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How I Made A Career Out Of Showing People My Cervix

Discussion in 'Gynaecology and Obstetrics' started by Egyptian Doctor, Sep 22, 2015.

  1. Egyptian Doctor

    Egyptian Doctor Moderator Verified Doctor

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    I’m sitting on a low exam table in an Orthodox Jewish medical school, wearing a hospital gown, waiting for my students to arrive. They knock on the door, and I call, “Come in!”

    There are five of them. They are all men, they are all tall, and they all look very professional and authoritative in their white coats. Two of them are wearing wedding rings; two are wearing yarmulkes. All five of them are about to see my cervix.

    And they are all, it becomes immediately clear, completely terrified.

    I’m a gynecological teaching associate, or GTA, which means I use my own body to teach medical, nursing, and physician assistant students how to perform safe, comfortable, and empowering gynecological exams. Basically, I go into universities and hospitals and take my pants off for feminism. I love my job: It has made me feel at home in my body in a way I never imagined, and I get to help the next generation of health care providers get really, really excited about ovaries. Given that they usually come to me scared and somewhat squicked out by the whole concept, this feels like a triumph.

    Even though that exam at the hospital was my first time ever teaching a group of real, live medical students as a GTA, it was entirely my show from the start. When I lowered my hospital gown to talk them through the breast exam, one turned so red I worried he might pass out, and they all stared fixedly at the wall. I pointed out that to examine my breasts they actually needed to be looking at them. But it only took a few gentle jokes to get them laughing, and from that point they basically imprinted on me like ducklings. They were so grateful that I was being kind to them, so thrilled to follow my lead, and so relieved to find that I knew what I was doing and wouldn’t let them hurt me. (“No, really, you can use more pressure. Can I adjust your hand? There, just like that. That’s my cervix!”)

    Most of all, they were innocently delighted by my body, and my willingness to show it to them. The first sight of my cervix was greeted with cheers. And when the first student successfully felt my ovary, I witnessed a phenomenon known to GTAs all around the world: the Ovary Dance. Healthy ovaries, you see, are very subtle and small, and it’s hard to be certain you’ve felt one. But a GTA who knows exactly where her ovaries are can usually get you there, and you can always tell when a student has actually found it by their grin and the shimmy that goes with it.

    I have always had an extremely detailed, somewhat obsessive desire to know all about bodies, and to teach other people what I know. At the age of 5, I managed to extract an explanation of how babies are made from my mom that was more detailed than what most adults probably understand now (although she refused to draw me a diagram when I was confused by the mechanics). I took my newfound knowledge with me to school the next day, where I taught my kindergarten friends all about sex, condoms (“penis caps”), the fertilization of an egg, and the gestation of a fetus. They say knowledge is power: I didn’t want anyone to have more power over my body than me, so clearly I needed to know the most about it.

    When I first heard about GTAs in 2011, it seemed like an obvious choice for me. I had been working as a full-spectrum doula in New York City, supporting pregnant people through any and all outcomes of pregnancy, including birth, adoption, fetal loss, stillbirth labor induction, and abortion. I had seen several hundred pelvic exams in a very short period of time, and noticed that younger doctors were performing very different exams than many older doctors, and communicating with patients much more clearly. When I asked other doulas about this, they told me it was because the younger doctors had all been trained by GTAs. Because the world of radical gynecology is small, many of the other doulas already worked as GTAs; one soon hosted a party so we could see her do a self-speculum exam and view her cervix, and I was hooked.

    As a medical anthropology nerd, I loved the idea of getting to be the person who shaped how medical students viewed and interacted with the female body. I also found out that GTA’ing pays outrageously well. I liked money, and I loved the idea that work that was so inextricably tied up in vaginas was so highly valued financially. It felt a little (irrationally) like mooning the wage gap. And of course, the anatomy-obsessed 5-year-old inside of me thought it was awesome. I signed up for the next certification course I could find.

    The training was arranged around the parts of the exam we were learning to teach: a three-part breast exam, then a three-part pelvic exam. The first time my fellow trainees and I took off our shirts to practice giving each other breast exams was, I admit, a bit strange, but we got used to it fairly quickly. Then we reached the pelvic exam. Our instructor asked for volunteers to practice teaching it during the next class; I raised my hand and offered to go first.

    I was very calm in the days between those classes, as I reviewed all the material I was expected to teach while I guided the other students through an exam on my own body. I was even calm about getting my period the same day I was first expected to drop trou in a professional capacity. So be it; we were expected to work with our periods, and I was just going to do it sooner rather than later. I felt fine straight through the morning of the exam, until it was actually time to put on my hospital gown.

    Then I freaked out. I went to the bathroom to change, because somehow the idea of a classroom seeing my butt was more terrifying than anything else. What if my butt was ugly, or hairy? Should I have shaved my pubic hair? I hate shaving my pubic hair! What if people think it’s gross? What if my vagina is gross? What if I smell bad? What if I bleed on someone??

    I was panicking, but I was also awkwardly inching backward toward the exam table. And then I was sitting on the table, and it was time to start teaching. I felt a moment of calm and I realized: I could either freak out about my body, or I could teach. My brain didn’t have enough processing power to do both. I chose to teach.

    It felt like putting down insanely heavy bags that I’d been carrying for so long I’d forgotten about them. It was actually a physical sensation. I put the bags down, I kicked them over to the side so they weren’t in the way, and I began. I remembered all the material I needed to be telling the students, I guided them to the right places on my body, I managed the room and checked to see if they understood me, I adjusted and engaged.

    I wasn’t thinking about my body, except to show them my anatomy and explain why it was “healthy and normal.” GTAs teach students to use a phrase like that to transition between parts of the exam — “I’ve finished the pelvic exam; everything appears healthy and normal” — precisely because it’s something the patient might never have heard or felt before. The power that simple idea gives patients — and the power it gave me — can be incredible.

    It’s an amazing thing to be so in control of how your body is perceived. I can go get groceries in New York wearing yoga pants and a sweatshirt, and men will still catcall me. I’m trying to run errands, not be decorative, and I definitely don’t feel sexy or sexual, but I get no say in that. But when I’m GTA’ing, even though I’m in a position that ought to be so vulnerable, I’m in complete control. I’ve never felt objectified or sexualized in my work; I’ve never felt anything but utterly respected. It goes beyond “doing no harm”; it feels healing.

    From my first time on the table with those five medical students, I’ve known that I wanted to turn being a GTA into my main career. Last year I started my own company, through which I now provide clinical skills training to Yale, Quinnipiac, and other universities and hospitals in the area.

    To my constant slight surprise, it has grown into a very real business, with five-year plans and reports and all sorts of official things. But internally we can do whatever we want, so we joke that our private business plan is written entirely in Harry Potter quotes. And one of its pillars, courtesy of Albus Dumbledore, is particularly relevant here: “Fear of a name increases fear of the thing itself.”

    For a lot of people, vaginas are scary. People are scared of bodies, their own and other people’s, scared to hurt and to be hurt. A lot of people are scared because they just don’t know, and if knowledge is power, then the opposite is also true.

    I feel immense power in naming the thing that everyone is afraid of. Naming it, and then taking my pants off to show them how “healthy and normal” it really is. It draws people in, and gives them the words to name what hurts. Sometimes it’s agonizing and cathartic and profound. Sometimes it’s funny: When you become a GTA, you immediately become a magnet for the weird vagina problems of anyone who’s even distantly connected to you. I’ve removed stuck menstrual cups from friends and solved birth control problems for people I’ve never even met, because they texted me detailed descriptions of their vaginal discharge.

    Getting over your own fear to say something frees you, and it can also free the people around you. One student I trained to be a GTA told me her grandfather teared up with pride when she told him about her new job, because when he married her grandma they did not have any idea what they were doing, and it was awful. He was proud she was out there educating people about their bodies so that no one else would have to go through that.

    Sometimes a student will get my uterus between their hands and seem astonished, disbelieving — and when I tell them gently that yeah, that’s my uterus, that’s what a healthy and normal uterus feels like, they start to cry. At this point in my life, my uterus has made more people cry than I have.

    Sometimes those women — so far, they have always been women — stay after a teaching session is over and tell me about the trauma they’ve been carrying with them for years. They talk about being assaulted or abused, or they share the damage done to them by unthinking words from people who are supposed to love them. They talk about what it’s like to never feel good enough, to have felt for years that their body is a prison they can’t escape. They thank me for being able to hang out casually on the exam table while they hold my uterus, and I tell them that it’s all just fine.

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