CW: Child Sexual Abuse, Pregnancy Loss
This year, European Cervical Cancer Awareness Week falls from January 28th. As a result, the past few days have seen my Twitter feed full of reminders that smear tests save lives; that cervical cancer is an awful way to go; that it is preventable; that a few minutes’ of (unnecessary) embarrassment and (minimal) discomfort are worth it if they save your life; that you really don’t want to be one of the 70 women in Ireland who dies as a result of cervical cancer this year.
I chose to believe this piece of research that instructed me that there is a statistically significant number of false positive results. I decided to nod in agreement with pieces like this from The Guardian. Never mind that it’s nearly 15 years old. I liked what I read. I also had a look at the academic journals and read the ones that would confirm my existing bias. As a full-time researcher in the social sciences, I know better; but I decided to suspend my natural and professional critical interrogative proclivities in order to tell myself I was making an informed decision. Hey! I wasn’t going to be publishing my findings, and I wasn’t going to be harming anyone (except, maybe, myself) if I was wrong. I also had a quick look at this website and decided I didn’t tick enough boxes to be anything other than ‘low risk’.
So, for the 16th year running, I won’t be having a smear test. Head-in-the-sand? Definitely. I wouldn’t normally be so reckless about screening (I had my first mammogram at 27 – before I’d even had kids), but a smear test is a slightly different screening exam to most, and the reason for my aversion is – sorry to say – rooted in my experiences of child sexual abuse, and subsequent sexual assaults as an adult. I want to feel empowered as much as, and as often as, possible. Smear tests aren’t really empowering.
All of that said, however, I think there might be a solution. I am not the only woman in Ireland with a history of sexual assault. There are thousands of us in the ‘smear test age bracket’ who have been sexually abused, and I think it might be a good idea if we were facilitated with a bit of compassion / understanding.
I’m reminded, very much, of the last time a health professional went faffing around at my nether regions. It was four years ago last week, and I was losing a pregnancy. This had not been an easy pregnancy to achieve, and I’d used donor sperm for a variety of reasons (that’s a whole ‘nother blog post). Anyway.
Losing this baby* was devastating. Not least because I didn’t have a partner to hug me and tell me it would all be all right, but because accessing healthcare was difficult for me. I decided to do what I could to take ownership of my own care, and empower myself as best I could. The first thing I did was drive an hour out of Dublin (passing, literally, by two maternity hospitals on my way) to Mullingar. I’m a doula, and although I rarely practice any more, I am still in contact with many members of the birth community; and I hear things, and I know things. One of the things I had heard was that I could expect to find more compassion in Mullingar than in the Dublin hospitals (for a variety of reasons).
In Mullingar, I was treated with kindness and compassion by the young male doctor in A&E who drew blood and tried to be as reassuring as possible. I was invited (and I choose the word deliberately) to return for further blood tests and a scan at the Early Pregnancy Unit. I thought about it. I wasn’t keen, but I steeled myself and showed up. When I was registering that morning, I noticed that the nurse (Deborah) wore a name-tag which indicated that she was attached to the SATU (sexual assault treatment unit) in the hospital. Ten minutes after sitting down, waiting to be called, I decided to take my treatment in my own hands, ignored the voice that said I was ‘being dramatic’ and ‘attention seeking’ (my abusers used to toss this at me any time I got upset about how I was being treated) and I approached this nurse. I disclosed that I had a history of sexual abuse and explained that I found trans-vaginal ultrasounds immensely difficult.
The amount of compassion and understanding I bumped up against was instantly reassuring. Deborah asked what I needed, how she could help, offered me choices (I didn’t need to have a trans-vaginal ultrasound if I didn’t want one, and could opt for the ‘old-fashioned’ way of drinking litres of water and having an abdominal scan instead). She literally held my hand throughout the procedure and did her absolute best to make sure that I felt empowered, comfortable and heard at all times.
I can honestly say that hearing the dreaded words ‘I’m really sorry – there’s no heartbeat’ was made that bit easier by the way I had been treated with compassion and dignity every step of the way.
Now, I know that having a miscarriage and having a smear test are different – but in many ways, they’re not that different. So what I’m wondering is if might be possible to have some additional consideration for women who have a history of sexual assault? Is there any chance, for example, that we could have our smears done in one of the SATUs around the country? Or – given that I know how over-stretched the SATUs are – could we have HCPs undergo additional training to make them more aware of the issues faced by abuse survivors? Is there any possibility that we might have trauma-informed care around smear testing? Honestly, if I were to re-consider my position, that is the one thing that would make me do so; and I don’t think I’m the only one.
This is one of those times when I’m going to say ‘do as I say, not as I do’ and encourage you – if you live in Ireland and own a cervix – to check here to see if you’re due a smear test. And if you are, to go and have one.
*Lookit, I know it wasn’t really a baby, but it was in my head, because I desperately wanted it to become one.