Greetings! Is it springtime yet?
This afternoon, I got a colposcopy. I was scheduled to get an endometrial biopsy, but that was postponed because apparently my cervix is too small and needs heavy duty drugs. I have to tell you, I was pretty spooked going into it.
When I found out that these were the procedures my gynecologist recommended, I was confident. Like a genuine, “Great! I love conservative medical care. This is exactly what I would want/recommend to my own client.”
And I really mean that. By conservative, I just mean checking shit out when it’s a little sus — even just a little. Anyone in the medical field for a while has stories of big conditions that they’ve either missed or found, and those experiences really stick. For me, I’m pro checking.
But as the date got closer, I faltered. I panic-googled. And then, I made a plan.
Whether it’s a pelvic exam, a PAP smear, an IUD insertion, or something more intense (i.e. surgical procedure), here are some universally applicable strategies for making any appointment you deem scary or potentially triggering a little more manageable:
Assess your true needs and history. If you have a history of medical trauma or sexual violence, you’ll likely need more support than recommended by your provider as “standard of care” (which, IMO, is often sub-standard). For example, it was recommended that I take some ibuprofen and drive myself home for my procedures today. Instead, I took some heavy duty CBD, have additional pain support lined up if needed, and my partner was in the exam room with me, drove me home, and ordered Indian food afterwards.
Designate someone/people to support you before, during, and after the procedure. This can refer to one person, but in an ideal world, it’s a crew. Do you have a mental health support person who can process this with you? Who will go with you, and would you like that person to be in the exam room with you? (Yes, this is an option.) Can some friends check in via text afterwards?
Once again: Even if you don’t [medically] *need* someone to drive you home, you’re allowed to need someone for support.
Advocate for pain and anxiety management. Although this is slowly changing, procedures like IUD insertions and biopsies often performed with ibuprofen only. This is a vestige of the sexist and racist history of the gynecology profession, and IMO, downright barbaric. If you would like pain management, ask your provider. Push. Many of these procedures can be done with some level of light anesthesia or can be supported through use of other medications. If you struggle with anxiety for something like a pelvic exam/PAP smear, ask your provider about a short-acting medication to support you.
Communicate with your care team: A day or two prior to the procedure, send your physician a portal message to let them know the accommodations you need. You are welcome to steal this generic script: Hi Dr. XX and team,
I am writing to let you know that I would like [your request] during my procedure. [You can give context, e.g. “I have medical trauma from my birth experience” but you DO NOT OWE ANYONE an explanation.]
Please let me know if this is a problem. Thank you!
Beforehand: Prep your nervous system: Ask yourself: what would bring you the most ease, calm, and joy? If you’re able, take the whole day off so that you can really lean into whatever that is. (Yes, I absolutely recognize that it’s a huge privilege to take a day!) Get your body involved to pump up that vagus nerve if possible — however it is you like to move. If you’re not able to take the whole day, plan for 5 minutes before you leave for the procedure. You can either do a mini breath work or movement practice or simply take a quick walk.
Beforehand/In-office: Prep your sensory system: Never, ever under-estimate your sensory system as a source of nervous system regulation. Wear the comfiest clothes possible. If you like smells, roll on an essential oil/lotion. You can also bring a disposable instant heating pad, an eye mask, a fidget toy, or headphones. If there is literally any possible way you can be more luxuriously comfortable, then that is the thing to do. In shocking news, you deserve to feel comfortable during this experience.
During: Request that your provider explain the procedure to you: Many GYN providers are focusing on efficiency and clinical skills. These are essential, but sometimes can miss the mark in terms of trauma informed language and care. You can simply say, “It would be very helpful for me if you could explain what you’re doing both prior to and during every step of the procedure.”
Afterwards: Give your body and brain space: If you have the privilege of taking a day, take a day! Take the time and space you need to physically and emotionally rest. Congratulate yourself on taking good care of yourself and showing up to your medical care. You may want to journal, talk with a friend or support person, or physically move (if appropriate) to process the experience. Or you may want to watch a shitty romcom and order in. Or both! You deserve ease.
Afterwards: If desired, give your provider feedback: Good providers — the ones you want to work with — really appreciate feedback, even when it isn’t easy to hear. If your procedure wasn’t what you had hoped for, or there is something specific that you would like the provider to improve upon for your care, don’t be afraid to say so. Usually, a portal message is great because it’s written and therefore well documented. A note that if things really went south, you do not owe any provider any emotional labor — you deserve better. However, you don’t need to withhold your experience and recommendations, either. If you want to give feedback, do it!
Phew! We did it. I hope that you found this guide helpful — please feel free to share it with friends and fam!
As always, I am always rooting for you. If you have questions or feedback, I love hearing from you! I am at cait@ritualpelvichealth.com.