What might be missing from your annual exam…
When I opened my naturopathic medical practice well over a decade ago, a goal of mine was to offer women’s annual exams in a way that was more comfortable than the typical experiences I had as a patient in conventional medicine. My experiences with my own pap smears and breast exams weren’t horrible (I was lucky, I would learn later), but they were cold, jarring, and generally unpleasant. I dreaded them, without really knowing why.
In my medical school clinical rotations, I was lucky enough to study under Dr. Kim Windstar, a naturopathic women’s health specialist who taught me that many patients need to re-write their history with gynecologic exams. These annual exams are incredibly important for prevention, diagnosis and treatment, yet many delay them because of past traumatic experiences. It was common for me to see patients who had not had an annual gynecologic exam in 10 or 15 years. It is still is.
Why would a woman delay her annual exam? Some of the stories I have heard make me cringe, from physical pain and injury inflicted during a pap to negative things doctors have said about a woman’s body while she is in a vulnerable physical position. It is no wonder that avoiding subsequent exams have been a way of coping with past medical trauma. But, I have learned than many patients who have avoided their annual exams, paps, and STD/STI testing, have done so even though their experiences with medical exams have been “fine.”
Trauma comes in many forms. For those born with a vagina and uterus, that trauma can be physical, in the form of abuse, or it can be more subtle but no less impactful. Shame around sexuality, desire, vaginal odor, menstrual cycles, and anything having to do with one’s reproductive anatomy is quite common, and often it is so buried, we may adopt a coping mechanism of avoidance without really knowing why. In my naturopathic medical practice, my goal is to provide trauma-informed care so that patients are able to access the care they need while feeling supported and whole.
A trauma-informed gynecologic annual exam goes something like this: I meet face to face with you while you are fully clothed, so we can discuss your health and any medical needs while you are relaxed and comfortable. I explain the exam fully before I step out to allow you privacy to undress and put on a gown. The exam room is warm, and you have a drape over your lap to keep you covered. I knock on the door to make sure I have allowed you enough time to change, and then enter once you give your consent. We start the exam with you sitting up and making eye contact, and I let you know every step before I proceed. I maintain eye contact with you and walk you through breathing to allow your muscles to relax. There’s a mobile on my ceiling so you have something to look at while lying down (I’ve always felt those white ceiling tiles are very anxiety-producing, but maybe that’s just me). I check in to make sure you are as comfortable as possible, and tell you each step of your breast exam and pap. Sometimes emotions come up and I breathe with you to allow you to process, pausing the exam until you give consent for us to continue. Once finished with your exam and pap, I make sure you are sitting up and feeling ok, then step out and give you time to get dressed. We finish the appointment when I come back in the room to talk about follow-up.
It is my opinion that, as a patient, it is your right to access trauma-informed care. If you are in need of an annual gynecologic exam or other medical care, I hope I have given you reason to reach out and schedule an appointment.