them to discuss your requirements with each other, instead of making you run a little relay between all these doctors, trying to find the best treatment? Ideally your doctors should be working more or less in concert for your benefit, not seconding guessing and contradicting one another. Your shrink should be able to communicate with the OB/GYN, too, or the referring GP could, to outline the particulars of your case, in order that you should receive the best care possible.

You can never tell what doctors are going to be awesome, and which terrible. I think a lot of female doctors, perhaps especially OB/GYNs are sometimes very callous as a result of studying for years with less than sympathetic male doctors. On the other hand, the most respectful, gentle and non weird doctor I ever had was a gay man.
posted by Kaleidoscope at 12:30 AM on May 2, 2014

Seconding the advice for a clothes-on visit first to assess the doctor, and also writing a list of questions and/or details you want to bring up so you can check it if you start to get anxious.

I use an implant (Implanon) and it has stopped my periods after a few months. It has the advantage of being able to be removed in a 5-minute process if for any reason you react to it or change your mind. Just another option to look into in case it's useful to you.
posted by harriet vane at 5:10 AM on May 2, 2014

As for the weight issue, as a fat person who feared getting crap from my doctors about it, I found an approach that worked for me was to bring my weight up first. I'd say something about how I was trying to manage my weight and ask for suggestions. At least in my experience, it changes the tone of the conversation, and it seems that doctors have been more supportive.

Also, have you ever been tested for polycystic ovary syndrome? It can cause heavy periods and can make it quite difficult to lose weight.

I'm not sure if this would be an option for you, but could you see an ob/gyn who specialized in pediatrics? I saw one as a teenager when my GP referred me to one after I explained that I was absolutely terrified of an exam. I remember she addressed my fears about having an exam during a lengthy (clothes-on) consultation, allowed me to have someone in the room with me, and took my complaints of pain seriously.
posted by inertia at 7:45 AM on May 2, 2014

I'm sorry I don't have more constructive advice, but as someone else who has a really hard time with gyno appointments due to gender issues, I wanna give you like forty hugs. My doctor has woman-targeted advertisments for facial peels and Avon products and "weight loss systems" and the whole thing makes me weepy. I'm too shy to say anything (you'd think my huge BOY / GIRL tattoos on my legs might give it away) because I just want to get it over with.

How can I manage my anxiety at the appointment

Make the appointment for your day off (trying to do this on a lunchbreak, oh god) and plan a special treat for afterward. Go to the park and have a good cry, take yourself out for lunch, go record shopping, see a movie - have a plan for once it's over that you can focus on to get through the appointment.
posted by Juliet Banana at 8:28 AM on May 2, 2014

Thanks everyone. I took your advice to heart and thought of it today when I had my appointment. No options for booking it myself. This one was different from the last OB/GYN I was referred to in that I had to fill out a detailed form so felt strong enough to mention the abuse and triggering aspects of my periods (leaving out the gender issues as it is a small town). And we talked long enough with clothes on beforehand that I felt like going through with it.

The exam was OK. I teared up a bit but focused on my breathing. Unfortunately I dissociated heavily afterwards and the medicine he recommended (Zoladex) I couldn't really ask questions about. It isn't covered by my insurance and they are waiting for governmental approval but I have an appointment in two weeks and since I won't have the papsmear hanging over my head should be able to ask further questions.

Right now I am in huge amounts of vaginal pain which I am unsure if is normal since it has been years since I had one. Hopefully it is just related to it bringing up trauma memories and the discomfort of the gender issue.
posted by kanata at 8:30 PM on May 2, 2014

Its possible the pain is from your past trauma. I use to have (and I'm sure I'll have them again since I'm scheduled for my first pap in ages) what my therapist called body memories.

Right now you need to be kind to yourself as much as possible. It's hell :(
posted by kathrynm at 9:08 AM on May 3, 2014

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