Shit Doctors Say
‘ Doctors have said some seriously bullshit things to me.’
‘…[today] the American College of Obstetricians and Gynecologists, backed away from that firm stance [promoting routine pelvic exams], acknowledging there is little to no evidence that the exam benefits asymptomatic women.’
–STAT, 2012.06.28 [2]
So, first we learnt that we didn’t need all the mammograms we were getting [1], and now pelvic exams for healthy women are of no benefit [2]. Until now, it’d never occurred to me to question this — you’re female, you get pelvic exams — because cancer, right? (Never mind that this is pretty traumatic for many girls entering womanhood.)
What’s going on here, anyway? When did this get started? And why? Because lady parts?
Only now does it occur to me: men get cancer too, and no one ever suggested that when boys turn 16 they should start going in annually to get their boy parts fondled.
Doctors. Ugh.
Doctors have said some seriously bullshit things to me.
I’ve had a few pelvic exams. Actually, I had the Mother of all pelvic exams when I had my vaginoplasty. This was 1989 and this was in Belgium. I grew up in France and the UK, so I’m fluent in both those languages. But the staff couldn’t seem to ‘get it’, and often replied in English, even as I addressed them in French. Weird. I think because they got so many American girls coming over and heard us conversing in English, they just got used to treating French as a secret code. Anyway, that’s how I knew, in the end, what’d really happened with my surgery. Afterward, as I was incapacitated in my bed — so sick — I could overhear the doctor and nurses discussing me.
He’d nearly killed me. He’d nicked something that was somewhere he’d not anticipated, and I’d nearly bled out [3]. This was before HIV screening, and the blood supply was insecure, so they did major surgery on me without any blood racked up. I was sick because I’d lost a large fraction of my blood volume before he got things under control. And I know by the somewhat unsatisfactory results that he rushed the job he did on me. He screwed up.
Oh, he never told me, of course (that he knew of). Once I got my strength back and was being discharged, I confronted him about it (in French). He brushed me off, with haughty irritation (in English). He also said this:
‘God made you a man, but I made you a woman.’
No shit, he actually said that. After screwing up and nearly taking my life from me. I was dumbstruck. There was no point — I just left.
A year before that I’d started hormones, using an endocrinologist other trans women were seeing. He had me on a low dose of oral conjugated oestrogen for a while, and nothing much was happening. I found out about another endo who had actually done research with trans women. She was really hard to get in to — not taking new patients, officially — but I got in somehow. I’m annoyingly persistent.
She was scornful of the treatment I was on. Come to find out, much higher levels of oestradiol are needed to counteract the effects of testosterone [4,5], levels not safe with standard oral oestrogen (due to liver toxicity), and I also should’ve been on a testosterone blocker. The guy who was treating the trans women I knew wasn’t doing his reading, and didn’t know his business.
My new endo put me on oral spironolactone [4], and liquid oestradiol to be injected into large muscle with a needle like a spike. Things started to happen after that.
After surgery my endo did my post-op care. When I asked if there was a need for on-going pap smears for a trans woman, she said, honestly, no one knew [6]. Better safe than sorry. And so the annual pelvic exams commenced.
A few years later my doctor moved away and I had to find another. When the time came, I made an appointment with a gynaecologist, choosing a woman practitioner. I was quite clear about my post-op trans status, to be sure she was OK with seeing me.
Everything seemed fine at first, but as she was doing the actual exam she started acting oddly. She seemed to be having trouble getting a sample and was causing a fair bit of pain. I asked if everything was OK?
‘I don’t even know why I’m doing this; this isn’t a real cervix anyway.’
And, legs in stirrups, all I could think was: But I’m real.
I’ve not had a pelvic exam since. Evidently I don’t need one.
Doctors. Ugh.
Notes
I have written about transfeminine medical transition, with a detailed list of considerations and some advice. I have also recounted my experiences of transition during the 1980s and have discussed hormone therapy.
To those taking hormones [4,5]: As with all medical care you agree to, do your research. Google it, read a lot, talk to others, get a second opinion, trust your gut, look for empathy. I strongly advise getting a second opinion. Trust but verify.
To those considering vaginoplasty [7,8]: Don’t let my experience frighten you — this happened long ago, the surgeon in question is deceased, and I am OK — everything ‘works’ fine now. Today’s GRS procedures are far advanced over those of 30 years ago, and you should be safe in the hands of an experienced surgeon.
To those considering breast augmentation [9]: Use a surgeon who specialises in working with trans women — it can be somewhat different skillset to working with cis women. [10] Also, should you end up with ‘tuberous breasts’, as sometimes happens with both cis and trans women, there is a fix for that: Google ‘tuberous breast correction’.
References
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