Today we bring you a guest post from Rugbyfan, who would like to initiate a discussion about an experience she had. It’s one of those cases where, as the slogan goes, the personal is political– very personal and very political. The topic is smear tests, one of those topics that’s not much discussed even by feminists. (In a rather lovely juxtaposition, Mr Jender just me a link to the Onion’s recent story “Renowned Hoo-Ha Doctor Wins Nobel Prize For Medical Advancements Down There”.)
It’s worth noting that there are at least two important things to discuss about this post: the particular experience involved (and others like it) and the general questions raised. We invite readers to contribute on both points. As always, please do observe our rules on being nice, to be found at Our Policies. These are perhaps even more important when dealing with this sort of topic.
Consultation with female gynaecologist yesterday:
Me: I have asked for this referral because I find smear tests extremely painful. My last attempted smear had to be abandoned because it was so excruciatingly painful. I am a scientist; I have therefore done a lot of research into the matter and I would like to discuss my findings with you so we can try to find a way forward. Basically, my research indicates that three factors may be coming together here to result in extremely painful smear tests: (1) I am not sexually active, (2) I am obese (making the cervix hard to locate because of pressure on the pelvic floor muscles), (3) some of the medication I take causes significant vaginal dryness. Are there possible ways we can get around these factors that could make the pain sufficiently manageable to enable a smear to be taken?
Gynaecologist: Would you like me to ask a nurse to hold your hand while I take the smear?
I know the medical profession has a very poor track record when it comes to pain management, but it’s hard to think of a situation involving significant pain to any other part of the body being dealt with in this manner (“I’m just going to drill into your tooth – no need for anaesthetic, the nurse will hold your hand.” “I’m just going to pop a few stitches into your split lip without anaesthetic or a numbing spray – now don’t worry, the nurse will hold your hand.”) Is my experience related in some way to the pressure put on women not to have epidurals while giving birth? And why is it that I have completely failed, over several years, to persuade nurses/doctors (female, every single one of them) to take this pain seriously? It’s always described to me as “Yes, some women do find smear tests very embarrassing” (I don’t, actually, find them any more embarrassing than going to the dentist), and “Most women find them uncomfortable” (I don’t find them uncomfortable; I find them agonising! In my medical records the nurses have written “Smear couldn’t be taken because patient found it too uncomfortable.”). When I try to insist that they take this pain seriously, their assumption is that I have some sexual hang-up (I don’t) or that I was once a victim of rape (nope).
What’s going on here? Is this indicative of the medical profession’s general failure to listen to patients? Or to women patients specifically? Is it something specifically to do with women’s sexuality or reproductive capacity which women cannot be trusted with and which needs to be “owned” by the medical profession? And why do women nurses and doctors collude in this?
Feminist Philosophers 
hmmm …. what sort of pain relief is offered for vasectomies? handholding? or maybe bullets to bite on?
Wow. I am glad I am not the only one who has this problem – I’ve had two pap smears done in my young life, after I turned 18. Because I am not sexually active, there is no history of reproductive-cancers in my family and my last two lab results were “spotless”, I am hoping I can bargain my way out of the next one. I also have unbearable pain during the procedure, and shake really badly, which makes it worse. I am not embarrassed or ashamed, either! I just find them extremely painful!
I was actually told that the HPV vaccination – which I have had – could very well make pap smears obsolete someday. I can only hope.
When I was a little kid I had pneumonia quite badly and had to spend a few weeks in the hospital. One of the first treatments was to have a large needle stuck in my side and have the gunk in my lungs sucked out of it. It hurt terribly. The only “pain relief” I was given was to have a nurse hold me. I guess it was better than nothing. Even still with shots and the like, including ones that are quite painful (a penincilin shot, say), topical numbing isn’t the most common. It is more common with kids, thankfully. This, despite the fact that topical numbing isn’t very hard or expensive. I guess that my point is just that this _sort_ of thing isn’t clearly restricted to _this sort_ of cases, but is common in the medical field where pain reduction isn’t common. (Ten years ago no dentist I went to used a topical numbing solution before giving an injection. Now almost all do. I think it’s just a tendency to do what everyone else does and think it’s what must be done that one finds in the medical professions.)
Matt– your anecdote got me thinking about the tendency to discount pain in children, even in supposedly medically advanced Western cultures. I’m thinking especially of male infant circumcision.
I also had a relevant dental experience: My dentist failed to completely numb one of the quadrants of my mouth from which he was removing wisdom teeth. He refused to believe me when I said I was in pain, insisting that I was mistaking pressure for pain. (I found this claim philosophically interesting enough to distract me at least partially form the pain.)
I find myself wondering if women’s and children’s pain is especially likely to be discounted or denied– which would be interesting, given that they are the ones supposedly most in need of protection. But you may be right, Matt, that this is a more general medical phenomenon.
I’d not be surprised if women’s and children’s pain is more discounted, especially by male doctors (though not, it seems, only by them.) I think doctors have gotten somewhat better about kids, but not great yet. I don’t have the experience to guess about women but it would be consistent with a number of things I’ve seen in the world, and it certainly wouldn’t surprise me.
And is it just me, or is the assumption that having your hand held will help you with the pain a bit sexist in itself? As in, women are supposed to enjoy/seek/need physical contact and be comforted by it more than men? Because I’ve always had “boundary issues” (I don’t really feel comfortable being touched by strangers) and have received strange/disapproving reactions for this much more often than male friends who feel the same way.
This sounds like a form of vaginismus, which is famous for being massively misunderstood/unheard of among many doctors, even /hoo-ha/ doctors.
Many women with vaginismus suffer excruciating smears (“just relax dear, most people don’t make this much fuss”), excruciating penetrative sex (“have you tried a large glass of wine?/ obviously this person is not *the one* for you/ why not have a nice bath?”) and cannot use internal menstrual protection (“you’re built to have a baby come out of you, of course a tampon/cup will fit in”).
Even if you do find someone who can competently diagnose vaginismus you get sent for psychiatric treatment, which usually centres around trying to find the hidden child abuse/rape/religious feelings/unhappy thoughts towards your partner buried in your past. And if they’re not there, because – oddly – not all people are built the same as the textbook example, you’re obviously *hiding* something.
(for many women the trigger of their vaginismus *is* an incident in their past. But most, if not all, vaginismic women will also need some level of physiotherapy if they want to have pain-free insertions. For the purposes of this post please assume that I am only talking about women who do *want* to have these insertions)
Or there’s the flipside, you can have penetrative sex but can’t use tampons, or a vibrator is fine but you can’t do smears, or smears are fine but penises are a no go… Then we’re back to ‘it can’t be vaginismus, try relaxing/a large glass of wine/a bath/tranquilisers/numbing creams’ (the drugs answer really makes me cross, especially when this is suggested to aid penetrative sex. Quite how a woman can discover that penetrative sex can be a fun thing when doped up and numbed out is beyond me. Evidently the woman’s enjoyment of the act is not the issue for some. Grrrr.).
So, Rugbyfan. In my experience of working with (and being a) vaginismic women, I would suggest the following (assuming, you know, the whole hand-holding thing doesn’t work out):
* Ask the person doing the smear to use the smallest speculum possible;
* Some women find that inserting the speculum themselves, if possible, is actually a great help;
* I’m not sure if its possible to lube up the speculum before insertion (does that affect the test results?), but see whether it is;
* You may want to try dilating before your appointment if that’s something you’re comfortable with. Inserting some kind of dilator (e.g. vibrator, condom-covered candle) to essentially ‘warm up’ your muscles in the days before a smear can be beneficial;
* Otherwise it is possible to get a smear under anaesthetic, but that’s not without its own risk.
To answer the actual question – vaginal pain in general is very misunderstood by the medical establishment. I think things are becoming a little better (as an example, I believe that being ‘cured’ from vaginismus is not now solely measured on whether a penis can be inserted or not; although on the other hand there are still single women in some postcode lottery areas of the UK who are refused treatment as there’s ‘no point’ until they get a man) but there’s still a long way to go. I’ve been lucky in that everyone I’ve seen about my own pain has been completely sensible. But it’s more common for women to go from doctor to doctor to doctor, often for years, wondering why they’re just being told to reeelaaaaaax and why no one believes why the pain is so intolerable.
I’m afraid this post is rather long, but fear you’ve pushed one of my buttons :)
I think that African Americans may have problems getting pain treatment, and indeed other kinds of interventions, some life-saving. Pain medication, by-passes, interventions after stroke and things like that are on the list, I think.
There may be something pretty profound going on. We already know that people are often less than wholly rational; it’s awful, but too possible, that care is first given to people like ourselves, perhaps especially if we are privileged white people. And of course women can ‘learn’ that men are more equal than themselves and/or that women hardly count.
If the behavior we see is grounded deeply in psychology (as Hume would have maintained), we really need some strong educational forces to counteract it.
My pharmacist (a young Chinese woman) and I got into ‘trouble’ with a doctor just recently; he wanted to give me a derivative of penicillin, to which I am deathly allergic. It was quite likely to be safe, but she thought not safe enough. Still, that was clearly supposed to be his decision, not ours, even though we had the statistics.
[…] on smears April 17, 2009 Filed under: Uncategorized — stoat @ 12:31 pm A recent post on this blog drew attention to the fact that the medical services are sometimes wholly unhelfpul in […]
[…] CfP: Dimensions of Pain May 9, 2009 Filed under: CFP — Heg @ 2:10 pm Here’s an interesting call for papers, covering the topic guest-blogger Rugbyfan recently raised: […]
[…] On hand-holding as pain relief for the ladies – This one may be of particular interest to those living in the circle of vulvar pain. Rugbyfan (I didn’t see her e-mail or blog link,) talks about her experience a gynecologist for a consultation. She tried to talk to the doctor about ways to manage the pain of smear tests and instead of brainstorming some options the doctor said, “Would you like me to ask a nurse to hold your hand while I take the smear?” […]