“My first year at Stephens College all the girls were getting weird diseases. They were just starting to make it with boys and went to the college dispensary with a whole lot of vaginal complaints—trichomonas, fungus infections and strange discharges that didn’t seem to have a name.”
We were discussing the ways emotional distress is often expressed through bodily complaints—once called psychomatic illness, now termed psychophysiologic distress, is often literally discharged through the vagina. Gynecologists are all too familiar with stubborn vaginal infections that clear up only when the patient’s mental state improves.
“I’ll never forget my first gynecologic examination. I was really scared. Getting undressed wasn’t so bad. Then I lay down on the examining table and the nurse put my feet in those metal things, what are they called?”
“Stirrups. They’re to hold your legs up, apart and steady so the doctor can see everything he has to see.”
“One of my girlfriends said she was examined by a doctor who didn’t have a nurse in the room. I thought that was a law.”
“There’s no such law. The nurse is there to hand instruments to the doctor and also to protect him from the possibility of a rape charge. Some patients are a little nutty when they have to have pelvic examinations.”
“So there’s no such law?”
“No. And I think some women would be more comfortable if only the doctor were there, though, of course, others feel better if a nurse is in the room. Doctors are considered good targets by some predatory patients and lawyers who know they are forced to carry malpractice insurance in large sums.”
“Well, then the nurse hung a sheet over my legs. What’s that for?”
“Some women get nervous when they see the doctor exploring their private parts. It’s also less embarrassing for those who would be embarrassed—both doctor and patient.”
“First, he seemed to be examining the outside of me. What was he doing?”
“He was examining the entrance to the vagina, the bartholin glands which secrete lubricating fluids, the urethra and the clitoris.”
“Then he used one of those instruments that are always so COLD!”
“That was a speculum. They’re made of stainless steel and look something like a duck’s bill. Many doctors try to warm them before use so they’re less uncomfortable.”
“What’s it used for?”
“With a speculum a doctor can see the inside of the vagina, including the cervix. First he lubricates the two rounded blades of the speculum so it’s easier to insert. After it’s in the vagina, he can spread the blades by pushing a lever. If there’s a discharge, he’ll note the color and odor and can take part of it for laboratory examination. Usually he’ll do a Pap smear too.”
“A Pap smear is a cancer test isn’t it?”
“Yup. There’s always some discharge even in a healthy vagina. Some of this mucus as well as a smear of the cervix is taken for microscopic examination. Very early cancer can first be picked up by examination of cells which have been sloughed from the cancerous tissue.”
She shuddered, “I don’t think I want any more Pap smears. It’d be horrible to find out I had cancer.”
“Not at all. Cancer of the cervix in that stage is 100% curable.”
“Anyway, that metal thing, besides being cold, is so hard. It hurts. Why don’t they make them softer—like bodies.” Her green eyes twinkled a bit.
“Well, they have to be sterilized for one thing. And I think that even if they were body soft (or hard) there would still be complaints of pain because many women are literally up-tight during a gynecologic exam. Plastic speculae are available. That would solve the cold problem but they break easily and can be used only once so they’re comparatively expensive.”
“Because it was my first pelvic exam, the doctor decided to tell me about everything he was doing. After he finished the speculum examination, he examined me with his hands.”
“A doctor’s hands are among his most sensitive instruments. Part of a gynecologic examination includes palpating or feeling the internal organs of reproduction—the uterus, Fallopian tubes and ovaries.”
“That’s right,” she said, “he would push up from inside me and have me feel just above the pubis with my hand whatever he was examining.”
“Do you know what this is?, he would ask.
“No, what is it?”
“That’s your right ovary.”
“He did that with both ovaries, tubes, and my uterus. After a while, I wasn’t scared at all. I was mostly curious about what I was going to feel next. Finally, he pushed up from inside again. What’s that? What’s that? I was really curious.”
“That’s my right index finger,” he said.
Dr. Schoenfeld welcomes your questions. Write to him c/o P.O. Box 9002, Berkeley, California 94719.