Pap smear etiquette

 

 

As a male doctor, one tries, when dealing with female patients, to maintain a certain professional distance, never more so than when doing a gynaecological examination, not just looking but touching and indeed penetrating the woman. There must be no hint of awareness of a sexual context.

Strangely though, women are generally at pains, when attending for such an examination, to be freshly bathed and to wear attractive underwear. In other words, they seem to demonstrate an awareness of a sexual context. I’ve heard it said that “all women are slightly in love with their gynaecologist.”

A female patient, leaving soon to go overseas to live, said to me “I really should have a pap smear, but I’ll have to come back. I couldn’t possibly let you see me until I’ve waxed my pubes!”

Younger women, especially, may make risque comments about the procedure. Some are flirtatious. I’ve wondered whether these ladies are over-compensating for their underlying embarrassment or shyness. Alternatively they may actually sexualise the experience to some extent or see it as a humorous predicament. Sex, and many things related to sex are after all fundamentally funny. There’s an old comedy line; “What do you say to a naked lady?” The converse, of course, is “What does a naked lady say to you?”

One young lady, whom I’ll call Maria, came to see me for her first pap smear. She was soon to be married, to her first cousin. Both families had initially opposed the union, but eventually agreed to it, in order to legitimise by marriage their already over-heated sexual relationship.

Maria was nervous about the procedure, but after considerable reassurance, she undressed and lay on the examination couch.

To our mutual dismay, as soon as I inserted the speculum, she had an orgasm!

Gynaecological examinations, it seems, can also be traumatic in ways other than the obvious.

Another young woman, still in her teens, came to see me and made a follow-up appointment for her first pap smear. Let’s call her Rebecca.

On the day she was due back, I discovered that the switch on my examination light had broken. I rang my electrician, who kindly came in at lunchtime to fix it.

My first patient after lunch was Rebecca. She was very, very anxious, but determined to proceed. I tried to relax her, while remaining as impersonal as possible, as I prepared the instruments.

Rebecca undressed and assumed the required position on the couch. I swung the examination light into place in front of her vagina and pressed the light switch.

There was a loud explosion, accompanied by a flash of light, a puff of smoke and a strong smell of scorched bakelite!

Rebecca screamed, of course. I hastily pulled the light away, to find that she had retreated as far up the bed as possible and was clutching her legs to her chest.

I must confess that I tried to make light of the situation, saying “Wow! Did you hear fireworks too?”

She didn’t laugh.

It took a great deal of resolve, on both Rebecca’s part and mine, for me to complete the procedure, taking her pap smear with my pen-light clutched between my teeth.

Certain women, on the other hand, make a delicate and potentially difficult situation more difficult still, not by their timidity or self-consciousness, but by their complete immodesty.

A vivacious young Asian woman, who might have been called Mei, came to see me, chatted for a while, and then said “Oh! I need to have a pap smear!” She stood up, undressed completely, walked over to the couch and lay down with her legs apart.

I offered to place a drape over her, but she replied “Why? You’re going to look anyway!”

I warmed up the speculum and was about to insert it into Mei’s vagina, when her phone rang in her handbag, on the floor beside my desk.

Mei jumped off the couch, bent down to rummage in her bag and, still head-down-tail-up, had a conversation with her boyfriend. She then, without a hint of explanation or apology, climbed back onto the couch and spread her legs.

Again, as I was on the verge of inserting the speculum, Mei’s phone rang, and again she leapt off the couch and, quite oblivious to the spectacle she was creating, stark naked with her bum in the air, had a fairly lengthy conversation, this time with a girlfriend. Again, without comment, she clambered back onto the couch and presented her pudendum.

A third time I tried, and I actually had the speculum partially inserted, when Mei’s phone rang again. Unhesitatingly, she slid off the couch, bent down to her bag, and began a conversation.

What else could I do? I tapped her on the shoulder and said “Just hold still. I’ll do your pap smear over here.”

Mei laughed, hung up, got back onto the couch and parted her thighs.

With the speculum in place, but the pap smear not yet taken, Mei’s phone rang again. I lifted my gaze to meet hers.

She didn’t answer it.

 

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