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.

TPL - if they are, that's a very recent development! Until very recently (and unless it's changed), they weren't available until age 25. Some areas would voluntarily test women younger than that on request, but only because they had the means to do so. It was essentially a postcode lottery.

This was very well publicized when Jade Goodey died. Lots of women (including me and most of my female friends) found that their only option for smear tests under the age of 25 was to pay privately. It was a big scandal in the papers, although you could argue that it's not efficient to let younger women get tested for free because cervical cancer is relatively rare in young women.

It's a feminist issue if a pelvic exam is not something she can say no to.

I am really surprised. I was 21 some considerable years ago and my friends and I all had smears done in different health authorities as we were at different universities. We discussed it at length at the time, I remember. There were leaflets advising us to do this.

I wonder whether some cost saving exercise brought in a new system in the interim and I wouldn't have been aware of it, being over 25 by then?

provinciallady I also started getting smears younger than 25 by some years. I got them done at brook advisory which is where i went for my pills.

I think things have changed since then though.

"Why are women under 25 not invited?
This is because changes in the young cervix are normal. If they were thought to be abnormal this could lead to unnecessary treatment which could have consequences for women's childbearing.2 Any abnormal changes can be easily picked up and treated from the age of 25. Rarely, younger women experience symptoms such as unexpected bleeding or bleeding after intercourse. In this case they should see their GP for advice.

In June 2009 the Advisory Committee on Cervical Screening reviewed the policy of starting screening at age 25 and agreed unanimously there should be no change in the current policy.

The Committee did agree, however, that in order to ensure that all women are screened by the age of 25, invitations could be issued to them six months before their 25th birthday.

Please see Written ministerial statement and Minutes of the Advisory Committee [PDF 86Kb] on Cervical Screening's meeting on reviewing the age to begin screening.

A research paper, Sasieni P, Castañón A, Cuzick J. Effectiveness of cervical screening with age: population based case-control study of prospectively recorded data. BMJ 2009; 339:b2968, focusing on women screened under the age of 25 was published in the BMJ. It stated:

'Cervical screening in women aged 20-24 is substantially less effective in preventing cancer (and in preventing advanced stage tumours) than is screening in older women'"

from here

It's interesting as it seems to indicate that the "changes" that were present when I was 16 and ended up having a bit burnt off or something might have been normal

I do think the medical profession on the whole have always been rather gung-ho when it comes to women's bits.

It really surprised me too TPL - I'm 27 and most of us thought we'd be able to just ask, but we were told no. I'm not very happy since my first smear turned up abnormalities and I'm waiting for another follow-up to see if I'm clear or not.

I am probably biased for that reason. But I can see that enforced smears are potentially very bad too.

It would be bad news for me if smears were in any way enforced, as a survivor of CSA and someone who has had really painful post childbirth problems and a crappy nurse making it much worse. I have chosen not to go for the last 5 years on the basis that I am very low risk. But now I'm wondering whether to ask the GP for a sedative so I can get through it. I wonder if they would do that?

That sounds like a possibility- certainly worth asking. I didn't mean to suggest I supported enforced smears at all, TPL - I don't! I just worry about them not being available on demand.

It's awful you're in this situation (as so many women are). That's the first thing needs to change.

Hope you find a solution.

I wondered last time why we're not allowed to do it ourselves - just having a hand on the speculum would make me feel a lot better and it doesn't feel as if I couldn't be in the right position and do that.

LRD I didn't think for a moment that you support enforced smears! I have read enough of your posts to get a feel for your views on that, I think It's an annoying situation to be in because rationally, I have no problem with it but it's a physical response. Hey ho.

DIY smears would be fantastic but I wonder whether they could be really accurate? I have sometimes had to go back 2 or even 3 times because the sample was wrong in some way.

In the US doctors want to make as much money as possible so telling women they need to have regular vaginal check ups from an early age ensures they get frequent and expensive visits.
Here women know you only need to go if you have a problem and for smears which are not compulsory.
I do think the US system exploits women for money. Especially young women. Their whole health care system does but it is worse for women.

TPL (thanks for the character assessment! ) - good point about accuracy. But then ... I wonder, if people took time to design better instruments, would it be more accurate?

One of the things that sticks in my mind and probably influenced me as a very wobbly baby feminist about 15 years ago was my first-year biology teacher describing to us girls how breast exams worked and observing that, in her opinion, if men went in for them they'd have designed a better system!

kim - as I understand it, full medicals have nothing to do with it - you can't get contraception without a smear test if you're unlucky enough to be in some parts of the US. They don't want to do a full medical, there is just a culture of assuming contraception is a favour women earn from the medical authorities, rather than something to be provided freely. It sounds scary and as you say, doubtless there are scary elements for men too.

I had my first smear at 18 at my local NHS surgery - this wasn't that long ago either and I was invited to come in. I then moved overseas, had them done yearly and Pre-cancerous cells found when I was about 20 so I'm damn glad I didn't need to wait until 25.

Kim, my DH has had to get full medicals for insurance and not once has he had to drop his pants.

The medical establishment seem to veer between telling us our bodies are wrong and broken and that we just have to live with the broken bits because it' normal. I know women who are in agony due to period pain for two weeks out of four and basically told by drs just to toughen up and get over it.

I was called for a smear test in the UK when I was under 25. Can't remember how old exactly I was but it was when I was at university.

My guess is that routine pelvic exams are justified by saying they can pick up abnormalities in the vagina, ovaries and uterus. But I don't see how it can really be that effective because as far as I know ovarian and uterine cancers don't have a better survival rate in the US.

I should have added this earlier but I forgot: the doc I saw most recently (this was in the US) made it clear she was unhappy about continuing to prescribe me the pill unless I had a breast exam. This despite the fact I am in the lowest risk category for breast cancer: young, no family history of breast cancer, self-examine and have taken the pill for over 10 years without any problems.

I agree with CailinDana about OP's friend - I don't see how you get a sense of "how a vulva should look" at that age without abuse being involved.

I don't see how you get a sense of "how a vulva should look" at that age without abuse being involved

Naturist camps? I never saw one close up of course, but I got a pretty good idea about how they looked from the outside, plus I saw my mum naked around the bathroom as a kid. And if the girls in question has, say, long inner labia then she'll be clearly able to see that other women don't necessarily have them visible at the bottom of the vulva.

I should add, most women at the campsites were wonderfully hairy as we were in France and they were all French and Dutch, but there were always some who had full waxes (yeugh) and the old ladies were often hairless through age.

Sorry, I should add - my aversion to full waxes is that it look pre-pubescant and that disturbs me, not that I think hairlessness is disgusting to look at.

And of course plenty of women have long labia, but it's something I know some women are very sensitive about and would see as abnormal in themselves if not EVERYONE had that.

Actually I think children could easily find pornography to look at in this day & age. The parents wouldn't need to have been looking at it themselves--think of all the nonsense children have always whispered to each other when they think they can't be heard (embarrassing memories, anyone?) I could imagine the girl seeing something and getting fixated on the way a woman "should" look. That's why I thought maybe therapy could help her understand that there are all sorts of vulvas out there, and it's very unlikely there's anything wrong with hers.

I'm in my late forties and had smear tests from the age of nineteen when I went on the pill so it's not a recent thing. I didn't ask for one but was offered it as a matter of course.