Saturday, December 26, 2009

Modern Gynecology

(The text formatting is weird, and I don't want to put in the time to figure it out. To see it in reasonable-sized font, with appropriate line breaks, click the title of the post (not the blog).)

I really dislike pelvic exams. I assume most of us do, who have to have them. I know it's healthy to keep on top of my preventative healthcare. But when I think about walking into that waiting room ... sometimes, I just need a little extra motivation.

Luckily, my favorite coping mechanism - snarky, inappropriate humor - has proven remarkably applicable to gynecological conversation. Who knew! In fact, I'm almost looking forward to my next appointment, because I know I'll have another hilarious story to tell.

At least, in retrospect it will be hilarious. In the moment, it's sometimes hard to see the humor.

Electronic medical records, in particular, have turned a visit to the gynecology office into a stand-up comedy routine. The medical assistant has to ask the same questions, in the same order, to every patient no matter what. The computer won’t let her go off script. Of course, I’m not your standard gynecology patient. They ask me all these questions that I just don’t have the right answers to.

“Do you know the date of your last period?”

“January, 2007.” Now that one should have been fairly simple except that it was unexpected. So then we had a little selective hearing loss situation.

“July 27th?”

“No. January, 2007.”

“Oh!”

Once that was cleared up it got even weirder.

“Are your periods regular?”

“Umm…?”

Now how was I supposed to make sense of that? So she just picked one, flipped a mental coin, I guess. She couldn't get to the next screen without answering. My official medical record, if you were to read all my gyn exams one after another, would say that my lack of period vacillates randomly between regular and irregular. Whatever.

“Are you on birth control?”

“… no?”

I’m on testosterone, but three gynecologists in a row have been notably non-committal as to how unlikely an unintended pregnancy is for someone on this dose. The medical assistant didn't appear to notice my intonation. Oh, well.

“Have you ever had an abnormal pap smear?”

“No.”

At this point the medical assistant turned to me in open disbelief. “And your last period was in 2007??”

How I would like it to have gone next is like this:

“Do you have my chart? My paper one? Because on the first page it says that I’m transgender and I’ve been taking testosterone for 3 years.”

“Oh.”

“Which also explains the facial hair.”

“Right.”

“And the fact that I didn’t respond when you called for “Ms. …” in the waiting room.”

“Okay dear the doctor will be right with you.”

But I’m not really that bold, or that mean. It wasn't her fault, anyway. Instead I just explained, all straightforward and apologetic-like.

The next time I went in, for a follow-up visit annoyingly shortly after that one, I had exactly the same conversation with a different medical assistant. Word for word. It was creepy.

I considered making a handout. It wouldn’t have to list the questions, or even full sentences, just my answers. Something like,

  1. 2007.
  2. Umm…?
  3. Not exactly.
  4. No.
  5. Yes.
  6. Yes, really.

I could just hand it to the medical assistant and let her sort it out.

The third time, I had the same medical assistant from the first appointment. She still asked all the same questions, but this time she believed me about each answer the first time I said it, so it wasn’t quite as funny. Then she started asking the behavioral questions, which for some reason had been skipped during the previous appointments. The conversation got exponentially more bizarre.

“Are you sexually active?”

I refer you to the quantum physics non-explanation of my dating life. I think I said “yes,” just for simplicity’s sake.

“Is your partner a man or a woman?”

“Umm … no.”

I felt sorry even as I said it. But I couldn’t think of anything else to say that would feel honest. Note how I restrained myself from launching into an explanation of quantum superpositional dating, wherein, in this case, the term “partner” is a bit of an overstatement during an unquantifiable, but large, proportion of the time. Interesting perhaps, but not pertinent. The medical assistant was confused enough.

“No?”

“She’s … ze’s … we … our genders are similar.”

That one took her a little while. I guess they don’t have a button for that in the electronic record system.

“Is there any possibility you might be pregnant?”

Given my recent (if largely uniformed) musings on quantum physics, the phrase “any possibility” may mean something different to me than it does to the medical assistant. Or maybe it's just that it goes against centuries of cultural habit to promise a positive outcome (i.e. lack of pregnancy) with so much certainty. I dampened the impulse to explain my completely irrelevant hesitations, and settled on “no” because I thought it would end the conversation sooner, which it did. Then it was time for the actual exam part of the exam, which I won't relate here, except to say it was far less amusing than the talking part of the exam.


It’s probably not nice of to mess with the medical staff so much. I could play along, I guess. Give away the punch line sooner, so at least they can attribute the confusion to my queerness, rather than feeling badly for not knowing which buttons to push. Sometimes I do consider dialing it back a few.

But then I think, whose comfort am I more concerned about here? The medical assistant is just having a normal day at the office. I’m having a f*%$^#! gyn exam. If coming away with hilarious stories about the MA’s confusion about my gender makes the situation just a little bit less miserable, or makes it a little bit easier to contemplate showing up for the next time, then I think I’ll continue enjoying their confusion.

4 comments:

Arjuna said...

My exchanges usually go:

Are you using birth control?

No.

Why not?

There is no way my boyfriend can get me pregnant.

*incredulous look*
Oh, really?

Yes, really. There's nothing coming out of his uterus or ovaries that can do that, at least not that I know of.

Zane said...

So about 7 or so years ago, I approached my then primary care doc about testosterone for transition, with a letter and was rejected which I'm sure you remember because I made a big activistic stink about it. At my last annual check up with my new doctor, who has been my doctor for say 4 years... for the FIRST time ever, he brought up my transgender status, and *followed up* on my transition status (or lack thereof). I think its the first time he read my entire chart in the entire time I've been his patient. *laugh*

cinnazimtanie said...

I think I read somewhere on your blog once that you're in Oakland. I recommend going to Lyon-Martin in San Francisco. The questions they ask are far more appropriate (for example, their form asks which pronoun to use). The waiting room is also a much more pleasant experience, since it is a clinic for queer folks.

http://www.lyon-martin.org/

Davey says ... said...

i know of lyon-martin, and they're great! but since i am lucky enough to have insurance, i choose to go to the place where my insurance can be used. otherwise this would all be quite expensive.