I am not registered with a GP.
Somewhere in the haze of school to bigger school to university, one city and one country to another, I never did the paperwork. I was aware, as one is aware of things like the fact that one in three get cancer and that your face will sag, of the importance of sexual and reproductive health. I lectured friends on getting tested. I also knew that we should all be demanding adequate care; demanding a future where racism, classism, sexism or homophobia no longer impede or affect the quality of medical care received. Those who are not what Mary McAuliffe describes as the “archetypal patient” – “male, white and middle class” – deserve to be listened to and believed by medical professionals.
“208 women, including, most famously, Vicky Phelan, were not told of the abnormalities detected in initially falsely negative smear tests, leading to late-stage cancer diagnoses. 17 of those women have since died.”
One friend of mine has such painful periods that she collapses in restaurant bathrooms and has to order painkillers on the dark web. No doctors have taken much notice. Another’s contraceptive implant ruptured into her stomach. The A&E doctors, sceptical of her pain levels, sent her home. May’s HSE study called for an “immediate and urgent” investigation into “alarming” perinatal mortality rates in Ireland’s African community, within which 6.3% of babies are stillborn compared to 3.7% for Irish mothers nationally. 208 women, including, most famously, Vicky Phelan, were not told of the abnormalities detected in initially falsely negative smear tests, leading to late-stage cancer diagnoses. 17 of those women have since died. Miriam Lloyd has criticized the Irish state for its “disordered relationship towards women for the waist down” and, confronted by these statistics, we might be reminded of how recently the eighth amendment was repealed, despite the unnecessary deaths of so many women either from unsafe pregnancies or from carrying out desperate DIY abortions.
“We need to know that we can speak about our bodies and that having genitals, and/or having sex, is not a shameful thing.”
In the light of this crisis, I knew that it could only be a good thing to discuss our experiences about sexual and reproductive health. Our conversations, our stories, are politically important – take, for example, the powerful impact of Savita Halappanavar’s death on the repeal campaign or Jade Goody’s on the fight to diagnose and treat cervical cancer. They are also personally necessary. I was terrified of getting my period. A girl at my primary school, when she started developing, concluded that she had cancer in the chest. I wish that both of us had saved months of trembling fear and spoken to the nurse, or a friend, or our mothers. We need to know that we can speak about our bodies and that having genitals, and/or having sex, is not a shameful thing.
But, to know these things in theory and even to preach them to other people is not the same as believing them yourself. I did not have a GP and I purposely remained unregistered. I did not want to receive, in the post, an invitation to a cervical smear. As a part of some deep fear that there was something very wrong with me, I avoided the idea that one should, at some point, visit a gynaecologist. In occasional panics, I emailed helplines or bought pregnancy tests. But, after one too many dreams about blackened teeth, I realised that if I really was going moldy from the cervix-out, cursed by the seething, misogynist guardian of female “purity”, I had better get on top of it.
Although I was late to the appointment, getting intentionally lost between hospital corridors and, childishly, taking the wrong bus, the gynaecologist did not shout at me – although I had, suddenly experiencing all those unwarranted but internalised feelings of embarrassment bestowed upon the young woman who has admitted to being a woman, expected her to. Shame hangs like humidity in rooms in which you will soon remove your pants. She asked about my menstrual cycle. I asked her whether a light or heavy period was better. She laughed at this, interrogating my toxic inner urge to be physically defined as good or bad. Indeed, to go through these details so seriously and to have someone take them down in a notebook was a comfortingly dissociative process – reminding me that I have a body, as do you, and its appearance and behaviours need not infringe on my sense of self. I realised that I had probably never considered the actual details of my periods – just felt the sharp fear of bleeding onto sheets or skirts or the embarrassment, as someone whose eating disordered pride in ever having succeeded at developing secondary amenorrhea persists, that they happened at all.
After the physical examination, I was assured that there were no growths or lumps or any otherwise dark creatures living inside me. But, she asked, had I been experiencing pain during intercourse? Unlike the earlier questions, I hesitated; why would one identify “pain” in an experience that I (wrongly) had assumed was necessarily characterised by a degree of discomfort? Drawing on a sheet of white card, she outlined a process of involuntary muscle spasms that might make this the case for me: vaginismus. It was curable, relatively common and, crucially, there. Even if I had identified painful sex as a problem, and looking back it is now obvious that it was, it had remained a subconscious thought. Sex, as it rationally turns out, need not be painful. She asked me why I had never wanted to tackle this before. I did not know I could, I said. I had not known if it was real pain.
When my friend collapsed in a restaurant bathroom, I was terrified. I asked her if I should call an ambulance. She said no, it was fine, it was just her period. But should a period make you collapse? To revisit my earlier insistence that the wider healthcare system needs to believe in people’s pain, I wonder whether some, gas-lit by a flawed system, have stopped believing themselves. Certainly, I had. I worry about the potential consequences of this act of self-silencing, of self-censorship. Pain is an indicator of physical distress and of danger. What happens when we stop allowing ourselves to admit to it? When we become, thus, unable to identify it? What happens when shame and/or dangerous third-party commentary interferes with our literal ability to feel?
I am cis and I am white, and I paid for a private appointment. My gynaecologist was experienced, professional and she seemed to understand why I might not have thought to inquire about this before, why I did not feel I could.
“Transgender people in Ireland sometimes have to wait up to five years for a healthcare appointment.
My visit to the gynaecologist was a positive experience. It interrupted the cycle of shame, guilt and paranoia that had infected me since puberty. But not everyone will find this, or even find an appointment. To (too briefly) note one glaring example: transgender people in Ireland sometimes have to wait up to five years for a healthcare appointment. A trans friend recently described to me the difficulty of communicating their experience to a cis-gendered medical practitioner. Issues of inclusivity, availability and funding all impede our ability to offer effective, compassionate healthcare. However, by continuing to encourage and amplify these discussions, we might cement the political and psychological notion that everyone is entitled to it.
