Smear Tests and Speculums: Sexual Assault, Sexual Health, and Me
So a few months ago, I had to get my routine smear test.
Okay, first up: it’s all good, nothing is wrong with me or my cervix, and I am beyond grateful that the services exist in my country to have regular smear tests and everyone I’ve come into contact with in the process of getting them has been incredibly professional and compassionate in equal measure. But there’s something I’d like to discuss when it comes to the process of cervical smear tests and other medical procedures that require vaginal penetration, and that’s going to require me to get a little graphic. If discussions of sexual assault or medical exams aren’t something you want to deal with right now, feel free to click on over to this picture of my lovely little cat.
Let me explain to you what my smear test was like. After my last one, which was a genuinely horrible and deeply upsetting affair, I was more prepared this time going in. I used my dilators a few times in the week before I was due for it to try and prepare my vaginismus-riddled vag for the task at hand, and I had taken painkillers and done some breathing exercises before I stepped into the exam room.
A cervical smear test basically involves the practitioner at hand opening up your vaginal passage with a speculum, and inserting a swab into your cervix (the entrance to your womb) to collect a sample to test for anything nefarious going on pussy-ward. I managed to get to the insertion of the speculum before I started having a panic attack, and, bawling uncontrollably, had to get the (very understanding, kind, gentle) nurse to stop at once. I sat behind the curtain after she left, feeling like I wanted to claw my skin off my body and use it to make some kind of LEAVE MY PUSSY ALONE FOREVER cape to wear at all times.
I had to go in a couple more times before I could actually get the examination done, and it took being dosed up on the anti-anxiety medication Diazepam (prescribed) and heavy-duty painkillers to get through it. Even then, it was excruciatingly painful, and I can honestly say that it took me a while to mentally recover after the fact.
Sexual assault is something I’ve dealt with a few times in my life, and, if I am being honest with you and myself, these kinds of invasive tests bring up some of that trauma. Even though I am totally consenting to being there, even though I am grateful for them, even though I know that these tests can be life-saving and I would never skip one – even though the nurse is kind and understanding when I start crying, even though she sat me down and talked me through what we could do to make it easier – the experience of being essentially jimmied open like a stubborn car boot, having something pushed into you while you are in extreme pain and want nothing more than for it to stop is strikingly similar to the way a lot of us experience sexual assault.
I spent a good couple of weeks after my multiple failed attempts dealing with intrusive thoughts about previous assaults, and the gut-punch of having to so viscerally relive those physical sensations yanked them to the front of my mind once more. And that’s with a nurse who was understanding and kind, who I was able to talk about my issues with before I had the exam.
Yes, I know that my vaginismus makes smear tests far harder than they might be for someone who doesn’t have it, and I know that most people aren’t going to struggle so much with the pain aspect of the smear tests. But being forcibly entered, even in a controlled environment like that, can be really triggering, and it got me thinking about how sexual assault impacts those people who have genitally-penetrative exams or procedures as part of their regular medical treatment.
This excellent article discusses the experiences of women who’ve been sexually assaulted and how that’s impacted their cervical smear tests, and also quotes the slightly shocking statistic that 20% of women who’ve been through sexual assault don’t ever attend a smear test. The thing is, I get it – it can be so terrifyingly triggering, even if you feel like you’ve got a handle on things, and skipping out on a test like this (or opting out of other treatment that involves vaginal penetration, such as certain birth control options) is potentially a seriously dangerous thing to do.
With rates of sexual assault against women so very high, the thought that a major chunk of those women could be putting their physical health at risk as a result of system which doesn’t help to make them comfortable or provide the support they need to get through these exams is deeply concerning to me. And I feel like there should be far more concern about it, to be honest – a lack of education given to health practitioners dealing with these kind of patients can often make the experience so triggering, and make it so much less likely that the patient in question will return for another vital exam.
How do we change this? Honestly, I think that the approach to giving these examinations and other vaginally-penetrative procedures need to change; people are often reported as being non-compliant with their examinations when they get the letters asking them to schedule them, but for so many, it could be a fear of re-triggering themselves into a terrible mental headspace that keep them out of the nurse’s office.
I would love to see a more compassionate approach that takes into account what this experience is like for people who’ve been through sexual assault; specifically, I would love to see an opportunity given to bring up a previous experience of assault with your provider, as well as the chance to “build up” to the final examination with a few practice visits to help control some of the anxiety and intrusive thoughts that can come up during these experiences.
While the cultural conversations around sexual assault have started to change in recent years, the impact of sexual assault in the long-term is still so often something shrouded in mystery and obscured, while the people who live with it have to deal with the very pressing reality of what it means to stay healthy – both physically and mentally – in the aftermath.
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