This blog post is insanely private, or at least I’m insane for writing it, but Sam Finch* inspired me to blog this (he’s a great writer and activist for trans rights) and I wanted people to get a better appreciation for what it can be like to be trans in the medical system, and how it’s ultimately failing us. I’m not talking about HRT or top surgery or bottom surgery or even mental health care. I’m talking simple medical care.
Full disclosure: this blog post is about my vagina. You’ve been warned.
Initially, this was about my urethra, not my vagina. I was getting urinary tract infections again, after years of not having any, and I was having problems voiding. I was five weeks into a urinary tract infection, and none of my meds were working. I don’t know if any of you have had a UTI, but they can be miserable, and I was absolutely miserable.
So I saw a urologist.
Most of my exam was pretty straightforward, but then came the dreaded pelvic exam. I’ve never had a bad experience with a gynecologist–most of them have been lovely people–but in the past decade I’ve noticed I’ve been more and more reluctant to go, to the point where, before I started testosterone, it had been five years since my last exam.
I warned my urologist. “I should tell you, I don’t like this process–at all. And I absolutely refuse a speculum. I’ve never had anything specific happen–no past trauma–but I will freak out if I feel even slightly uncomfortable.”
The urologist agreed, and she was careful and quick. During the exam, she pressed down on my pelvic floor. “Is that tight?”
“Yes,” I said.
“Does it hurt?”
“Yes.” I had assumed up until this point exams were supposed to hurt.
She stopped pressing. After ordering more tests, she recommended vaginal physical therapy for my tight vulva. Yes, I have a tight twat. And yes, vaginal therapy is a thing. Ironically it wasn’t the first time I’d heard about it either; a year before, my most recent gynecologist had recommended it. I had laughed in her face (I later apologized).
Since two doctors recommended something not entirely unreasonable, I agreed to vaginal therapy. I was told I may enjoy it. That would be most welcome, certainly. I entertained visions of me orgasming wildly on a table in a medical office, but I didn’t think it was likely.
I met with the physical therapist, and explained to her I was a transman. She said she had never treated a transman before, but since all the parts were the same, she was confident she could still provide my care. While that was a bit… non-affirming of my gender, I let it go.
We got down to business. When she first pulled back the sheet and exposed my lower half, she did a double take, and whispered, “Oh.”
I almost apologized for being hairy. Almost. (Hey I had even trimmed, because, y’know, politeness and shit.)
She recommended some exercises (which I still do), and performed all sorts of odd tests, including hooking my (hairy) asshole up to a bunch of electrodes and having me squeeze and release my pelvic floor. It was all very boring, and not sexy. But it wasn’t painful.
She also asked her own questions, and one of them was, “Is it painful to have sex?”
I admitted my husband was a bit of a big boy, and well, it was already established I had a tight twat, so yes, sex was sometimes painful.
She wanted to stick a dilator in my vagina, and she claimed it wouldn’t hurt, but she’d gradually increase the diameter until my vestibule was more stretched out, and it would decrease the amount of pain during intercourse, which also may somehow eventually help loosen my insanely tight pelvic floor. (Interesting to note: the pelvic floor tightens up from the impact during running, so the fact I’ve been running since I was fifteen may be partially responsible for my tight pelvic floor.)
“Okay.” Her plan sounded reasonable.
When she took the “dilator” out of the box, it was very clearly a hard plastic dildo–a medical grade dildo. But you should try everything at least once, right? She said it wasn’t supposed to hurt.
Imagine… I’m lying on a table, with my lower half naked and legs spread, and she’s coming at me with a hard white dildo. She’s standing over me with it, her hands gloved, as she lubes the thing up….
She barely entered my vagina, before pain shot through me. The dildo was cold and unyielding. “It hurts,” I said.
“Really?” She looked shocked.
Why would I lie about something like that? “Yes.”
“Okay.” She moved back to the cabinet, and pulled out another box, with another dildo. And–fuck me–but that one didn’t look any smaller. Whatever. I let her try.
“It still hurts.”
She pulled it back, but didn’t pull out. “This is the size of an average erection.”
I didn’t even have words. I just stared at her.
She pushed into me again. “Still hurt?”
I grit my teeth. “Yes. Do we have to do this?”
I let her stand over me, pulling the dildo in and out and twisting it all around. I started to sweat and feel sick, and I wanted it to be over. Eventually it was.
She explained she would prescribe me lidocaine and vaginal Valium for intercourse.
I nodded numbly.
I staggered out of there with three prescriptions for fitting my husband’s cock into my vagina, and no explanation for why I get frequent urinary tract infections. Instead of a diagnosis, I had pills to take every time I was fucked.
Twelve hours later I developed a urinary tract infection from her digging around in me. I sat outside my house, in my car in the driveway, and I let myself go. I didn’t cry for long, maybe ten seconds, because whatever I was feeling couldn’t be released with a good cry, but whatever she had done to me lingered in my body… making it impossible to forget.
I canceled my appointments with my physical therapist, and informed my urologist of what had happened. I admitted physical therapy wasn’t necessarily supposed to be comfortable, but I felt as if a line had been crossed. I reiterated I was upfront with both of them about my phobia of gynecological exams, and how this certainly didn’t help. (I have a complete hysterectomy scheduled for later this year.)
You know what my urologist said? “Well, everybody’s got their own thing they’re weird about.” And she didn’t inspect my genitals to see if any permanent damage at been done, even though I’d been in pain for weeks.
If you’re still wondering how this all relates to trans health care, consider this: my cis husband was getting better care for my gynecological problems than I was, because heaven forbid it when a man can’t stick his cock into a pussy.
So I started drinking, and I’ve just been able to slow it down, and write this blog post. It’s been half a year.
Article posted to Queerdeer Media:
*Link to Let’s Queer Things Up by Sam Finch: http://letsqueerthingsup.com/