He said, "You don't really need an exam or tests; that's mostly to make sure you haven't picked up any STIs or things that could result from them."
"What about something that could be wrong with my reproductive tract that doesn't result from sex?"
"That's not very likely."
I said, "And what if I continue to not be sexually active?"
He said, "Well, if you think something is wrong, you're having irregular bleeding, or pain, you should have an exam. If you want to have the exam, that's fine. But it's really up to you; you don't need it."
I was under the impression that there were standards for regular gynecological care whether or not one was sexually active. I realized that maybe the doctor hadn't understood the length of time I was talking about-- I might be fine at, say, twenty-five without any care, but what about thirty? or forty? I felt too awkward to say anything more, unfortunately.
I was thinking about that today, and I decided to look up more definite and authoritative standards. I consulted Scarleteen and the American College of Obstetricians and Gynecologists.
The ACOG, in their publication "Your First Gynecologic Visit," says these things:
"Girls should have their first gynecologic visit between the ages of 13 years and 15 years... The first visit may be just a talk between you and your doctor. You can find out what to expect at future visits and get information about how to stay healthy. You also may have certain exams... Even though you probably will not have a pelvic exam, you should know what one is. Another test that you will have later (at age 21 years) is a Pap test."
So the ACOG guidelines are fairly clear: start seeing the obgyn as a teenager, start having Pap smears at age 21. Pap smears check for the effects of STIs, but you can have cervical complications if you're not sexually active.
In response to the question "About how old should you be when you start visiting the Ob-Gyn?" Scarleteen writes,
"To ensure proper sexual health, women should start getting annual gynecologist check-ups shortly after they start having periods. Check-ups are especially important if...
- You have a family history of reproductive cancers and conditions.
- You are sexually active.
- You have really irregular or abnormal menstrual cycles, including excessive pain and excessive bleeding.
- You are over the age of 17 and have not had a menstrual period."
This is also fairly clear: go as a teenager, especially if you're having sex.
"In a female-bodied person's teens or twenties, either after having at least somewhat regular periods, after becoming sexually active, or because of some sort of reproductive health concern, question or issue, we may begin the habit of having a yearly exam or even just a consult with a gynecologist or a general healthcare provider who can provide gynecological healthcare. It's smart to check in with a reproductive/sexual healthcare provider every year or two as part of our overall preventative healthcare... Do you need to go when you're very young and you haven't been at all sexually active yet (in other words, had any kind of genital sex)? No. It's not a need yet, especially if you're not having any issues when it comes to your period or any kind of pelvic or vulvar pain or discomfort. In fact, if you do go now, not having been sexually active at all, and if you have no issues you need investigated -- like severe menstrual cramps or an absent period -- it's likely your first visit won't involve an actual exam at all, but will be more like the general physical you get at your yearly checkup from your family doctor. You may even just have a consultation, where you and the doctor just talk.
... If you have not been at all sexually active yet, and are not having any possible reproductive issues you want him or her to look into, your exam may end with that abdominal exam and blood work. But if you have been sexually active, if you're in your late teens or twenties, if you do have complaints or issues with your period or any part of your menstrual cycle, if you've been having any sort of reproductive issues -- like pelvic, vulvar, vaginal or rectal pain or discomfort, unexplained vaginal bleeding or spotting, or any unusual discharges, etc. -- then the rest of your exam will likely continue as follows.
... You may or may not get a speculum exam: if you have not been in any way sexually active and/or are under 21, you won't usually need a speculum exam yet.
... The ACOG is currently advising that pap smears, specifically, begin either at age 21, or three years after first vaginal intercourse, whichever comes first. Whether or not you get a pap smear often depends on the specific doctor's practice -- and when you want to start them yourself -- but as of right now, the most general guidelines of most medical associations and practices are roughly in agreement: those who have been sexually active for three years (or less), or who 21 or over (including those not yet sexually active), are usually encouraged to begin pap smears and have them yearly to every few years."
So, basically, my doctor gave me bad information, and I really wonder at it. Was my doctor of the opinion that if I were not sexually active I did not really need gynecological care, and trying to spare me unnecessary procedures? Was he assuming that my question about not being sexually active was just to save face? Did he think I was worrying about not getting laid for a few months instead of contemplating the possibility of lifelong celibacy?
I'm worried that doctors giving people inaccurate information because they don't take celibacy seriously is going to lead to people making poor medical decisions. I never sought gynecological care from that doctor, or a recommendation to an obgyn; after what he said, I wasn't sure how to bring it up. The recommendations for people with vaginas do seem to be fairly clear, so it's a question of doctors following those recommendations. This seems like it could be a problem for aces with vaginas*, since many people in the ace community are not only celibate but contemplating the possibility of remaining so for a large part, or all, of their lives.
Has anyone else had similar experiences? Any stories to tell about navigating reproductive health care from an ace standpoint?**
*I don't know anything about reproductive health guidelines/timing of exams/whether recommended onset of exams is linked to onset of sex for people with penises, but it could be a problem here too.
**For any set of genitals.
6 comments:
I'm not so sure about pelvic exams, but your doctor was not off the mark for paps. The American guidelines are for paps for everyone 21 and over, yes, but take a look at the reasoning:
"An upper age limit for when to initiate screening is needed for providers who don't ask patients about their sexual history and for adolescents who are unable or unwilling to disclose prior consensual and/or noncon-sensual intercourse. Such an upper age limit ensures that young women, including victims of sexual abuse, are protected."
Basically, they don't trust you.
Pap smears test for cervical cancer (and abnormalities that could become cervical cancer), and there is some debate over whether or not that can develop in the absence of HPV. If it can - and that's an if - it's very rare.
If you're having symptoms, of course, get thee to a doctor, but my own conclusion has been that asymptomatic, cervix owners who've never been sexually active don't need pap smears.
I've found it impossible to actually figure out whether I should have a pap smear or not, and have long since given up on the whole matter. Part of the problem is that treatment is so sexual-normative, and generally heterosexual-normative too. There's a general assumption in society that you will have sex, and that pretty much everyone over a certain age bracket will have done so.
I've found plenty of sources that say that cervix-owners who've never been sexually active don't need pap smears - but due to that cultural narrative, I don't know whether that's true. Because if the people giving that advice assume that everyone will be sexually active by a certain age (and often wording of the advice implicitly assumes that!) then I can't trust it to be accurate for people who never begin sexual activity.
I've also found plenty of sources who state that you should definitely have a pap smear after a certain age - but then (as Miriel commented already) I don't know whether that's because any cervix-owner over that age actually needs a smear test, or because sexually-active cervix-owners need a smear test and they're assuming that pretty much all cervix-owners will be sexually active by then, but some of them won't be willing/able to say that they are.
I've pretty much decided against going, for various reasons, this being one of them.
Recommendations can change, and they're usually made with the public health (not the individual) in mind. Since 99 percent of cervical cancer is caused by HPV, I see no reason for someone who has never had any genital sexual contact to go through a Pap smear. Of course, I'm a nonprofessional, random anonymous Internet person! ;)
They don't start gyn exams here until you're 30 anyway, but after that they recommend it for *everyone*, though they do stress that urgency may increase with the more sexual partners you have (or if your sexual partner has unprotected sex with more people, I guess).
I just got my first letter about participating in research to detect cervical cancer early (I'm turning 30 next month). As far as I know, everyone with a cervix turning 30 gets that letter. They also recommend getting an exam at 30, and then every 5 years after, even if you don't participate in research.
Interesting! Thanks for the feedback, everyone!
I don't know if you're still interested in getting comments on this, but I thought that anyone who reads this article might be interested to know that my doctor (who knows I don't really have any interest in sex) said that if you're not sexually active, there's usually not much risk to not having a pap smear done, although if you have specific symptoms suggesting there's a problem it is of course a good idea. I don't know how much that advice applies to older women, but I'm in my mid-twenties.
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