A Pap Smear Gone Haywire
Written by Steph Marshall
Illustration by Jessica Oddi
For any adults with a uterus, a pap smear or cervical screening is an inevitable part of maintaining our sexual health and preventing cervical cancer. However, sometimes the way we are treated by healthcare professionals can have a profound impact on our health-seeking behaviours.
I went to get my first pap smear when I was 18. I called the free university health service and requested a female doctor. I was incredibly nervous, so I kept it vague and asked for an appointment for "women's issues." As a self-conscious, socially-awkward queer and non-binary person (at this time still deep in the closet), I was not thrilled at the idea of whipping out my vulva for a stranger.
When I arrived for my appointment, my assigned doctor seemed stern and impatient, like she wanted me in and out as soon as possible. She was not warm or gentle, and this didn't help my nerves. In no way did her attitude encourage me to offer my vagina for probing. She asked what I had come in for and I mumbled, "I need a pap smear…."
Her first response was to get angry. She snapped and said, "I wish you hadn't booked a pap smear first thing in the morning, I like them to be afternoon appointments."
My face burned with shame for inconveniencing her.
My face burned with shame for inconveniencing her. How stupid I was for not considering she might have a preferred time of day to scrape cervical tissue. If I were in her shoes, maybe I would also need a cup of coffee or a solid lunch before having to go rummaging around a nervous adolescent's bush.
Next, she asked when my last period ended.
"About five days ago…"
"Well why would we bother going to all the trouble of you stripping down to just find dried old blood up there?!"
As she glared at me for my lack of understanding about my period, the shame continued to eat away at me. I was just trying to do the right thing for my sexual health, but I felt like I was failing at womanhood. For the record, getting a pap smear during your period is not ideal for accuracy of results, but you're generally in the clear after a few days. To me, her attitude indicated she really just couldn't be bothered right now.
Her final response was to scold me for not having had a pap smear sooner. How dare I be sexually active for several years and not have had this procedure. As most older vulva owners will know, pap smears were previously recommended every two years from the age of sexual debut, or after you've turned 18. Today, the updated procedure is referred to as a cervical screening, and Australian health guidelines recommend one every five years beginning around the age of 25.
I never got the pap smear. The shame and embarrassment stayed with me for years.
We ended the appointment quickly, just enough time for a condescending lecture about safer sex and a demand that I come back at a better time. All I left with was a renewed oral contraceptive prescription and a deep sense of discomfort and dismissal. When my mum picked me up I burst into tears. I never made another appointment there.
I was raised in a conservative and religious community that repressed discussion about sexuality and bodily functions. Periods were dirty and secretive. I was barely comfortable asking a friend to borrow a tampon, forget trying to talk to my mum or any other adult about the responsibilities of being sexually active. But, apparently it was my own fault that I had a lack of understanding about a procedure involving inserting something into my vagina.
This story is for anyone who has been made to feel ashamed of their body by a medical professional. I know this experience is trivial compared with some trauma and discrimination other people face when seeking health care. I am aware of the privilege I had to access a free healthcare service in the first place. Nonetheless, the humiliation I felt for not understanding enough about my menstrual cycle and for wasting this doctor's time was enough to scare me out of seeking sexual health care for years to come. I truly believed that if I ever tried to talk to a doctor about sexual health again, I would be met with a patronising, rude and critical reaction, so I avoided it altogether.
These kinds of experiences aren't limited to pap smears and pelvic exams. I have plenty of friends who were shamed for being so young when trying to access hormonal contraceptives as teenagers. Doctors can also be complicit in fatphobic, homophobic and transphobic microaggressions towards patients. Minimising a female's pain is another common anecdote. Ask any person with endometriosis or other period-related issues and it's likely they will recall an experience when a doctor made them feel belittled or questioned the legitimacy of their concerns.
My frustration is rooted in knowing this doctor was supposed to be catering to the healthcare needs of university students, and the prospect that her attitude might have led others to avoid seeking sexual health care just as I did. How can we expect doctors to help enable young adults with sexual autonomy, if they cannot be sensitive to the fact that many of us were severely lacking in comprehensive sex education and felt shame around our bodies?
At a social level, any woman or person assigned female at birth will be exposed to criticism and scrutiny over their body and their sexuality. We are used to this from peers, our families, mass media and social media. It reflects the patriarchal standards of modesty and secrecy that force us to pretend we don't bleed on a monthly basis. Sociocultural forces also prioritise sex appeal while simultaneously slut-shaming us. But, it's important to remember that sexual shame is not only perpetuated in obvious ways. Even some professionals who we presume are there to provide care and support can neglect to consider the lasting effects of their treatment towards vulnerable young people.
I'm 26 now, a few weeks ago I had my first cervical screening and it was completely fine.
The growing visibility of sex-positivity and sexology as an industry, along with great work from public health advocates, gives me hope that compassionate, inclusive and shame-free sexual healthcare is becoming increasingly normalised. I know that there are so many amazing and supportive healthcare workers out there. For queer people especially, healthcare centres which specialise in sexual health issues do incredible work to maintain respect for diversity in experience. I'm 26 now, a few weeks ago I had my first cervical screening and it was completely fine. Thankfully, my sense of sexual shame has diminished significantly over the years, I didn't even feel the need to apologise for not trimming my pubes beforehand.
Steph Marshall is a queer and nonbinary post-graduate Sexology student, following on from their Bachelor's degree in Psychology. Steph is an aspiring sex therapist, who also is passionate about providing comprehensive sex education to young people, visibility for gender diversity and intersectional feminism. Steph is originally from Canberra, but is now based in Perth, on unceded Whadjuk/Noongar land.
Jessica Oddi (@oddi.jessica) is a disabled graphic designer in Canada with versatility to spare. She is particularly interested in collaborations involving much needed representation, inclusivity and empowerment.
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