@cleolinda: I'll talk about it more elsewhere, rather than inflict the details on everyone. It's a pro-active effort, not serious illness.
I don't normally go into this kind of detail, but I'd like to try this time, rather than have people be worried I've been diagnosed with something catastrophic, and because I think it might be helpful. But I'll go ahead and warn you, this involves reproductive health issues and a bit of gynecological trauma. Very vaguely described--"it hurt"--so this is more a warning of emotional trauma than anything. And then it just gets weird. But it'll explain my cryptic "can't write because health" statements over the years.
Basically, I was diagnosed with PCOS (polycystic ovarian syndrome) in college; it's a not-uncommon hormonal imbalance that can lead to some really unpleasant symptoms (as well as actual, extremely painful, even dangerous, ovarian cysts). Usually it's treated with hormonal birth control, simply enough, and I was on that for a couple of years in my early twenties. The first visit to the gynecologist circa 1998ish (?) went fine, pelvic exam and all; the second visit didn't involve a physical exam; the third was... traumatic. The third was weird. This was the same clinic, same doctor, all three times, but the third time, she had a total personality change? The whole thing was bizarre. I walk in and the nurse starts weighing me; I was very neurotic about being overweight, and I sort of pitifully asked her not to say the number out loud. So the nurse TURNS TO THE REST OF THE OFFICE AND ANNOUNCES IT. Which was not only embarrassing, but also very antagonistic. That's not a good feeling to have in a doctor's office. Particularly not a gynecologist's.
It got worse from there. I wasn't even worried about the pelvic exam--for those not familiar with this, this is the internal exam where you get the Pap smear, a scraping of your cervix. At best, it's not exactly comfortable, but I'd had it before and it went okay, so I was prepared to just shrug through the self-consciousness and deal with it. But this time? It was horrible. It was so painful that I had a panic attack and the doctor couldn't even finish it. I'm guessing what happened was vaginismus--not the similar-sounding vaginitis, an infection--a sort of "locking up." I don't know that I'd ever had it before that visit--before that moment, even. But I've had it ever since.
The rest of the consultation was no better. I really don't want to get into it, but the doctor was dismissive and snarky. Among other things, after the debacle of the pelvic exam, I nervously asked it everything looked okay--did I have some kind of physical, I don't know, deformity that was interfering? She just stared at me like I was an idiot and went on to the next subject. Despite being the doctor who initially diagnosed me with PCOS and prescribed birth control as a treatment, she refused to renew the prescription until she could "be sure I didn't have cervical cancer" and sent me for an external sonogram in lieu of the manual pelvic exam. (Which went fine, because she didn't administer it. Yes, I'm a smidge bitter.) Then, no one ever sent me the results. Considering that I haven't died in the last fifteen years, I'm assuming I didn't have cancer. The visit finished with the doctor saying, "And don't come back until you've played around with a tampon."
I'm thinking that "and don't come back" is probably not a phrase that should ever leave a doctor's mouth, but sure. That's not even getting into the idea of a girl with vaginismus being told to "play around" with a penetrative object until she just gets over it.
So I was a bit traumatized by the physical pain and panic, yeah. But I think the real problem was the attitude of the visit--just so antagonistic and unsupportive that I didn't want to go back to any gynecologist. I was only 20-21-ish; it was years before friends told me that I'd been treated badly. I felt like I must have deserved to be treated that way--by both the doctor and the nurse--to be embarrassed and belittled, and that any other doctor would do the same. Everything had been fine before, but then something had happened to change the way they treated me--I had gained weight, I froze up--and so of course anyone else would treat me the same.
So I didn't see another gynecologist for fifteen years. Until yesterday.
My psychiatrist--the only doctor I do see regularly--has been urging me to finally go and see one for a few years now. Both she and my new gynecologist agree that PCOS (causing horrific periods and cramps), depression (I'm bipolar II, as frequently mentioned--manic depression, as it used to be called), blood sugar issues (I'm apparently pre-diabetic now), and weight problems are all interconnected--a system of problems. They all contribute to and exacerbate each other, essentially; we've treated the fuck out of my bipolar disorder, but the PCOS hasn't been addressed since I was 20. And a major consequence of the whole system is that I am tired most of the time. The only reason I can tell it's abnormal fatigue is because sometimes I do have manic upswings where I do have energy; otherwise, I would probably just believe that I am a bad and lazy person. Then, throw in the horrifically dysfunctional menstrual cycle--I've started tracking it on the Clue app, and it's all over the place. I've had heavy periods that lasted for three weeks, to the point where I became anemic; I've gone six months without having one at all; I've had cycles that lasted twenty days and cycles that lasted (*checks app*) fifty-nine. The last couple of months, I've had cramps every other week, but no period ever came.
Depression, physical fatigue, headaches, and spells of menstrual illness--when I say I've had health issues keeping me from getting the recaps done, this is what I was talking about.
(I'm sure someone will say, "You should have gotten over yourself and gotten this taken care of so we could have regular recaps." They can go fuck themselves. I cannot tell you the guilt I am dealing with now, that I let this go for so long. Essentially, guilt that I was physically traumatized, and when I'm able to think of it that way, I refuse to blame myself for that. And then I sit and wonder how different my life would have been if this one doctor had been more compassionate, and said, yes, you do need to go down the hall and have an ultrasound, but I'll go ahead and prescribe you some more birth control, and we can do ultrasounds until the exam is more bearable for you, and let's talk about why you had trouble with it and what we can do about that, and I want to help you get through this. I've dealt with chronic pain, fatigue, and outrageously heavy menstruation for fifteen years because of this doctor--and because I couldn't work past it. But I just can't think about how my life could have been different. There's nothing I can do to change that now. You can't do anything but look forward.)
So, several years later, I went back to the website for the same clinic--a very good clinic--and picked out a new doctor who seemed to have a sympathetic expression in her picture. Aaaaand then I proceeded to put it off making an appointment for two years, feeling deep dread every time I so much as contemplated it, promising my psych I would go next month, sure, totally. I'll be honest, the impetus for finally seeing a new doctor was Dragon Con coming up early next month. I can't be going through hell menstruation while I'm in Atlanta. I can't. I just barely dodged it last year. Put me on a hormonal contraceptive and make sure I won't be having it Labor Day weekend. Do the thing and do it now.
So I steeled myself to go in--I figured, I'm 36 now, surely the pelvic exam wouldn't be that bad, surely it would go better. I was honestly more anxious about having to sit down and explain all this background--and I had to, because she would need to take my three antidepressants into account when prescribing a hormonal contraceptive--and actually having to say, "Yeah, I haven't seen a doctor about my debilitating condition for, oh, fifteen years, and it has severely impacted my life in pretty much every way, including my increasingly untenable weight problem that also makes me really anxious about seeing potentially judgmental physicians. Hi." But I could get through the exam okay, I figured.
But first, they had me do a mammogram. "I've already had two," I told the tech conversationally, "in my early twenties."
"Yeah... here, even. Fifteen years ago, when I saw Dr. B."
"That's not... you said your great-grandmother had breast cancer, no one in your family since? That's... they shouldn't have had you do that. Twice? We usually don't have people do them until 35, then at 40."
I mentioned it to the new gynecologist and her nurse as well, and they were both equally surprised. I also explained how horribly the previous exam had gone, and the new doctor said, "She wouldn't prescribe birth control because she thought you could have cervical cancer? At age twenty? And you don't smoke and you weren't sexually active?" (Here's a bit more about the potential causes.) "You wouldn't have had that."
Whenever I admitted who the previous doctor was--I was oddly concerned about hurting her reputation?--everyone, word for word, said, "That WAS a long time ago."
Look, I'm not saying all of this was sketchy, exactly, but there seem to have been a number of... irregularities in the situation fifteen years ago.
So then we get to the pelvic exam. And it was horrific. Probably worse than the last time, because we actually went through the whole thing. I white-knuckled my way through it, because I knew if I blurted out "no," she wouldn't finish, and I was hellbent on getting this fucking done. But it was really, really bad. And there's just something... I don't know how to explain it, exactly, because the doctor and all the nurses were very, very sweet and supportive. In that sense, it was very different from the last time. And I insisted on getting through it; it wasn't done against my will. But there's just something about pain inflicted--not naturally occurring, which I deal with a lot--in a sexual/reproductive area. Intellectually, I don't know how to explain why it was worse than than, say, a procedure somewhere else--even a breast tissue biopsy, for example. You can probably understand why, and I think I probably can on an instinctive level, but I just could not rationally accept why it would be so upsetting. Everyone did the best they could, as kindly as they could, and I needed it to be done. But.
At my age, I am honestly not ashamed of anything to do with sexuality, but I'm very private about it, as longtime readers have probably noticed. I don't like to talk about that aspect of my life because I feel like I'm so open about my mental health that I've just got to keep other things to myself--for myself. I can't, for my own emotional privacy, be an entirely open book. I think it's great when other people write openly about sex; that's just not the job I chose, as it were. Even now, I'd prefer to discuss this in terms of reproductive health, not sexual health; maybe that's a meaningless distinction, who knows. I'm talking about it now because I think that other people who haven't been diagnosed or treated for similar problems might recognize themselves in this and realize they should ask a doctor about it, or feel reassured about asking for help. I know, in particular, that there's a lot of shame about vaginismus, and I just... don't have shame about that any more. There's tons of forums full of women trying to cope with it--there's an entire subreddit, even--and I just don't see it as weird or abnormal anymore. Unfortunate, but not shameful. I don't know--I'm 36, and I just don't have enough years left on this earth to feel shame about things that aren't my fault. And one of the reasons I started talking about being bipolar--honestly, it was one of y'all who asked if I might be, based on posting habits that were manic at times, and that's the reason I got correctly re-diagnosed in the first place--was because no one has ever made me feel bad about mental illness at all, and I know how rare that is. And maybe other people can have a moment of "If she doesn't feel ashamed, I don't have to." And that's finally the point I've gotten to with my physical health, for the most part. If anything, my weight is what I've been ashamed of all my life--incredibly so--but I feel more hopeful now about getting healthy, treating the hormonal fatigue and the blood sugar issues and the depression so that I can become more active and engaged with the world, and whatever my weight settles at then, that's fine with me. Because I just really don't care what the actual number is anymore. After a lot of thinking the last few years, I have given up the Fantasy of Being Thin, and I've finally convinced myself that I deserve to take up space in the world--everyone does--and I can't feel bad about that anymore. If I do everything I can to feel better, then the number is whatever it is.
(Anyone who wants to parachute into my comments section and start fat-shaming can also go fuck themselves.)
I will admit, though, that once I was alone getting dressed, I cried a little. Not because of the pain--a certain soreness faded as the afternoon went on, but was with me for a while--but because I was so deeply disappointed that the exam had gone so badly, after all my hopes that it would be better this time. I felt a little betrayed by my body, maybe. After all I just said, I know that I wasn't "broken." But for a few minutes, that's the feeling I was flooded with.
But the doctor herself was great. She prescribed Sprintec (a hormonal contraceptive--idiomatically speaking, The Pill) and Spironolactone (which treats a number of things, but in my case, would regulate hormones; apparently skin care aficionados speak highly of it), a battery of blood tests, exercise, and a low-sugar/carb diet. None of which is terribly unexpected, except that I was surprised to get a second medication. I'm also a little uneasy because that's now five prescription meds I'll be taking daily--that's a lot of moving parts, so to speak, at a time when my psych and I are adjusting two of the antidepressants. But I see my psych again in September, so we'll discuss how all of that's going then. The gynecologist also sent me to get another external ultrasound, because while she was, so help me God, able to finish the pelvic exam, she didn't get as good a diagnostic look as she wanted. And I was just like, fuck it, I'm doing it all today if they can work me in. (The fasting two-hour glucose test she also ordered would obviously have to wait for another day.) So I go down the hall to the lab to get the blood work done.
I have to add here that I was terrified of needles and blood as a kid. This was due to a couple of bad experiences as a young child--a gory IV removal when I was in the hospital with dehydration from a bad case of the flu at age four, for starters. And while this is not an uncommon fear, I used to go into absolute fucking hysterics the moment a syringe came out. Just total involuntary sobbing meltdowns. And that happened until I was seventeen--not seven, seventeen--at which point I had to have blood taken fairly frequently (long story), and I just told myself, look, we can't be melting the fuck down on a weekly basis as a near-adult. You are just going to have to power through this. Not that anyone else with a phobia should have to just "suck it up," but that was what I decided to do. And I managed it--I get nervous now, but I look away, and unless the phlebotomist is really inept (which has, in fact, happened a number of times. "Do you even HAVE veins?" "YES IT'S RIGHT HERE CAN YOU NOT SEE IT") (one time, our snarky family doctor gave me a giant bruise and deadpanned, "Don't you tell anyone I did that to you") (man, I... I have really not had great doctors in my life), I get through it pretty well. Fortunately, yesterday's blood-taker was really good.
@cleolinda: Holy shit they just took like all my blood
I mean, I was fine with that, because please, do ALL the tests so I don't have to come back and do this again.
@cleolinda: I am serious, there are like six vials sitting there (I wasn't looking)
@cleolinda: Welp, I just realized the four smaller vials on the table had to have also been mine. They took TEN vials of blood yesterday.
"Oh, I guess the other vials are just someone else's they left out...?" Look, I was lightheaded and not making a whole lot of sense at the time.
Back to yesterday again:
@cleolinda: I have to have a two-hour glucose test sometime soon, not today
I asked if it would be literally two hours of sitting there with a needle in my arm, because, again: lightheaded, but no; they take blood at the beginning and then again, two hours later, after you've drunk a sugar solution, apparently. It's more that they want to see what happens after two hours pass, not, like, monitor your blood the whole time. LOOK I DON'T SCIENCE VERY GOOD OKAY.
@cleolinda: Been in various waiting rooms/offices for four hours. Morale is low.
@MitigatedText: @cleolinda this displeases me. Doctors are a necessary evil. In the long run, it's for the best. Let me know if you need anything
@cleolinda: @MitigatedText Oh, it is both necessary and overdue, and everyone's very supportive. It's just... ugh.
The ultrasound people were able to work me in at 11:30, an hour later. Except that for some reason, the tech thought I was having an internal scan--you've heard of transvaginal ultrasounds in a political context? That, basically. And I was like, I mean, I'll give it a shot, but that's kind of why I'm here in the first place? The not being able to do that? And the tech was like, "... ohhhhh." And she was happy to do it externally, just... no one told me I'd need a full bladder for that. So I spend the next forty minutes pacing up and down a tiny side corridor, drinking a truly vomitous amount of water from the water fountain. Probably nine or ten paper cup refills of it. A nurse finally came and got me--and apologized profusely for the mix-up; like I said, everyone I encountered yesterday was very sweet and supportive--and said to go on and give it a try. The ultrasound took about ten minutes, tops. Also, the gel they put on your stomach these days is weirdly hot. Gel technology has either greatly improved in the last fifteen years, or the previous doctor was using weird cold sketchy gel, because of course she would.
So I staggered out of the hospital five hours after I'd gotten there, too nervous to have eaten much for breakfast, down a good bit of blood, still cervically sore--glad to be done but, on the whole, fairly demoralized by the whole ordeal. Reader, I will confess that I strongly considered calling up my psych's answering machine, shouting "FUCK YOU I FUCKING WENT AND IT WAS FUCKING HORRIBLE SO YOU CAN SHUT THE FUCK UP NOW" and hanging up. She is a very good psych, and I never speak to her that way. I was in a necessary but not terribly good place right then.
@cleolinda: To be fair, I had like four different diagnostic procedures, and everyone was very supportive. (Cleo is now a free elf)
So that's what happened yesterday, and that's what's been going on. I keep thinking that posting this will in some way bite me in the ass, but it also feels like something I want to say? And that I want to be heard? If you take nothing else away from this: 1) reproductive health care is important, it affects a lot more than just those specific parts, but those parts are also important, and anyone who wants to take access to that health care away from you also needs to go fuck themselves; 2) competent, supportive doctors are also important, and if you get one that makes you feel bad about yourself, it's not your fault, and you deserve better; 3) both mental and physical health generally are weird and complicated and it's okay if you need time to work on it. No matter what's going on, you as a person are okay, and you are worth it.