One Lucky Girl: How to Get Through a Pap Smear

Wed, July 16th, 2006


Cassendre Xavier a.k.a. Amethyste Rah is a self-described "renaissance negresse" (musician/writer/actress/visual artist). She is the award-winning founder and former director of Philadelphia's annual Black Women's Arts Festival (est. 2003), and currently resides in her native city of New York.

Ever hear of a little thing called "vaginismus"? Pronounced "va-gin-ISS-muhs", it's a condition that some women have that makes any kind of vaginal penetration, no matter how small, unbearably painful.
Women who have been sexually abused, experienced a painful first pelvic exam, and/or are dealing with serious diseases, such as cancer and (especially if undergoing radiation/chemotherapy) are among the most common to suffer from this condition.
Treatment often includes using a set of "vaginal dilators", which are basically dildos in graduating thickness and length. The woman is prescribed these expensive objects by her physician, who then instructs her to insert them daily for a minimum of fifteen minutes.
Or, you can use other methods, such as your own or your lover's dildo or finger(s).
Having this condition makes it darned difficult to get through a pap smear, the annual pelvic exam every woman should have at least once a year, moreso if cancer runs in her family.
But women suffering from diagnosed or undiagnosed vaginismus aren't the only ones. Women who have issues with their genitals for whatever reason, especially transmen (women who are transitioning to the male gender) tend to ignore or put off this very important process. This is one reason cancers of the female reproductive system are on the rise among this population. I also believe that deep and long-held resentment (holistically thought to be the main cause of cancer) of these areas are also a major reason.
Be that as it may, I happen to be one of those chyks. I won't go into details, but let's just say that going to get my "bits checked out" as my dear friend Kelli Dunham
http://www.myspace.com/kellidunham says on her new/forthcoming comedy album "Almost Pretty" urges each of us to do, regardless of our feelings about said bits, used to be a very, very difficult thing for me.
In the past few years, it's been much easier, and at my annual check up yesterday, it was such a breeze that I can honestly say that I officially am no longer afraid to go get prodded with plastic! Not bad for over twenty years of practicing, huh?!

Here's what I've found works like a charm. I hope it works for you and that you'll be good to yourself and try and try until it goes from being sheer hell to uncomfortable to bearable to not scary to a breeze!


HOW TO GET THROUGH A PAP SMEAR

(By the way, a "pap smear" is a swab of cervical cells for the early detection of any cancer-causing abnormalities. This is done once yearly with a "pelvic exam", which involves the probing of an object called a "speculum" which holds the vagina open for said probing activity. An annual pelvic exam also checks for any other diseases or conditions of the reproductive organs and surrounding internal and external areas. So there!)

1) Don't worry about it before hand. In fact, completely put the appointment out of your mind until the actual second the speculum is being inserted. If you must think about your appointment, try to change all scary and negative thoughts like "it will really hurt" and "i bet the doctor won't understand" to "it won't be so bad", "each time is easier", "it will go very fast", or "I'll have a great doctor who will be patient, compassionate, and understanding!"

2) Ask your friends for support. I got a very supportive text message minutes before my appointment yesterday. You can also ask a friend to accompany you to the appointment. Be very specific about what is required of your friend, give them ample notice of your appointment. For example:

"Dear [Good Friend], I'm going to the doctor in two weeks on such and such a date. It would be tremendously helpful to me if you could change your plans if necessary to accompany me because going to the doctor is extremely difficult and I could use your kind of help. What I would need specifically from you is: meeting me at my apartment. You calling us a cab. Sitting in the lobby with me, and then talking small and cheerful talk before and after, and then going back to my apartment with me for tea or something fun. This would be from about 2pm to 8pm. I realize this is big chunk of time in your day, but as I said, it's really important. Please let me know within 48 hours if you can do this, and if not, if you can do any of those things. Thank you for your consideration!"

This approach will very likely garner a positive response, because it gives your friend enough notice, is very clear about what is expected from her/him and exactly how much time is required.

I used to need to go for pelvic exam appointments with a friend. The lobby talk was the most comforting thing to me, as was the ride to and from the appointment. Thankfully I no longer need this, but I still need to talk to a friend or two before and after the appointment, to wish me luck before hand and I also know they're sending me psychic thoughts of support and energy that helps a lot. Afterwards, I report how well it went. This makes each appointment better and better.
I expect that someday I won't need these calls at all, and maybe I'll be the one someone calls to ask for support before and after their appointment. "Full circle", as we say in the business. And what "business" is that, you may ask? Oh, I have no idea! Read on, babycakes!

3) Reserve the right to not work with a doctor you don't feel completely comfortable with. I'm really happy this hasn't happened yet, but an example of something like it was when I went to an intake session for psychotherapy once and the person was a man who looked something like the person who abused me sexually and physically when I was growing up. First of all, I felt very uncomfortable with his maleness (I was living in wimmin's community, and totally used to chyks healing chyks) and secondly, I was totally triggered by him. I was so upset I didn't even get to the point of mustering up the gumption to say something, because I was too upset to figure out that I was upset and then decide what to do about it. Luckily being a sensitive shrink, he figured it out and surprised me, mid interview and application fillage outery, "Would you be more comfortable with a female?" I breathed a HUGE sigh of relief and said, "Yes! Yes, I would!" Kids. That's what I was at that moment, anyway, a nine year old kid. Inner Child Work. Ya gotta love it!!

Anyway, if you don't feel comfortable with the person who's gonna ram a piece plastic and then her/his fingers up yer girlhole, then you totally reserve the right to say so. And only you know the reasons why you're uncomfortable. And even if you don't know the reasons, you should stick to yer gunnational devices.

But since you're probably triggered a lot, give yourself a limit of discomfort. It's highly unlikely that the 100% absolute dreamiest, perfect, most gentle person will be there. Most likely you'll be at least a wee uncomfortable, so allow for that. Otherwise you'll waste time putting of the exam til you find this perfect person who doesn't exist. Oh, and by the way it's not always a doctor proper. Sometimes it's a nurse practitioner, and they, in my opinion, rock and are BETTER than doctors. Yeah, I said it. Check 'em out!

4) Do breathing and relaxation exercises. For several weeks before your exam, spend some quality time with your girlhole. Talk real nice to it, lube it up and maybe stick some things in it to stretch it out. I was really really lucky that weeks before my appointment I had a lover who was quite skilled and did some of this "work" for me, heh-heh. But it's your bod and your responsibility, so even if you don't have a lover, or as I fondly like to call them, "pooty-hole stretcher", do the goshdarned gig yourself, chica! I'm such a sentimental romantic that I really don't want to do the penetration thing myself - I really prefer to leave it to someone who will really appreciate it. I've never really been that into penetration of the girlhole region - I dunno, mayhap the EXCRUCIATING PAIN of previous decades did more than a wee damage to my expectations that it could be pleasant. Now it's not so bad but still, there are many other things that feel nicer, so, but hey, where was I?? Oh yeah, stretch your hole! This is not only good to physically make the workfield more pliant for the actual exam, but mentally it gets you familiar with how and when to relax your vaginal walls so that it won't hurt when the exam is going.

5) Know the routine. You don't have to know the routine until the actual session, minutes beforehand when talking to the healthcare provider. But if you really want, you can google it, or even go to YouTube.com and watch an exam in progress. Then you'll know what to expect.

6) This is a huge one, HUGE. You ready for it? Okay, here it is:

Insert the speculum yourself.

Call me a slow ass learner, but it took me many years and exams to figure this one out. A stroke of brilliance happened when years ago, when it was still traumatic for me to go, and I kept moving away from the speculum to the annoyance of the provider, suddenly, I offered, "Hey, what if I put it in myself?", to which she very surprisingly and quickly agreed. And just like that, in less than a minute, I had inserted the speculum myself. It was much, much easier, because I was directing the insertion myself, I was breathing out to relax myself down there, and I wasn't scared she was gonna do something like clamp it or whatever. The twisting of the speculum afterwards was uncomfortable, but that was then. Now, it's much much easier, as it will be for you after practice!

7) Request the smallest possible speculum, and lots of lube. Your provider should comply, and these things make all the difference. One of the reasons for my "condition" was because I had a very traumatic first pelvic exam, which included a speculum much much larger than what was appropriate for me, inserted very fast, roughly, and without warning. I felt raped, and was in so much pain that even sitting in the car was very uncomfortable. No wonder I was afraid of future exams! I say this to emphasize the point that when it comes to speculums and women who are incest/sexual/physical abuse survivors, or have any issues like this at all, size really does matter, as does the "delivery" of the instrument. Slow is the way.

8) Talk through session. If that works for you. Some people are more comfortable not talking, but I personally like to know what's going to happen before it happens. That's what makes me feel comfortable and calm, which is what I need to be to go through the process with as little discomfort as possible.

9) Feel free to celebrate when you're done!
After my session, while I was still on the examining table, on my back, right after my provider removed the speculum, I started laughing and clapping like a retarded seal. "Is it okay that I'm clapping like a dork?" I asked her. "Sure!"
We had a great time, and you'd hardly recognize me from the chyk of yesteryear - totally terrified.

10) Don't put off making appointments. If you're worried you might have cancer or something, go anyway, because early detection could save your life. Go to the appointments, and expect the best results. I get my results in two weeks, and I'm expecting to hear that I'm healthy. If I hear otherwise, I will share my experience and treatment in my writing, I'm sure. But for now, I focus on the fact that no cancer runs in my family at all, and that I'm not about to start that tradition, so there! But my life is art so even if I do go through something, I'll just do what Audre Lorde did with her Cancer Journals. But I'm focusing on the positive. I'll be writing about other things instead, like recording my next albums and publishing my forthcoming books from the comfort of my home, for example! (Just for starters!)

Well, I hope this has helped you or maybe someone you know (please feel free to forward). I know that Pap Smear Difficulty is not the usual thing that folks blog about, but I really want to be of service with my writing, and after the session, it was made very clear to me that I should share this experience. I really wanted to talk about this, and reiterate what Kelli said, that we really should "get [our] bits checked out".



All best,

Cassendre Xavier a.k.a. Amethyste Rah
renaissance negresse
www.cassEndrExavier.com