Content note: this post mentions blood, describes a minor medical procedure and discusses non-consent in a medical setting. If any of those are difficult for you, feel free to give this one a miss, and join me next week for a new Smut Saturdays post instead!
Also, please forgive me for the title; I couldn’t help myself. As you can see, this post is a continuation of one from last week, available right here, but hopefully it’ll make sense as a standalone piece too. (Except for, y’know, the title.)
After I explained to my doctor that I had recently learned that my post coital bleeding wasn’t “normal”, and my doctor explained to me that bits that were meant to be inside the neck of my cervix were, in fact, on the outside, I was referred to a treatment centre to have it looked at.
I am not a shy person, as evidenced by my Twitter full of nudes and the existence of this very blog. I am not averse to jumping onto a clinic bed and having a stranger examine my bits (though, like most vagina-owners, I am a tiny bit averse to the ol’ speculum. That thing is a bastard). Being autistic and anxious, I hate appointments in general (travelling to new locations? Introducing myself to new people? Wearing outdoors clothes?!), but I wasn’t any more upset about seeing the Vag Mechanic than I would be about going to the optician. I showed up to the treatment centre early and was beckoned into my appointment after about ten minutes of apprehensive knitting.
The nice Vag Mechanic lady sat me down and asked me a number of very predictable questions about my recent sexual partners, my periods and my oral contraception. Then she asked, “And do you experience any tearing upon penetration?”
I explained, somewhat sheepishly, that I did a bit, sometimes, but only when things were rushed. She had some stern words to say about foreplay and lubrication, but we agreed that since the bleeding I’d been experiencing didn’t always correlate with the hurried sex and tearing sensation, it was likely cervical ectopy, as my doctor had suggested. I was taken into the next room, shown a curtained-off corner where I could have some privacy, and instructed to strip from the waist down in my own time, whilst the Vag Mechanic went and got a nurse to observe.
Once I was on my back with my legs in stirrups and a nurse standing on the right-hand side of the bed, the Vag Mechanic started unpackaging a speculum whilst the nurse chatted with me, presumably with the intention of keeping me calm and somewhat distracted from the impending plastic jaws that were about to wrench me open. (If you have a vag and you haven’t experienced a speculum before, please be aware that I’m largely being dramatic, and am hypersensitive to a number of sensations because I’m autistic; speculums (or speculae?) are, at worst, distinctly uncomfortable for a few moments as they’re being inserted and a few moments as they’re being removed. Do not be deterred from attending important gynaecology appointments because I’m a gigantic baby.)
The bastard thing went in, and the Vag Mechanic pulled a light on an arm down between my knees so that she could have a proper look, which wasn’t a surprise. What was a surprise, however, was the screen to my right, directly next to the nurse at my bedside, which displayed footage of what looked like…
“Is that my cervix?” I asked excitedly, pointing at it like you might point at a very cool zoo animal. The nurse informed me that it was. “And that’s live?” Yep, it was a closed circuit live feed of my very own cervix. Being the sex nerd that I am, I was ecstatic.
The Vag Mechanic slid a cotton swab into the opening of the speculum (and, by extension, the opening of the me) and used it to point out to me on the screen where some of the tissue was red and raw-looking. She prodded it gently and blood oozed out, confirming that it was indeed cervical ectopy.
I expected to have the speculum withdrawn, to be able to sit up, and to have a discussion about the benefits and drawbacks of cauterizing the tissue (the most likely treatment option, according to a quick Google search and literally zero medical professionals that I’d spoken to thus far).
I did not expect her to unsheath a glorified toothpick and begin explaining, as it drew nearer to my bits, that this was silver nitrate, and she was “just” going to “quickly” cauterize it. I hadn’t even had a chance to Tweet about the confirmation that it was what I’d suspected. I lay there, frozen, unable to object or ask questions. All my thoughts were replaced by terror.
And then, to make it worse, the nurse very deliberately moved in front of the screen.
Desperate to regain some control of the situation, I asked, “Have you moved in front of the screen because sometimes it smokes and that freaks people out?”
“Exactly that,” she said. When I tried to crane my neck past her, less spooked by my smoking cervix than by unknown things happening to my genitals in real time, she fucking leaned so that I still couldn’t see it. Before too long it was over, and the nurse and the Vag Mechanic were completely unaware that they’d put me into fight or flight mode.
The moments after that are hazy in my memory, presumably because I was having a minor trauma response. They gave me a piece of paper about looking after my newly-scarred cervix and I made some joke about the line that forbade me from horseback riding. I had to put a pad in my underwear (no internal menstrual hygiene products, so no beloved menstrual cup) to catch the blood that my disgruntled vagina was ejecting along with bits of silver nitrate-y crud. Nobody had told me about that beforehand, either, and some warning would have been nice: apart from the fact that I very rarely have pads in my bag nowadays, I find them intensely distressing on an autistic level on account of the rustling, the stickiness and the scent, so I would have benefited from mentally preparing myself for the bastard things.
And that’s the point, really: I would have benefited from mentally preparing myself for all of it. Mostly, you know, for the cautery.
I don’t want to be ungrateful for what was a minor but important medical intervention that I received completely for free, thanks to the amazing (if strained) NHS. And I totally understand the logic behind “getting it over and done with”, and I understand the nurse’s insistence on shielding me from watching the process happen. Most patients would want to think about their raw cervical tissue being chemically burned as little as humanly possible, I’m sure, and taking the speculum out just to give them an opportunity to worry about it would be cruel. But I’m not most patients: I’m autistic, for one, and benefit from a clear outline of “the plan” from the outset in order to feel safe and in control. Maybe more importantly than that, though, I’m a survivor of sexual trauma, and so I want to know and understand what people are doing to my genitals at all times.
Maybe it was a miscommunication – maybe the Vag Mechanic assumed that my doctor had laid it out more clearly to me, or maybe the nurse thought that the “Generalised anxiety” bit on my notes meant that I’d pass out at the sight of the cautery taking place… or maybe they just made some assumptions based on their previous patients or what they themselves might have wanted… but regardless of why they didn’t check what I wanted, they didn’t check what I wanted. They didn’t explain. They didn’t make my options clear to me. They probably had the very best of intentions, but they took away my agency at a vulnerable moment and that made me feel unsafe.
I don’t think any medical setting, but especially a sexual or reproductive health-oriented one, should ever make a person feel unsafe. Ever.
There is a happy ending to this story in that my recovery was fine, I no longer have the post coital bleeding and I only dread my next Vag Mechanic appointment a bit, but that doesn’t take away from the feelings of fear and helplessness and discomfort and the rest of it that I carried home with me as well as my leaflet. If you found this article because you think you might have cervical ectopy, I want to make it clear that you absolutely do not need to feel this way, and you have every right to tell the Vag Mechanic before you get into the stirrups whether you want the procedure explained to you before, during or after, as well as any other worries or needs you might have. If you found this piece because you’re a healthcare professional who deals with genitals, I urge you to check in with your patients about how much they’d like to be aware of and involved in procedures that you’re going to do – even minor ones like mine.
And if you found this article because you’re a regular reader of mine, I’m always grateful for your support and I’ll see y’all next week with some unapologetic smut.