There’s a reason why genitalia are called “private parts,” and it’s not just because they’re usually shrouded in clothing and irrelevant to most conversations.
It’s also because our society tends to shush open discussion of any body bits related to sex, sexual pleasure, and reproduction — even if, of course, they’re also good for other uses, like urinating, breast-feeding or, you know, just plain feeling good about yourself.
This kind of shaming (sometimes called “sex negativity“) blankets bodies universally, but it comes down especially heavily on both trans and cis women, trans men, and nonbinary people — as does most body-related shaming within our patriarchal world.
It also has a quirky reversal switch: When we don’t censor ourselves in discussing other people’s genitals, it’s often a sign of disrespect or that we see that person more as an object than as a human, something without feelings or a right to privacy.
Both of these dynamics have a long history when it comes to trans people.
Thankfully, these days, much is being written about cisgender society’s awkward — and often invasive — curiosity about trans folks’ “down theres.”
With trans people’s increasing visibility and the number of articulate guides now available on how to respectfully interact with us about our genitals (hint: just like you would with anyone else), it seems we’re approaching a cultural consensus where the general rule around trans genitalia is: Don’t mention it.
But while the speak-not-until-spoken to credo about my own personal junk has largely served me well — indeed, I’ve never had to blink uncomfortably at a stranger in line at a grocery store after they gestured at my crotch and asked, “So, have you had ‘the surgery?’” — I’ve been noticing lately that it’s also not given me everything I need in order to have a healthy, shameless relationship with my body as a trans man.
And I’ve found that one of the common results of this tacit “Don’t ask, don’t tell” policy, among many, is tight lips around the gynecological health of trans men who have not undergone certain genital reconstructions — namely, a hysterectomy (uterus removal), oophrectomy (ovary removal), and/or vaginectomy (vagina removal).
That is, to use the medical terminology for lack of better universal language: men who currently retain their uteruses, ovaries, and vaginas. Men like me.
The current lack of healthy, open, guilt-free discussion about our bodies feeds into a serious gap in trans men’s healthcare that has potentially fatal consequences when you consider that pap tests are used to screen for cervical cancer.
Body shame, combined with fears over transphobic treatment from medical providers and an increased likelihood of gynecological care not being covered by health insurance, amounts to a potentially deadly health disparity that’s unique to trans men.
So here is a list, written both for other trans men and for all others who simply care, of what I’ve considered asking my doctor when going through a gynecological exam to make it more comfortable, and to feel like I have a say in my own self-care.
I’ve written it to give the trans men to whom it applies some tools and agency over getting the healthcare we need, and to also give medical providers some pointers, especially on language.
1. Set the Expectations for Gendered Wording and Correct Pronouns
Pap tests are, when you burrow below all of the quote-unquote “womanliness” of them, medical procedures. Clinical. There’s nothing about them that has to be particularly gendered or “feminine” in order to get the job done.
After all, the reality stands that certain people of all genders have body parts that require gynecological exams. It’s just that the gender binary permeates every aspect of our lives so fully that people have a difficult time separating body shapes from gender assumptions.
Your doctor shouldn’t be one of these people.
They are a professional who took an oath to care for each patient’s individual needs.
But of course, in reality, your doctor may not be in an LGBTQIA-focused health center or have trans-specific training, so they may not know to ask about your correct pronouns or if you have alternate names for your parts, as many trans men do.
In other words, this is a conversation you likely have to start yourself. Ask you doctor to keep the wording around your body gender-neutral and give them the alternate language you need them to use.
On my first gynecological visit, I made clear my own personal preferences, “I use male pronouns. I want you to know that I’m okay with you referring to my parts as a ‘vagina,’ ‘cervix,’ ‘ovaries,’ and ‘uterus.'”
2. Ask to Verbally Walk Through the Procedure Before It Happens
There is often nothing more frightening than facing the unknown.
For a trans man going through his first pap test after beginning to publicly identify as male, this can be utterly terrifying. Even if a man experienced pap tests previously, approaching one as a man — and I can say this from experience — is a wholly new prospect.
When I received my first male pap test, I found my mind had totally blanked on what to expect. All morning I was so anxious that I might be misgendered that I could barely think two steps ahead, and I zoned out completely when my doctor used the dreaded phrase, “Please place your feet in the stirrups.” Thoughts like “Will he really still see me as the man I am afterwards?” floated through my head.
Taking a moment before the procedure to ask your doctor for a blow-by-blow can be really helpful in calming your fears.
You always have the right to know what is going to happen to your body. You also have the right to set the pace by asking a doctor to slow down or pause for you to take a deep breath. And the easiest time to set up your expectations for the exam is beforehand — not when you’re midway through.
If your doctor cannot respect this, you can consider switching to a different doctor.
3. Bring in Other Tools to Make Touching More Comfortable
So you’re in the throes of a pap test, and it’s one of the more awkward situations you could probably ever imagine being in. Sure, you have to accept the exam lying down, but the terms are something you can take a stand about.
Ask yourself: What calms me down when I feel anxious?
For some people, it’s constant chatter; for others, it’s blocking out sound. For some people, it’s having a companion along (see below); for others, it’s getting in and out with no observers. For some, it’s getting the low-down on what to expect in the minutes before the hospital gown goes on; for others, a self-taught course in gynecological health does the trick.
Lastly, there are two tools that often help humans through tough times: Music (or other artistic expression) and humor. Music is something you can actually bring with yourself right into the exam room; let your doctor know you’re going to play some tunes on your MP3 player and pop the earbuds in before your pap begins.
But you can also find ways to de-stress afterwards, either by listening to or playing music, or expressing your feelings in other ways, like through writing, drawing, painting, or through expressive movement like dance (indeed, exercise is one of the best emotional pressure-release valves).
Another fantastic coping mechanism is using humor; making light of uncomfortable situations helps them not feel like such a threat.
4. Bring Along a Support Person
Doctors and patients have an unbalanced power dynamic that can leave you feeling like you lack control in medical settings.
This is only compounded by a history of trans people rarely being considered the “experts” on our own life’s narrative and body’s needs.
Bringing an ally with you can help you feel like you’re taking back your power — and you have a witness!
When you make requests of a doctor, like telling them to use your correct pronoun or to pause the exam when you ask them to, having another person in the room who’s observing their behavior holds the doctor more accountable to get it right.
Further, when I bring a friend with me into a doctor’s office, I talk to them about a game plan ahead of time. I pick someone who’s comfortable with verbally intervening if they sense a doctor using disrespectful language, but can tell that I’m too nervous to say a word. You can even agree on a signal, like three quick blinks.
Plus, they can help you debrief and defuse tension afterwards, if you feel comfortable discussing your exam, by using that healing, heaping dose of humor.
5. Look for Pointers to Educate Yourself on Gynecological Health
Back in the 1960s, a collective of American women were fed up with the fact that their doctors weren’t giving them all of the facts that they needed to be well-informed about their own health. They banded together and wrote the now-classic guide to female health self-education: Our Bodies, Our Selves.
This year, a group of trans folks did the same thing, producing Trans Bodies, Trans Selves, as an introductory primer to all dimensions of well-being.
The point? Knowledge is power. Power is agency. Agency is being able to call more of the shots in your own life.
Seeking out books and online articles by doctors is a super helpful first step to informing yourself about your own body’s health needs. A medical degree is not required for you to learn more about your body.
While it may be uncomfortable to read gynecological guides emblazoned with smiling lady uteruses and splashed with every shade of pink, try to compartmentalize that gendered mumbo-jumbo, and focus on the neutral, clinical facts about your parts.
Keep in mind the big picture: If you’re a man, your body is a man’s body, no matter what anyone else says.
This article is the opening of a new conversation.
How can we make it more safe and comfortable to talk about trans men’s genitals, even while maintaining the message that prurient, misinformed curiosity is harmful?
Because we, as trans men, need to be able speak openly to our doctors, allies, and among ourselves about our whole health and be unafraid of misgendering while doing so.
Choosing to speak openly about our body parts, as I do, doesn’t mean we have to welcome ogling and speculation about what we look like underneath our clothes or suggest that all trans men have the same kind of body.
Breaking the silence will help these two utterly unhelpful, objectifying defaults society goes to when talking about trans bodies ultimately disappear.
There simply have to be more constructive, affirming ways we can discuss the topic because it’s inevitable that as human beings, at some point, we all need support around genital health.
Let’s get talking.
Mitch Kellaway is a queer, biracial, transgender reporter, writer, and assistant managing editor for Transgress Press. He is the co-editor of Manning Up, an anthology of personal narratives by trans men. In addition to covering trans news for Advocate.com, Mitch’s writing has appeared in the Lambda Literary Review, Huffington Post, Mic, and Original Plumbing magazine, and has been published in several journals and anthologies including Jonathan: A Journal of Queer Men’s Fiction, Cliterature, RE*COG*NIZE: The Voices of Bisexual Men , Man the Yards, and Best Sex Writing 2015. He holds a degree in gender studies from Harvard University and lives with his wife in Somerville, MA. He can be reached at MitchKellaway.com or @MitchKellaway. Read his articles here.