Confession: I became a midwife because I hate pelvic exams.
I mean, yes—I am in awe of pregnancy. And I can vividly remember the New York City cab ride I took home after witnessing my first birth, where I sat teary-eyed and beaming and said, "This is it. This is my life now."
But really, it all began with pelvic exams. Because let's be honest: They are awful.
As a patient, it took me years before I was able to get through the entire exam; I had to schedule multiple appointments to make it happen the first time. At my first appointment, knowing how terrified I was, my extremely caring nurse practitioner just had me put the gown on and practice lying on the table. The next time, I put my feet in the foot-rests. I don't remember exactly what number visit I had my first actual speculum exam, but it was a lot.
Through it all, I kept thinking about how I couldn't be the only one out there that hated this—even though no one talked about it. I decided that I wanted to be part of the movement that was going to make pelvic care respectful.
Despite my difficulties as a young adult, I am lucky. Because the upsetting truth is that our medical system is not set up to support the sensitive type of care that I received. Most people with vaginas are rushed through the process of a pelvic exam without consideration of the profound impact they can have.
The pelvis is complex, beautiful and powerful. It is also the home of some of our deepest vulnerabilities. And for people that have experienced sexual assault or traumatic birth, or for people who have vaginas but do not identify as female—well, the experience of a pelvic exam can be downright awful.
Plus, our society has ingrained a very negative emotional connection to the pelvis: It is dirty, gross, lewd…and wrong.
A huge part of the problem is the speculum—that metal or plastic device that brings a sense of dread to probably all of us.
Yona is made of a team of designers who have set out to redesign the speculum, and thus significantly improve the pelvic exam experience.
Freethink made an excellent video explaining this amazing new speculum concept. (Highly worth the less-than-six minute watch. But please note, they share some quotes of people who have had traumatic pelvic exams, which may be triggering for some.)
Freethink's video shares the very upsetting history of the speculum we all know and… hate:
They were designed by a man and tested on enslaved women. As Yona team member, Hailey Stewart, an Industrial Designer and Design Researcher, says, "putting the comfort of the patient first was certainly not on the top of his list."
Using a method called "radical empathy" (we love them already), the team at Yona has set out to change it all. They are also addressing the fact that "not all people with a vagina identify as female;" every person with a vagina deserves to have appropriate medical care to prevent life-threatening diseases, such as cervical cancer.
The new speculum design offers the following innovative features:
- Improved view-field (so your provider does not have to expand the speculum as wide to see what they need to see)
- Relaxed handle angle (so you don't have to move your bottom as close to the edge of the table as you currently do)
- Single-handed operation (so your provider only needs to use hand to operate the speculum)
- Concealed locking (so you don't have to hear of feel all that clicking)
- Silicone coating (so you can say good-bye to the discomfort of metal or plastic)
So much YES, I can't even handle it.
Yona is not available in providers' offices yet. But you can check out their page for ideas on how to make this vision a reality (for example, share this information with your provider, and ask them to bring Yona in the office).
In the meantime, here's what you need to know about pelvic exams:
1. In the absence of symptoms or concerns, experts are not sure how often you need one.
According to the American College of Obstetricians and Gynecologists (ACOG):
"A limited number of studies have evaluated the benefits and harms of a screening pelvic examination for detection of ovarian cancer, bacterial vaginosis, trichomoniasis, and genital herpes. Data from these studies are inadequate to support a recommendation for or against performing a routine screening pelvic examination among asymptomatic, nonpregnant [person] who are not at increased risk of any specific gynecologic condition. Data on its effectiveness for screening for other gynecologic conditions are lacking."
In other words, we don't know enough yet. Ultimately their recommendation is this: "Pelvic examinations should be performed when indicated by medical history or symptoms… [or] if a [person] expresses a preference for the examination."
2. You should still see your pelvic health provider every year
Even if they don't do a pelvic exam, it's important to meet with your provider yearly to discuss your health and make sure you are up to date on screenings, vaccines, etc.
3. One of the most important aspects of a pelvic exam is the pap smear (a swab of the cervix that checks for cancerous or precancerous cells)
When a pap smear detects abnormal cells, there are several treatment modalities available to prevent it from progressing. And, if it is cancer, treatment is available and often effective.
Here are the current Pap smear guidelines for people without a history of abnormal results, according to the U.S. Preventative Services Task Force:
- People age 21 to 65 years: Pap smear every three years
- People age 30 to 65 who would like to lengthen the screening interval: Pap smear with human papillomavirus (HPV) testing every five years
If you have a history of abnormal results, your provider will guide you towards your specific recommendations.
4. Doctors (obstetricians and gynecologists) are awesome, but they are not your only option
Many people are surprised to learn that they have more options than they knew for pelvic health providers. Midwives and nurse practitioners provide comprehensive health care even when you are not pregnant and might be a great fit for your pelvic health needs.
5. Free and low-cost healthcare options are available
Clinics such as Planned Parenthood offer free and low-cost pelvic exams, as well as testing and treatment for sexually transmitted infections, and the prescription of birth control.
6. Until Yona arrives, here's how to make your next pelvic exam better:
- Talk you your provider and tell them you're worried, uncomfortable or scared. If you don't feel like you are being respected, leave (but promise me you'll find someone else and try again).
- Bring your bottom all the way to the end of the table. OR, make two fists with your hands, and stack them under your bottom to help lift your bottom off the table.
- Use the footrests (aka stirrups) if you want to, or feel free to ask your provider if you can keep your feet on the table if it feels better.
- Fan your knees out to the side like a frog. SO MUCH EASIER SAID THAN DONE, BUT, the more relaxed your muscles are, the less uncomfortable it will be, so take deep breaths and visualize a beach, a lake, or anything that makes you feel calm.
- Wiggle your toes and relax your jaw.
- Ask your provider to touch the outside of your leg with the back of their hand first. Then the inside of your thigh. When you say, "I'm ready," they can start the pelvic exam. Not before.
- Ray Rachlin, midwife, and owner of Refuge Midwifery in Philadelphia, recommends telling your provider that you'd like to insert the speculum. They can guide it to the right place, but you are in charge of the speed at which it goes in.
Your body, your rules. It is not rude, wrong or unacceptable to tell your provider how you would like your pelvis to be examined.