A Transmasc Person’s Guide to Pelvic Exams

With increasing amounts of young people (i.e. under 18) coming out as transgender- transmasculine or “transmasc” in particular, there are many trans guys have been on testosterone and/or are planning gender-affirming surgeries and treatments that haven’t even been to a gynecologist before. A colleague of mine- his son is transmasc and young, and has an intense fear of pelvic exams. He is also planning on getting a hysterectomy. So this young man has inspired this article: “A Transmasc Guy’s Guide to Pelvic Exams.”

In my opinion, one of the worst things about being assigned female at birth (AFAB) is the dreaded pelvic exam. Let’s be real. They fucking suck. Like, a lot. Why do AFAB people need pelvic exams in the first place? Basically, these exams are performed as a means to screen for cervical cancer, and to assess overall vaginal health. And luckily for me, and for pretty much everyone who chooses to get a hysterectomy, they will likely never need to get one again. 

The process of a basic pelvic exam is fairly straightforward- but so very uncomfortable. What happens is that the gynecologist will instruct you to undress completely from the waist down and put on a hospital gown. No pants. No underwear, and lay on your back on the exam table. The doctor will then come back in and instruct you to put your feet in stirrups that are attached to the table. Though you are in a hospital gown, the doctor will still cover you from the waist down with a sheet. 

The gynecologist will then examine the vulva, vaginal opening, and perineum (the area between the vagina and anus). They will then break out the dreaded speculum. Have you ever made a duck bill out of two pringles before? That is basically what a speculum looks like, more or less. This tool allows the doctor to open the vagina enough to perform the exam- not only to just look inside, but also to access the cervix for a cervical swab. Using lots of hospital grade lubricant, they will insert the speculum and open it. The speculum does not feel the same as having penetrative sex. It is a slight pressure, and maybe a bit cold (some offices will warm up the speculum first). It should not hurt. Please tell your doctor if you are experiencing any pain. There are different sizes of speculum that they can utilize, especially if the largest thing you’ve ever had in your vagina was either a tampon or a finger. 

The gynecologist will look at the inner walls of the vagina, and assess the health of both the vagina and cervix. Next, comes the cervical swab. This, unfortunately, is even more uncomfortable than the speculum. The doctor will take basically what looks like a really long mascara brush, and- they will say they are going to “swab” your cervix, but it’s more like a “scrape.” It feels like a rough pinching sensation for 2-3 seconds, and then it is over. The doctor will then close and remove the speculum, give you a paper towel to wipe the lubricant off, and leave the room again to allow you to get dressed and cleaned up (i.e. clean away the extra lubricant). And that’s it! Unless there’s a specific issue that needs to be addressed, the whole process takes maybe 10-15 minutes at the very most. The cells that were taken from the cervix are sent to a lab to be screened for cancer, the results of which you will get in a few days to weeks. And that’s it! So, why, for transmasc people, are pelvic exams so uncomfortable and scary?

For myself, at least, I don’t want anything in or around my vagina. Point blank. It makes me uncomfortable and dysphoric to even talk about my vagina with doctors, much less have someone I see once a year to be looking in it. 

I remember my first pelvic exam. It was a couple of years before I started transitioning, and I had a male gynecologist. Staring up at the ceiling of the exam room, I remember how cold the speculum and lube were. But I was sweating buckets. And there was a minor, but quite distressing (at the time) problem. The doctor couldn’t find my cervix. He was not-too-gently moving the speculum this way and that, and I asked him “Um… is everything okay down there?” He said, “Oh yeah everything’s fine but your cervix is not where it’s supposed to be. I can’t find it.” WHAT? You’ve seen literally thousands of vaginas and cervixes, and you CAN’T FUCKING FIND MINE??? Dude, what the hell? Then, he tilted the speculum all the way in one direction (I don’t remember which direction), and said “Oh! There it is!” Turns out that I had a severely retroverted uterus, meaning that my uterus was tilted in exactly the opposite way it was supposed to be, causing my cervix to be in a different spot. This still baffles me, because in my brain, the vaginal canal is not exactly a large area, so how the hell could he have straight up not been able to find it??? But I don’t know. I’m not a gynecologist. 

It was at that exact moment that I decided that I was going to get a hysterectomy. I had not even realized I was trans, yet somehow I knew that I 100% did not want all of the issues that come with having a uterus and ovaries. Turns out that womanhood was not for me. 

With all of this being said, transmasc people: do not forego getting a pelvic exam. I know they’re uncomfortable. All AFAB people know that. But they can be lifesaving. 10-15 minutes of intense dysphoria and discomfort is well worth the possible issues that can be caught early by this simple exam. If you are extremely terrified of the exam, I recommend bringing up your concerns to your gynecologist. I’ve heard in some cases, doctors may prescribe a one or two-time dose of an anxiety medication such as valium or hydroxyzine to make you more comfortable. All in all, pelvic exams are an uncomfortable and icky, yet so very necessary procedure that all AFAB people should be getting, unless you have gotten a hysterectomy.