Body ownership in the medical system. (long)

[MrsFionaCharming]

I should start by saying I'm not sure if this is even a feminist issue, but I'm feeling uncomfortable and I'm hoping someone will be able to help me order my thoughts.

I was discussing with a friend from the US that a friend from the UK was considering a vaginoplasty as she feels that her vulva doesn't look 'right'. My US friend pointed out that if there was something wrong with it, surely a doctor would have said something. I told her that my friend hadn't seen a doctor about it yet. At which point she told me that shes had many pelvic exams as part of routine physicals (I should add, she's 19, so I assume these started as a teen?).

I didn't want to ask her much about this, in case I was being ridiculous and prude-ish, but it made me really uncomfortable.

Now, I understand that doctors see so many vulvas and vaginas that there's no need to be embarrassed. And I can confirm that I'm the quickest to get mine out for a doctor if there's a problem. But that's the key issue. I don't feel right about teenage girls being expected to allow doctors to poke around their healthy genitals 'just to check'. Something about it really doesn't sit right with me.

Especially as, in the US, often you're required to have a doctor sign off on your physical in order to get health insurance. So essentially, no matter how uncomfortable a girl feels, she has to agree to the examination in order to get 'signed off' and given insurance. Which I can just see leading a girl being almost forced into an intimate examination she doesn't want by her parents and doctor. (This is the main thought that bothers me. The possibility of a girl being told not to be silly, and laughed at for being shy, and essentially feeling like she has to agree - it seems a little to much like rape in my opinion).

I would really like to hear other people's opinions on this as I can't decide if I'm being unreasonable to feel so uncomfortable. After all, I'd have no problem with a doctor checking my eyes, and it is just another body part. Am I being ridiculous? Is this because I've been socially programmed to find my body shameful and secret?

Now to try and make it feminist, but I can't imagine many teenage boys being expected to allow a doctor to inspect their genitals for no reason. Are women not trusted to know their own bodies?

I realise that I've rambled quite a lot, but I'm not actually sure what I'm even asking. I'd be interested in hearing other people's thoughts on the issue.

I've just looked it up because I couldn't remember - women in the UK are invited for smear tests from the age of 25. Maybe it's earlier in the US? They seem a lot more keen on gynaecology there - don't US women see a gynaecologist every year? I agree it's a bit OTT and I wouldn't like it, 3-yearly smears are bad enough, although I am very grateful for them.

How sad that your friend thinks her vulva doesn't look 'right' - what/who is she comparing it to? I have heard that vaginoplasty is a growing industry and that is most definitely a feminist issue.

Boys quite often have their testicals handled during physical examinations. I think it is a way of looking for hernias iirc.

I don't even mean smears, (I know that the friend I'm referring to is going for her first smear this year) more routine physicals as a teen. I completely understand the importance of smear tests.where apparently they are just checking that everything 'looks normal'.

About my friend who wants the surgery, I'm not sure why she's not happy with it, but she first mentioned it to me when we were 11, so it's something she's worried about for a long time.

In Germany an internal is standard every 6 months when you're on the pill. They now even started using ultrasounds, rather than manual poking around only. Breasts are getting checked at the same time. Apparently it's to check for cysts and other problems, but I think it's just a cultural thing - obsession with diagnostics, whether there's a need for or not.

I found it a bit weird when I moved away to the UK that suddenly there weren't any checks anymore apart from the smear, which is yearly in Germany. It felt a bit "unsafe" until I realised that the evidence base doesn't really support the German approach.

That said, I paid privately to see my german gynaecologist each time before I started ttc, for a check up just to be on the safe side.

i'm 43 and i have never had to undress infront of a doc, even as a child, as far as i remember.

the vaginaplasty is a symptom of the pubeless times we live in, back in the 70's women diddnt have such asthetic concerns about their genitals because they were coverd in pubic hair.
i dont know if it's porn culture becoming mainstream or just that bikini's got so skimpy that it wasnt worth just doing the bikini-line but it seems to me to have just created one more thing to worry about now.

Yes being expected to submit to internal examinations for no medical reason is abusive. And you are right. Men would not be expected to submit to routine internal rectal examinations.

Older men are. To check their prostate.

Yes for medical raesons. But not for insuirance reasons which the OP is talking about

In the US the advice is normally to begin having a full annual gynae exam at 18 or on becoming sexually active, whichever is earlier. So that must mean that at least some women (who haven't had sexual partners at age 18 or older) are having medically unnecessary exams. I don't know what the full situation with insurance is, as different providers have different requirements, but I can definitely imagine pelvic exams potentially being part of full medicals required by some employers.

As I understand it, the evidence doesn't support having pelvic exams this frequently, so I have always felt that the way an annual exam is normalised in the US is a feminist issue. But it is also connected to the fact that everything is over-treated and over-medicalised in the US system anyway (if you have insurance, that is!).

For personal reasons I refuse to have internal exams and it is always a bit of a struggle to convince the doctor that I am not going to have one - they always seem a bit shocked - as if they don't ever encounter anyone who says, no, I'm choosing not to do this.

I think the situation with your friend is very sad, especially that she started feeling this way at 11 .

Honestly I think the woman who wants to get her vulva rearranged (and has wanted it since she was a child!) would do better to get psychological counselling. I do understand about personal autonomy, but this seems more like a self-hatred issue.

To be honest if a girl started talking about the look of her vulva at age 11 I would seriously suspect abuse. That level of awareness of how a woman's body "should" look is very very unusual at that age.

Ummm...she is going to have it operated on? she is going to need an examination?

Firstly. What's a pelvic floor examination?
Why would you need one unless you were having incontinence issues?

And
The woman who wants plastic surgery. I wouldn't like to say what the situation is with her. There certainly are people for whom this type of surgery is a real need and lots of others who want porn-perfect bits. I think you should talk to your friend and try to find out why she wants it and take it from there.

Oh sorry mis-read.
Pelvic exam
What's a pelvic exam?
What does it involve?

It would be interesting to know what they're looking for during these routine pelvic exams, and how often they find anything of note.

It appears to be a cultural thing in the US, totally unremarked upon there (as far as I know), and I wonder if it's in part a billing issue - you need to do something if you're going to have your clients visit you annually.

We don't have the same system of visiting specialists directly so it doesn't apply.

Pelvic examination.

I've never had one in the UK.

good LORD... from the wiki

"For educational purposes, trainee doctors have performed pelvic exams on unconscious women. The subjects are those undergoing surgery for unrelated causes, and they were rarely informed the examination had occurred. This practice was forbidden in the United States and the United Kingdom, which now require the patient to consent in advance. The practice still continues in Canada according to a study published in the Journal of Obstetrics and Gynecology.[3] The director of the Medical Health program at the University of Manitoba claimed in response that the revised 2006 guidelines of the Society of Obstetricians and Gynecologists of Canada forbade pelvic exams without consent,[4] though the original impetus for the study of pelvic exams and consent was an incident in 2007"

I have had a pelvic exam to check if everything feels okay. Basically the femal Dr stuck her fingers inside and had a feel around. But it was when I was having a problem. So absolutely fine for a medical reason, abusive if not.

SQ - Used to be routine apparently to do this in the UK too

SQ {shock]

I've always felt uncomfortable with this too. It's another symptom of the medical establishment treating women's bodies as though they are essentially wrong and likely to malfunction at any moment. If an annual preventititive check up so vital, why isn't everyone, male and female, expected to have a full rectal examination every year? Someone might have undiagnosed piles or cancer etc but I don't see a rush to get in there just in case, when there are no symptoms.

I feel there are two separate issues.

Surgery on your genitals is one: IMO that's straightforward from a feminist theory POV though obviously incredibly fraught from a personal one. Women should not have to feel they need to look a certain way. But, I understand why we do.

The second issue is tests. Now I get that it's probably good to have smear tests available younger than they are in the UK. Cervical cancer is pretty rare in under-25s. It is certainly linked to exposure to semen. There is an argument that setting the limit for tests at 25 is discriminating against young women who have been sexually active for a perfectly legal 9 years.

OTOH, I was really upset to learn that in the US, you can be refused birth control pills if you won't have a smear test. I just find that appalling. I think - sorry, very rude, but - the US is utterly misogynistic about women's bodies.

So, I think while there are arguments to be made for making smear tests available to younger women, the US is not a good model for this since it is more common that smear tests are, in effect, compulsory for sexually active women.

I'd also love to see more money and attention dedicated to developing better ways of testing for cancers that affect women, but that's a long-term issue.

LRD I thought that in the UK, smear tests are available to anyone who is sexually active OR aged 25 and above? I started getting tested at 21 and I have friends who started at 17/18 (and one friend received treatment for early abnormalities at 19...she had a large number of sexual partners from a young age).

You've all made sme very interesting points, thank you.

My friend who wants the surgery - it is very sad, and I hope she figures it out. She isn't yet sexually active as the one time she tried, the guy made a comment on how she looked and it's put her off trying again. And it only made her want the surgery more. I'm not sure how to help her with her feelings about it.

The friend who told me about the examinations - they were just part of routine check ups from her peadiatrician (people often continue seeing a paediatrician until their 20s in the US) rather than specialist appointments with an ObGyn, which for some reason makes it feel stranger. Though hearing that others aren't necessarily comfortable with it does make me feel better! I also know that she wasn't sexually active at that point, so it was unrelated to that.

Possibly a lot of it is social conditioning, and being from the UK I see doctors as being their for when I need them, rather than the other way around? If that makes any sense.

The twat who made a comment about how she looked has probably been watching too much porn.