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An Empowering PAP Smear - Healthcare Series Vol 1 Pt 1

Updated: Jan 28, 2020

Listen to the audio version.

So much has changed in healthcare over the last twenty years. Expect more from your provider, as they go the extra mile to help you feel at ease with better communication. Explaining what will happen with carefully articulated terminology and more eye contact, are among the few positive changes happening. I imagine we will continue to see more empathy and improved communication skills, as we transition into a whole new world.

Expect a pelvic and breast exam tutorial

Providers really SHOULD give a brief overview of the steps to the exam, before placing their hands on you. I despise the term “should” however, I am going to allow it in this case. I want you to know what to expect and to not have any surprises on the exam table. Whether this conversation happens in their office or the exam room, ask about the flow of the exam before taking your clothes off.

Dear Pap provider,

Please tell me everything you are planning on doing, before you do it.

Thank you,

Amazing Me

Do you give your permission?

Not only is it appropriate for providers to review the steps to the exam, it is also standard for them to ask if you are ready to proceed. Listen to these two examples and notice your reaction.

“Open up your legs now.”

What does this statement bring up for you? Sit with these words for a few moments.

Now step away from these feelings and listen to this next phrase.

“Would you mind letting your legs fall to the side, please?”

Choose the one that makes you feel the most comfortable. When given the choice, the answer is clear. This is a simple communication tool that is often over-looked in the medical field. With healthcare, specific to pelvic and breast exams, I want you to expect more sensitivity and clear, direct communication. To be asked instead of told what to do, is a basic common courtesy that we all deserve.

Before attending your next pelvic exam

Get referrals

Choose a healthcare provider based on personal referrals. You want to hear first-hand advise from friends and family who have been there and done that. Ask as many questions as you can think of before deciding on your Pap provider. When looking for LGBTQIA-affirming care, GMLA and OutCare are good resources to review on-line. I am in the process of starting a resource list on my website, so stay tuned!

Talk to your provider, before your exam

When booking your appointment, ask if you will be meeting the practitioner in their office, while your clothes are still on. If the answer is “the assistant will have you put on a gown and get onto the examining table before the provider comes in,” ask to meet the provider for a consultation first. If your request is denied, find another practitioner. No-one should ever be left waiting on an exam table with legs up and open. Having the chance to talk to your provider, while sitting in an upright position, is standard protocol.

Gone are the days of performing a pelvic exam under the drape!

For the past twenty years, pelvic exam trainings at major universities have been teaching practitioners to move the drape up to the belly. This will allow you to see what they are doing and for the provider to see your face. The midwife, doctor, or nurse needs to look at your face, from time to time, to notice whether you are experiencing any tension.

Offering you a mirror

You can see your cervix! If you are not offered this amazing opportunity and are interested, please ask for it. After the provider has your cervix in view, they will give you a hand-mirror. Sit up to position the mirror so that you can see your shiny pink cervix. It resembles a donut with a small hole in the middle. The cervix is quite remarkable when you think about its function. It can expand ten centimeters across to allow a baby to be delivered through it. Seriously! I’ll forever be amazed at how incredible the human body is.

Is there a poster on the ceiling over the exam table?

You are not meant to stare up at the ceiling at a poster of rainbows, next to bright fluorescent lights. If you see a poster, the office may be following old guidelines. As stated above, eye contact between provider and client is a good thing. You are a part of this exam and being included in what is happening will empower you. You will also learn more about your amazing anatomy.

Hair removal

Don’t shave, wax, or pay for laser hair removal, before your GYN appointment, because you feel you NEED to do this. Only do these things because you want to. This is a personal decision, in and out of the bedroom. Your provider will not care about the hair!

Skip the stirrups and insert the speculum yourself!

As an FYI, healthcare providers are now taught to call stirrups: "foot-rests." Not everyone is comfortable placing their feet in metal foot-rests, either due to hip pain or past trauma. A pelvic exam can be performed by pulling out the table. With feet together and knees to the side, a pelvic exam with a speculum can be performed easily.

You can ask to insert the speculum yourself. If you think this would be empowering, speak with your care provider about this request, before your exam. If they deny your request, you may want to consider switching providers, if being the one to control the speculum would help you feel safe. A routine pap test is not a sterile exam and there is no reason why clients should not be able to do this.


I have been very impressed with the communication protocols that have been improved regarding LGBTQIA clients. However, it is just a start and we have a long way to go before everyone feels safe and comfortable with healthcare. Major universities, as well as the V.A., are incorporating diversity trainings to broaden their sexual-health history questions.

Discussing hormone therapy, gender identity, and pronouns, are topics that clients want to feel safe doing so with their healthcare provider. Personal referrals will lead you in the right direction to finding the practitioner that is best for you. LGBTQIA-affirming midwifery care is a great place to start, if you are not sure where to turn.

Expect pressure, not pain

It is not common to feel pain during a routine pelvic exam. Downward PRESSURE is felt as the speculum is being inserted. You should not feel any pain and if you do, speak up. Your care provider will stop, to figure out the cause.

Common reasons to feel pain during a GYN exam:

· A hair is being pulled

· Not enough lubrication has been applied

· Common vaginal infections, such as yeast

· Provider rushing through the exam

· Vaginismus

· Fear of pelvic exams

· History of sexual or physical abuse

The majority of reasons why you may feel pain during a pelvic exam, can be easily remedied. When practitioners take their time, explain the steps, and provide opportunities for questions before the exam, you are likely to feel more at ease. Providers SHOULD always stop the exam if their client is fearful, in pain, or asks, for any reason.

As a Licensed Midwife and an instructor, I have had the pleasure of teaching empowering pelvic and breast exams, at four different universities. I work alongside amazing medical skills instructors, teaching medical students and established healthcare providers, using live models. Doctors, nurses, midwives, and physician assistants travel to Florida from all over the US for breast and pelvic healthcare refreshers. Teaching “old” and “new” practitioners, all of the amazing ways to help people feel more at ease during such a sensitive exam, leaves me feeling empowered myself.

***This post is the first in a series of informative healthcare tips.***

Anastacia Elizabeth Walden

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