Not your mom's gyno visit

—queer and curious edition: 

First of all, my title isn’t meant to be a trigger, and I’m sorry if it is for you.  I know that not everyone has a mom in their lives, some for not-so-great reasons, some because they have two dads, some because families are different in many ways.  But we haven’t figured out how to hatch people in a lab and incubate them, so some woman carried you and birthed you, and hopefully had a great obstetrician/gynecologist (OB/GYN, or gyno) along the way. 

That’s what I did when I could practice: I was an OB/GYN.   One of the things that I miss is seeing a young woman who is terrified for her first visit to the gyno, talking her through it, and hearing at the end, “That wasn’t as bad as I thought it would be.”  Pretty amazing Minnesota compliment. 

I wrote the teen and young adult version of this with those patients in mind.  I realized that, without meaning to, I had not addressed some of the issues specific to the queer and curious, and possibly alienated them with the discussions on pregnancy and infections.  Don’t worry, you’ll still get to hear all about it when I publish that version.

I then thought, “What if?”  What if the default entry isn’t the supposedly heteronormative one, but the LGBTQIA+ one?  What if I published THIS first?  So, here you go.  

A reliable online resource for more questions is the American College of Obstetrics and Gynecology (ACOG): https://www.acog.org/womens-health/faqs/your-first-gynecologic-visit

• Yes, it is skewed to hetero issues. It still has great information.

I can’t do your visit or exam, but I can talk you through it.  Here are some of the things you should know: 

• A gyno is a safe adult that you can have a private discussion with, and know that the information is in the vault.
  

  •  Your parent may REALLY want to be in the room with you the whole time, or you may want that.  At some point, every good gyno provider will ask the adult, if you have one with, or friend/peer/partner to leave the room and talk to you alone.  This information is protected, private, and can’t be shared with anyone UNLESS we are sincerely worried about your safety or someone else’s.  This includes abusive situations, known STD’s where the law requires partner notification, thoughts of hurting yourself or others.  (Come to think of it, that’s important enough that I should update the heteronormative tips to include it.  Thank you.) 

  • It does not include asking your parent(s) about your SO or preferences when we see them at school functions, or church, or whatever.  We just don’t do that.  We can’t do that.  So if you want to come out to the gyno first, go for it.  We won’t share it.  

  • Yes, you will have to come out to your gyno. Hopefully not more than once.

  • If you have labs or tests done and use your family insurance for the visit, they may see that you had this testing done.  Some of it is routinely recommended for all teens.  It’s okay to throw us under the bus and use that line.   

  • Whatever your stance on reproductive rights, Planned Parenthood provides more preventive care in testing, paps, and birth control than any other service.  No questions asked, no need to use your family insurance if it isn’t safe.   There are other clinics that do this as well, likely in your area.  You have a friend that knows, or you can ask your family doctor or school nurse.  When you reach your teens, your doctor should give you the chance to ask questions and be asked questions without an adult in the room.   

• A gyno may not be the right doctor for you.  Your family gyno may not have the knowledge or comfort level to answer questions about sexuality, hormones or top or bottom surgery.  But most of us can point you in the right place.  A well-informed family doctor, pediatrician, or internist can as well.   
  

  • Many LGBTQIA+ women avoid the gyno because of heteronormativity, and the need to come out to someone you’ve just met.   We don’t know your needs unless you tell us, whatever they are.  Most of us have been around the block enough not to look shocked even when we are, and we want what’s best for our patients.  

• Not every visit to the gyno means that you need a pelvic exam with a speculum (aka duckbill, though this drawing looks like a T Rex to me): 

  • Many teens worry about this part for the entire visit, when they may not need it.  If your visit is for cramps, or heavy periods, or you don’t want to get your period and want to start the pill, you don’t always need a pelvic exam. 
    

• But sometimes you do need a pelvic exam: 

  • A pelvic exam means that the provider will take a look at the outside to see if things are okay, and may take samples from the inside if needed for infection testing.  We have swabs that pick up DNA from some of the most common STD’s (sexually transmitted diseases or infections), so we only need to use a skinny swab, like a long q-tip.  If the pelvic muscles are relaxed, we can feel with just one or two fingers if the insides are normal for bleeding/cramping issues. 
    

• “But I forgot to shave my legs!” 

  • Your provider does not care.  Also, we do not care about chipped toenail polish.  A shower in the past 24 hours is nice, but not mandatory.  
    

• Speaking of shaving... 

  • It is the cheapest way to remove unwanted pubic hair.  It is also the most likely to cause problems, like a skin infection.  Skin infections can be irritation of the hair follicles, folliculitis, which sometimes needs antibiotics.  Infections can also be more serious or annoying, especially if you use someone else’s razor, like molluscum.   Which can spread to your partner.   If you can afford it, a clipper or waxing is much safer.  Laser is the Mercedes of hair removal--nice if you can afford it, but not the only way to get there.

  • Shaving also causes micro cuts in your skin, which increases the risk of some viral infections, like herpes, HIV, HPV.  We don’t have a cure for any of these viruses.  Condoms help, but aren’t perfect.  They particularly don’t protect areas that you would shave, or if your partner doesn’t have a penis.  
    

• “You said partner.  Define partner?” 

  • Anyone that you have had sex with is a partner for infection definitions. 
    

• “But I’m a virgin.” 

  • Two things: you’ll still be a virgin after a pelvic exam 

  • Define sex: any contact between your mouth, vulva, vagina, anus (any and all of the “down there”) with anyone else’s down there, including penis, vulva, vagina, anus.  Or their mouths with your down there.  

  • I stopped using the question “Are you sexually active?” when I realized that lots of women interpreted that as “am I having sex with a penis in the vagina right now?”  or today, or this week.  Really, what we want to know is your risk for infections and/or pregnancy.  Infections are much less likely, but not impossible, with two female partners.  You can get chlamydia (one of the most common STDs in the US, often asymptomatic) in your throat.   So, if you have sex of any kind with more than one partner, or they have had another partner, you should be tested. Another way to look at it is when you have sex, you’re also being exposed to every other partner that they have ever had. And vice versa. 
    

• “I heard an exam hurts.” 

  • It shouldn’t.  If you have used a tampon, you can relax your pelvic muscles.  Relaxing your pelvic muscles is the best way to make the exam easier, and shorter.   

  • What a stupid thing to tell you to do, relax when you’re nervous.  Here’s what I would tell you in my office: 

    • Tell your provider that you’re worried/nervous.   

    • Take a big breath in, count to 3, and let it out for a count of 4.  Do that as many times as you need to during the exam.   

    • Music can help.  There’s science behind this.  Ask your provider if you can listen to music, and keep it at a level where you can still hear her voice.  

    • The whole thing feels super weird.  Nobody looks forward to the exam, not the first time or the fiftieth time.  Your buns will be all the way at the end of the exam bed.  When they feel like you might fall off, you’re in the right place.  You won’t fall off. There are holders for your feet, called stirrups.  These should be at a place where your knees are bent without feeling cramped.  These can be adjusted if needed.   

    • Think about pushing your bum down towards the floor.  I know, sounds weird.  But it relaxes the right muscles, and you want this to be efficient, right? 

    • Speaking of weird, relaxing the muscles on the inside of your thigh (upper leg) and letting them fall open, like a frog or a butterfly, is just the trick.   

    • Having a speculum or a finger in the vagina exam will probably make you feel like you have to pee.  You won’t pee on anyone.  You will feel a little pressure.   

    • Make sure you tell your doctor if this is your first exam, if you’ve never had anything in the vagina, or if something pinches or is painful. 

  • Your doctor should wear gloves. This is a medical exam. You can always have someone else in the room for an exam.  It can be a nurse, an assistant, or a family member.   
    

• If you have had a female circumcision or sexual assault, tell your doctor.  This exam can trigger a powerful emotional response or PTSD, and your doctor will try to help.    
  

• “I heard I need a Pap Smear every year” 

  • This has changed since Gen X.  Pap smears start at age 21 at the earliest.  There has been A TON of research on this.    Also a ton of research on the HPV vaccine, which helps prevent cervical cancer (see more below).  You should get the HPV vaccine if you haven’t already—a true allergic reaction is incredibly rare.  

  • If you were born female, and have your cervix, you should have a pap smear after you turn 21.  Several groups now recommend HPV testing as the first choice, with or without a pap, at age 25. It depends on the resources available to your provider and clinic.

  • This can be less frequent if you’ve never had sexual contact with a male.  The HPV virus that causes precancer of the cervix and cancer of the cervix is spread by sexual contact, BUT very rarely women who have no history of such contact will have precancerous changes, worst case, cancer.  You don’t want to be one of these case reports.   

  • If things are normal, the soonest you should have another pap exam is in 3 years.  This may be longer if your provider is doing testing with pap and HPV (after age 25).  Ask your doctor.  If something doesn’t look normal to your doctor, you should have a biopsy or see someone for another opinion—regardless of pap or HPV results.  
    

• “Didn’t I just have a pap smear?  I was in the ER.” 

  • Likely nope.  A pelvic exam does not mean you had a pap smear.   

  • Pap smears look for changes that can become cancer of the cervix.  The cervix is the doorway between the vagina (where you put a tampon) and the uterus (where periods come from when you’re not pregnant, and a baby grows if you are).  Paps are designed to pick up these changes before we can see them, and now to pick up the virus that causes cervical cancer.   
    

• Any woman who has had sex, especially with a male partner (yes, even one), has probably been exposed to HPV.  It is the common cold of having sex.  Like most people with a cold, these changes usually go away on their own and don’t cause long term problems.   Most young women will have the virus but not get cancer, which is why we no longer look for it under the age of 21.   Stay tuned to a reliable source (like ACOG) for what happens as more young people who have had the vaccine reach the age when we worry about cervical cancer.   

  It’s going to be okay.  And feel free to treat yourself afterwards...you deserve it.