#PAP smear

[rjalker]

>:(

if anyone tell you pap smears don't hurt they're a gods damned liar

next time I'm going to ask them to just give me fucking laughing gas or something.

Edit two days later:

For the fucking record to ward off jackass, this post is being made by a nonbinary trans person. My pronouns are it/its. Any TERFs or other transmisics who touch this post will be fucking vaporized.

For a damn preface, for those unaware, a pap smear is a procedure done on people with vaginas to test for cervical cancer or other health problems. It involves sticking a medical device into the vagina and using it to widen the walls of the vagina so the doctor can stick a tiny brush into the cervix to collect cells for testing.

And if you try to look up whether or not this procedure can hurt, every where you look will tell you it doesn’t.

And I'm still fucking infuriated by this. Because it’s a fucking lie. Everywhere I looked beforehand said it wouldn't hurt, I might just feel some pressure. Every single fucking website and blog post and video said "It won't hurt! It doesn't hurt!"

Even now when I am specifically trying to find other people talking about how it hurts, 99% of the results are saying it doesn't hurt, and if it does, it's just because you're nervous and anxious and causing yourself problems.

Except every where I fucking looked told me it wouldn't hurt. The doctor said it wouldn't hurt. My fucking mom said it wouldn't hurt.

I was not tense. I was not anxious. I was told it wouldn't hurt and I believed all the people who'd said so.

And then it felt like having a knife shoved inside my body.

And I was told to just do some fucking breathing exorcises and relax.

Even though I'd been fucking relaxed until it started hurting, because everyone fucking old me it was painless, just mildly uncomfortable.

And I am not talking about pain like "a little pinch", I mean fucking pain like being stabbed with a needle or having a knife twisted inside you. And it just got worse the longer it went on. They had to fucking stop early and might not have even been able to collect the fucking cells they were supposed to be testing.

And when this was finally over the doctor told me that the only reason it hurt was because my hymen was intact (So what about all the fucking shit going around for years about how that breaks for everyone in fucking gym class???? More fucking lies!!), as though that had anything to do with the pain inside.

And now every fucking thing I try to look up for reasons why it can hurt is literally just fucking repeating the same shit about how it doesn’t hurt, and if it does, it’s only because you were nervous and anxious and embarassed and all the fucking things I WASN’T. BECAUSE I WAS TOLD IT WOULDN’T HURT.

Every where I fucking look, I’m told that these things don’t hurt, and it’s just anxiety, and blah fuckity blah.

For fuck’s sake, this is real fucking medical gaslighting going on on a fucking absurd level.

These fucking websites and videos and blog posts and articles may as well just fucking call my hysterical at this point for all they fucking give a shit about people who are hurt by this procedure.

Everyone’s too fucking busy insisting that it doesn’t hurt and you have to get one and if you avoid getting one then you’re a bad person and you’re going to get cancer and die.

I’ve literally found exactly one (1) article talking about how it does hurt for some people, but that this gets constantly brushed under the rug and shouted down, and how this is a fucking problem. One fucking short article out of almost a hundred that I checked.

If you are so hellbent on getting people to get pap smears that you will literally fucking lie about the fact that not only can it hurt, it can hurt extremely, then you are not fucking helping anyone! If no one’s allowed to fucking talk about how painful this procedure is, no one can actually fucking give informed consent, because all of society is apparently too damn busy lying and saying it doesn’t hurt!!!!!!

This is blatant fucking medical misogyny and medical gaslighting everywhere you look and I’d have to be fucking knocked unconcious or given fucking laughing gas before I ever agree to do that again.

There’s even a fucking tiktok someone put on youtube where the original person was talking about offering anesthesia for pap smears, and then a fucking gynecologist comes in to say that’s stupid and useless and absurd and pretends that the only reason it can hurt is because people aren’t relaxed enough.

This is literal fucking society-wide misogynistic lying and gaslighting and it is pure fucking evil.

So pro fucking tip, for people who need to get pap smears: It can in fact hurt. Do not fucking let anyone tell you that you’re imagining it or you’re immature or you’re causing it yourself by being anxious. Do not fucking let them gaslight you and victim blame.

Pap smears can hurt, a lot, and anyone who tells you they don’t or can’t is just straight up fucking lying to your face.

So does this fucking mean I have endometriosis? Vaginismus? Some other fucking horrible thing I haven't heard of yet??? I don't fucking know! And it's gonna take three weeks to fucking find out the test results, assuming they even got to collect any of the gods damned cells in the first place!

Either fucking way, the fact that no one is allowed to talk about how this procedure can be excruciatingly painful because everyone else is just shouting at the top of their lungs that it doesn't hurt and you need to be a Big Girl™ and stop being embarrassed and go get one is fucking evil and I am fucking enraged.

(Edit again for the anon: Yes, you can reblog this, I am not embarrassed, more people need to talk about this so people can at least have some fucking warning. Feel free to copy and paste to other sites too.)

[thescrumblingmidwife]

Hi! I know other people have sent similar asks before but I thought I'd send my own just to be sure. I can't fit more than a finger... up there. And even then its a tight fit. That's enough for me but I'm worried about if I go for a pap smear (I think that's what its called, I have a bad memory): something has to go up there right? Will it fit? What happens if it doesn't? Is it going to be a hassle to request a woman? How much do I need to "clean up"? No pressure to respond right away, I get that you're busy. I just wanna know what to expect. Thank you! 😊❤

Hi Anon!

How old are you? You don't need a pap smear until 21, and you don't need a pelvic exam at all before then unless you've got some kind of complaint or you want to get fitted for an IUD. If you are 21+ and have had zero sexual contact, you can discuss a modified schedule with your provider.

PELVIC EXAMS

Reminder - pelvic exam is when the doctor/midwife examines your pelvic area and vagina. This can include the use of a speculum or not, and be done for a number of reasons. Pap smear is a screening test where we take a cell sample (like a cheek swab) from your cervix to check for HPV/precancerous lesions. A pap smear is usually conducted in conjunction with a pelvic exam, but not all pelvic exams include a pap smear, as you don't usually need one every year.

Let's go through your questions one by one. But first I want to start by saying that medical consent is the same as regular consent - you have a right to refuse or defer any procedure or examination, or to stop one at any time. You have the right to fully understand everything you're consenting to, and ask as many questions as you need to feel comfortable. If you make an initial appointment with an OBGYN or midwife, and she doesn't pass the vibe check, you are not obligated to go through with the exam. It can be scary to stand up to someone who seems like they're in a position of power, but you should know that you can.

"Something has to go up there, right?"

At your first GYN appointment, nothing has to go anywhere. You'll meet with a provider, she'll take your full medical history, your menstrual and sexual history, your family history, ask if there are any concerns you want to discuss. At this point, you should talk to her about your issues with insertion and your anxiety about it. She may want to have a look (literally just eyeballs) to ensure there's nothing going on, but she will ask permission before doing any touching, and explain everything she's doing. If she thinks it's worth attempting a pelvic exam, she would start very slowly and only with your full buy-in. It may be necessary to try to figure out if you've got an underlying problem.

When a pelvic exam is warranted (like when you need a pap), the provider may first insert fingers while pressing on your belly (called a bimanual exam) to assess your anatomy, and then use a device called a speculum, which allows us to actually see the inside of the vagina (speculum exam). The speculum will be lubricated, and the provider will coach you through the insertion process. You can also ask about inserting it yourself. Usually, you lie back and put your legs up in stirrups, and are coached to let your knees fall out and give a deep breath out, so as to relax your pelvic floor muscles, while the speculum is inserted down and back (towards your tailbone) in a smooth motion. You'll then feel a bit of pressure as the blades of the speculum are slowly opened so the provider can peek through. It shouldn't hurt, but it can be uncomfortable. I don't know anyone who actively enjoys speculum exams, but most people would say they're not too bad. The whole thing is over in a matter of seconds.

"Will it fit?"

Speculums come in a wide range of sizes, in plastic or metal (if metal, it will be warmed). You can ask for the smallest speculum they have (they make pediatric-sized speculums, so there are definitely small ones - see middle device in the image below, about the size of a finger). The provider will use one that should fit based on your history, anxiety/preferences, and her visual inspection of you - but don't be afraid to speak up.

"What happens if it doesn't?"

If you have an anatomical variation that means even a pediatric speculum could not fit, the provider will likely catch this before you get to the speculum stage. If you've got something going on like vaginismus, this will help her diagnose you. The most likely scenario is that you just need a competent and compassionate provider you trust and some good coaching. But what will NOT happen is the provider trying to jam something into you that doesn't fit!

"Is it going to be a hassle to request a woman?"

Absolutely not. It's very normal to have gender preferences with medical providers, especially for something so sensitive. Just ask for a female provider when you're requesting your appointment. You can also ask to see a midwife -- we're something like 96-99% female-identified, with most of the rest being AFAB trans/GNC/NB. (There ARE a few male midwives, but they're really rare).

"How much do I need to 'clean up'?"

If you've got time and it would make you feel better, take a shower before you come, wash with soap and water like normal. But if you can only get in on your lunch break or something, that's fine. Otherwise, you don't need to do anything! I promise your pubic hair is not so forest-like that we will not be able to examine you. Don't douche, or use any fragrances or lotions unless you would like some patient education about how you should not use "feminine products."

Okay Anon, that's an initial GYN visit in a nutshell!

[ice-block]

Idk if anyone is interested but I thought I’d put it out there because the other day I was talking w my therapist and she said when people have a negative experience with something they’re WAY more likely to tell everyone they know and when they have a good or neutral experience they don’t think much of it SO I’d like to put something positive out there for anyone who might be in the position I was in.

So anyway here’s my experience getting my first pap smear, as someone with an INSANE amount of anxiety about it:

I try to keep some less than pleasant personal stuff off this blog but I’ve got a decently sized medical phobia, general mistrust of gynecology after reading too many horror stories, and some weirdness about gender/sexuality/body (???) I don’t entirely understand myself. I also understand that maintaining personal health is important even if it’s scary so when my doctor told me it was time to make an appointment with a gynecologist, I did it, then spent the next 3 weeks having nightmares, anxiety attacks, and experiencing a general sense of impending doom as the appointment approached.

Things my therapist and I talked about before hand included:

1.) save your stress for the future, if it goes good, great! If it goes poorly, you’re allowed to be stressed then . Don’t make yourself suffer unless you need to.

2.) know what accommodations you want and be prepared to ask for them confidently and clearly. I wanted the smallest speculum, a warning BEFORE any and all touching, and to be able to stop at any moment.

The appointment eventually did arrive and while I was still a ball of nerves I got myself there and obediently went through the steps of registering as a patient and remaining sane in the waiting room, I was called to the back (if you have a support person you want to bring with you you can but I went alone) and chatted with the nurse about health history etc, this pretty much resembled your standard doctors appointment, they take your heart rate, BP, etc. the nurse wrapped up and told me the doctor would be in in a minute, I should undress from the waist down, and showed me a cloth (which was basically a really big napkin) I could cover my lap with. I definitely went pale at this and if my high blood pressure didn’t tip her off she definitely knew I was internally freaking out. She offered to have the doctor come in first if that would make me more comfortable and I declined.

I was left alone to undress, it feels really weird to take off your pants in an office with fluorescent lighting, after a minute the doctor knocked then came in (there’s also a curtain in front of the door so nobody walking past can just see you pants-less) she was a very kind woman who asked me some questions about it being my first time, at this point I was prepared to say my demands but I was very shocked when she beat me to it! She outright offered the smallest speculum and said “I’m going to show you the tools, we’ll talk through the procedure, and we’ll decide if a Pap smear is something we want to do today” which made me instantly feel so much better. My other surprise was how SMALL the smallest speculum was! It was about the size of my pointer finger. If it had been larger I honestly don’t know if I could have done the procedure but once I realized it was tiny I knew it’d be ok. (Also side note: it feels really weird to talk with someone while pants-less and holding a big napkin over your crotch)

I was instructed to lay on the exam table, which was really low to the ground when I got on it then raised up like a dentists chair, the little foot holds popped out from underneath it and I was instructed to put my feet in the holds and scoot all the way to the edge, I kept looking at the doctor through this and was told that during the exam I would have to look up at the ceiling. She warned me before even the slightest touch (“I’m going to put my hand on your thigh now”) asked if I was ready, when I said yes she inserted the speculum, which felt weird but not painful, it didn’t even feel painful when it opened. Just strange. Then the doctor took a cell scraping which felt REALLY weird for a part of the body not used to that sensation at all. It felt scratchy and then for a brief second their was a bit of pain (I’d rate like a 3 out of 10) and I thought “if this lasts any longer I can’t do this” but it was really only a split second and the worst moment was also the end. The speculum was quickly removed making the Pap smear a total of like 30 seconds max. Then the doctor told me she would check my uterus and ovaries and (still maintaining consent and giving warning) inserted a finger and pressed with her other hand hard on my stomach, this didn’t hurt either and the pressure/rubbing on my stomach made it so I wasn’t thinking about her other hand at all! Then I was allowed to sit up again, close my legs, the doctor asked if I had any questions and I was out of there!

Anyway hopefully this can help someone out there I tried to include all the details I had wanted while doing frantic research before hand, if you’re in the same boat, you can do this!

[wallerina]

saw a post abt this earlier that triggered me and fucked me up rly bad so tw for discussions of pap smears and sexual trauma

im 21 which means im supposed to start getting pap smears but i honestly feel like id rather die im so terrified but everyones always like "its uncomfy but you have to do it" "well some people have slight discomfort but its not supposed to hurt if done properly" "its a widdle akward but its over in no time 🥰"

like no you dont understand i have cptsd and just the thought of it makes me want to very very literally kill myself. also i cant even insert a fucking pinkie finger without searing pain. so exactly how the fuck am i supposed to lay on my back with my legs spread and let a complete stranger hold my vagina apart with a speculum and then scrape my fucking insides with a tool. "they can talk you through it" oh yeah thatll fix it. ive had full blown panic attacks just thinking about it and it makes me feel sick enough to vomit id rather die. and it makes me so fucking angry too like you mean to tell me none of these motherfuckers have bothered to find a different way to do this? too busy creating erection pill number 10,000? okay

[derrydeer]

adam looks like what i think a pap smear feels like

[the-cheshire-cat-grin]

Ok i need to open up about something extremely traumatic. Trigger warning for pap smears and talking about vaginas i guess.

So friday i got my first pap smear, which i fully expected to be pretty uncomfortable, but i genuinely have never experienced that kind of pain. Nothing, and i mean nothing, could have prepared me for it. It was the kinda of pain that made me think i was dying. Even now this is hard to type because all i can think about is screaming and sobbing in that drs office, and as gentle and kind as my dr was, i felt so so alone. I wanted my mother. I wanted to die. It was a nightmare. I sobbed in my coworkers arms 30 minutes later because i had to go to work after.

But what i need to know is, is that normal? Because everyone ive talked to said that it was uncomfortable and weird, but i genuinely felt like she was ripping me open. Being stabbed would have hurt less. Is it supposed to be that painful or is there something wrong with me?

[aroaceconfessions]

tws ahead of time: venting, discussion of medical examinations of sex organs (pap smear), masturbation mention

so i am. very asexual. sex ambivalent but i’m really just not interested overall. i’m also afab. which means when i’m 21 i’m gonna have to get a pap smear. which is gonna SUCK

being trans makes this twice as bad. i’m low dysphoria but the idea of ANYTHING entering my body like that makes me want to cry. like i get panic attacks at the thought of having to put in a tampon (i’m a pads person) it’s like. bad. technically i’d be able to handle it (had a short period of time before realizing i was ace + trans where i thought i HAD to masturbate bc “everyone did it” (my parents gave good sex ed but normalized masturbation a bit too much lmao)) but i’d hate every minute of it

so the idea of a pap smear horrifies me. first off- i have to let a doctor see me half-naked. this part doesn’t bug me too much because . it’s a doctor and it’s completely non-sexual but i still don’t like the idea of anyone seeing . that

then i’d have to just fucking sit there while they put a fucking giant cold metal tool in my body so they can reach my fucking CERVIX???? and THEN they’d have to brush cells OFF of said cervix??? no. no no NO that gives me such bad anxiety it’s fucking insane.

i’m also terrified it’ll hurt because. i’m not gonna be sexually active and i don’t even fucking use tampons. and i KNOW that if i go to a good gyn then they will find ways to help me be less scared or feel it less but i still hate the idea of sharing that vulnerability. i’m a crier and i do not want to cry in front of a doctor because i’m scared of such a normal procedure. it’s less a fear of judgement and more just a pride thing i think. i know they deal with it frequently i’m just kinda horrified. the idea of coming out as ace to someone who has control over my health is also actually terrifying esp bc i live in texas

if i could i’d just get my whole uterus removed and solve the problem but apparently it “produces important hormones” that i don’t want to throw off balance so. guess i’m stuck

idk i need to talk to my mom about it (she gives good advice) or maybe my aunt (similar feelings towards sex as me) but god it just sounds so scary. i’m incredibly scared for it.

that being said if you have a cervix and are 21+ (25 if ur british) then you do need to get a pap smear once every three years. it may be horrifying but cervical cancer is way scarier. i’m sorry it sucks for us but it’s like life-or-death important. can’t really afford to skip out on it unfortunately :(

if anyone else has similar worries and/or has had a pap smear i’d love to hear about it in the notes. no pressure of course privacy n all but it’d make me feel less alone so if you’re comfy sharing. hope everyone’s having a good [time of day]

[paisholotus]

This is what a Colposcopy is. And I am horrified 😟

PLEASE WATCH WHOLE VIDEO!

[rjalker]

I think you post is one of the two (2!!) testimonies i found online about how much pap smears fucking hurt. I have a gyne appointment in two weeks and im honestly terrified. Last time i couldn't even get the pap smear done because i started screaming as soon as the doctor picked up the speculum and even the ultrasound probe felt like someone was cutting me open with a knife and all my doctor said was "uh weird. Can you even have sex?" and i said i don't have sex and the conversation ended. Now im going to another doctor and im still afraid she will brush it off because "pain is part of womanhood" or whatever the fuck!! I almost cried when she mentioned on the phone that i should actually get a pap smear done. I've been having nightmares about it... I think I will never get one again, honestly I prefer the risk of cervix cancer. And it's not even that, now im terrified of gynecological visits all together. And literally NO one talks about it ever. It's just "try relaxing! Try doing yoga! :)" fuck off!

(Link to the original post in question)

Yeah, I have to get another pap smear in three years, and I'm flat out going to refuse unless they knock me out for it. If they will not do that I'm not getting it. And I will not be shamed into allowing myself to be tortured. If doctors want me to get this procedure, then they need to provide anesthetic or laughing gas or what the fuck ever.

More people need to start speaking up about this and saying plainly, "Yes, it can literally be agonizing". Because at this moment everything you google about pap smears is literally just systemic fucking gaslighting and victim blaming.

I'm glad my post is helping other people feel seen and understood. Now we need to get more people to talk about it without being shamed into silence. Maybe more people would be willing to get pap smears if doctors weren't literally lying to their faces about how it doesn't hurt, and actually anesthesia or whatever the fuck you wanna call it.

This is systemic medical misogyny and it needs to be talked about and called out. People deserve to know the fucking truth instead of being lied to and guilted and shamed into getting a pap smear without any warning of how horrible it can be.

It is not our responsibility as patients to be propaganda machines for a procedure that is torturous just because doctors refuse to fucking provide pain relief for it. This shit needs to change. Any doctor who performs pap smears needs to be required to offer anesthesia of some kind, at no fucking cost to the patient.

[sapphic-sex-ed]

wasn’t a pap smear the procedure that a lot of people say are really painful? or is that something else? i know iud insertion can be very painful but i thought there was some kind of test procedure that also was

IUD insertion can be painful, yes. I would say that pap smears are the most invasive test as for other STIs you get your blood drawn or have a genital swab or urine sample. I only write from my experience, but I found that while it wasn’t painful it wasn’t comfortable at all either. There’s a feeling of pressure that my body wanted to get away from and the discomfort feels sort of like… this isn’t painful but if I stay here it very much probably will be. It’s not pleasant but I wouldn’t say painful.

Of course, again, that’s my experience having done it twice by now. Other people may very well have had different experiences, but it’s not a topic I’ve discussed a lot so I don’t know much about others’ experiences. Do please share here in the replies if you’ve had a Pap smear. Was it painful for you? Was it not? How did it feel?

-mod liz

[plaguedghosts]

I just saw a post about how pelvic exams/pap smears are not *that* bad, and while they can be fine and dandy and just seem scary at first, they can also horribly go wrong and I felt like this needs to be brought attention of consent. And instead of RBing the post and lowkey trauma dump, I thought I would make a separate post. Doctors need your consent for a pelvic exam, and remember y’all, consent can in fact be revoked at any given time for any situation. My first Pap smear ended up with me getting raped because the doctor decided to hold me down and do the exam anyways, and did it improperly which caused me a lot of pain, tearing, and heavy bleeding because she did not use lubrication and used a lot of force when holding me down. It was so bad I cried because of how painful it was to sit when driving home. Remember just because you initially gave them the consent before the appointment, does not mean you can’t redact that consent prior or during the pelvic exam. If you don’t want someone to touch you, and they do anyways, report them to your local DOPL (Division of Professional Licensing) as well as the clinic/hospital you were seen at.

[prettybi4ajedi]

Just in case any humans who require pap smears haven't gone because, like me, all they heard were horror stories and are all anxious af; it's definitely no trip tp Disney World but it wasn't NEARLY as bad as I had built it up in my head.

[little-miss-selfships]

I'm pretty sure everyone's sick and tired about the pap smear talk but ever since I had one My stomach is sore, I'm sore down there and I think I'm starting that time of the month And just being fatigued

[aroaceconfessions]

Just had my first gynecologist appointment, and even though it's a medical context and not a sexual context, it definitely confirmed that I'm asexual considering I started crying uncontrollably as soon as I was undressed. Yes, even before the pap. Even though I knew they weren't going to do anything besides, you know, their fucking job. I do not want ANYONE touching me but me, ever.

[thescrumblingmidwife]

what advice would you give to a trans person who is terrified of getting health checks such as pap smears? I'm generally rather touch-averse and that doubled with the dysphoria makes it very scary to think about.

Hi Anon,

This is a topic close to my heart, because I myself am touch-averse and have a trauma response to pelvic examinations. I also want to make sure everyone understands why it's important to get pap smears!

Let's start with what pap smears are, why they're important, and who they are for. Maybe understanding that will be the first step in finding the strength and courage to go through with them.

QUICK ANATOMY & PHYSIOLOGY LESSON - THE PAP SMEAR

What is a pap smear for?

Your cervix is the gateway to your uterus, sitting atop the vagina. It's a thick ring of muscle that is normally closed, opening just a tiny bit for menses to escape (the sensation of the muscle opening is what causes cramps).

Now, the trouble comes when cervical cells have been infected with a virus called human papillomavirus (or HPV) - especially certain "high-risk" strains. HPV is very common in the human population - almost everyone sexually active has had it at some time, with about 50% of infections being a high-risk type. Most people just clear the virus themselves and never even know. But sometimes, this viral infection will start a process of dysplasia (basically growing weird cells), which can be the start of cervical cancer.

The job of a pap smear is to check the cervical cells for dysplastic changes that indicate things might progress towards cancer, or for the virus itself. (What it looks for specifically depends on your age and previous results, but the process is the same for you). When lesions are found early, they are VERY easily treatable. The pap smear saves thousands of lives every year by preventing cervical cancers.

How is a pap smear performed?

A device called a speculum will need to be inserted into your vagina to hold open the walls of the vagina and allow the provider to visualize the cervix. Once this is in place, a soft brush-like device is passed up through the vagina, pressed against the cervix, and swirled around several times to collect cells. This may feel weird or uncomfortable, but shouldn't cause pain. Most people don't feel it at all, the speculum being the worst part. The whole thing takes about one minute.

Separate from the pap smear, the provider may also perform a bimanual exam, which is when they insert fingers from one hand into the vagina while pressing down on the abdomen, to look for masses, abnormalities or tenderness.

Who needs a pap smear?

CURRENTLY (as of 2023), everyone with an intact cervix who is 21 or older is recommended to get pap smears, regardless of gender identity, sexual orientation, or sexual history. Between ages 21-29, you should go every 3 years, and after age 30, every 5 years (depending on results - if you get a positive, you would need more frequent observation).

If you are older than 21 and have never had any kind of sexual contact with anyone at all (including hands, mouths, or sharing toys!), you can discuss with your provider to see if a modified schedule may make sense based on your risk level.

Note: The HPV vaccine may change these recommendations in the future! I strongly recommend getting the vaccine if you have not already!

---

OK, Anon. With that public service announcement out of the way, let's talk about the real meat of your question.

The best thing I can recommend is to take the time to find a provider you vibe with. Someone with whom you feel safe, with whom you have mutual respect. See if your local LGTBQIA+ support group has recommendations, or if any clinics in your area have providers that specialize in LGTBQIA+ or trauma-informed care. Call and ask providers questions about how they handle people who struggle with pelvic exams. Generally, avoid crusty old men.

A good provider will warn you before ever touching any part of your body, go slowly, and ask permission each time, and stop the second you tense up. A GREAT provider will make you feel in control the whole time - they may let you insert the speculum yourself and not make you use stirrups if they're triggering for you. Medical consent is the same as sexual consent - just because you're disrobed in that room doesn't mean you need to let anyone touch you. You do not have to undergo a pap smear with a provider you don't trust. You are allowed to walk away.

Other things to try:

You can ask for a short-acting anti-anxiety medicine, like Xanax, to take before the visit, provided you've got a ride.

You can bring a companion, or ask for a nurse to hold your hand.

Chat nonstop, tell stupid jokes, or listen to music on headphones, whatever kind of distraction works best for you.

Meditate, practice belly breathing, really focus on full body relaxation, especially of the pelvic muscles

Remind yourself that it's one minute every few years for the piece of mind that you won't get cancer.

Be open to the possibility that it won't be as bad as you're fearing.

Know that you are brave and strong. You can do hard things. You can do anything for one minute.

If any other trans folx out there want to share tips with Anon for how to navigate gynecologic exams, please share!