Last time I tried to go in for my annual, my GYN of three years suddenly noticed I was fat. Before the exam, while I sat there clutching my paper dress together, he started to lecture me: I was obese, he said, fiddling with the chart that would have told him I had an eating disorder history if he’d bothered to look at it, and I absolutely needed to lose weight. Up until this point he’d been a fairly cool guy -- a little intensely enthusiastic, and a little obviously enamored of his own biceps, but even as a dude who was clearly into his physical appearance, he’d never made me feel uncomfortable. He just asked what kind of exercise I’d been doing, and I rattled it off, and he said “Good!” And then we’d get on with the annual, at which point shockingly my cardiovascular and muscular fitness would never come into play again because it was a VAGINA EXAM.He asked this time too, and he asked what I ate, but he didn’t wait for an answer. I had to exercise more, he said, having no idea how much I was exercising. I also needed to eat less than whatever it was I was eating which I hadn’t gotten a chance to tell him. Dear god, what cutting-edge medical research! I certainly never thought of “eat less and exercise more,” especially not when I was bulimic, which incidentally is in that file of papers you’re holding which we like to call “records.”“I’m not concerned about it,” I said tightly, “and if it comes up again I’m going to have to find another doctor.” “Any other doctor would tell you the same,” he said, as though I hadn’t been coming to him, just as fat as now, for several years.“Well, I prefer a doctor who at least waits to hear what I eat before telling me to eat less.”He looked exasperated. “There’s no possible way you’re not eating too much.” After that, I was sort of blinded by a fine mist of fury particles for a little while, and when it cleared I was dressed and headed out the door while flinging “Thanks, but I won’t be paying today” over my shoulder at the receptionist. Then I called Kate Harding and left her a 10-minute ranty voicemail, because what’s the point of having Famous Internet Fatties on speed dial if you don’t call them when you walk out of your GYN’s office for giving you crap about your weight?Now, don’t get me wrong: I’m proud of not taking that nonsense lying down with my feet in stirrups. But there are so many things I wish I’d expressed better at the time. Chief among them: If you want to shame me for my body and then mess around with my lady parts, the time for that was when I was 22. It worked great then. That ship has sailed.But also, I wish I’d expressed that this kind of horseshit KILLS PEOPLE. Obese women -- by which, just to make it clear, I mean women whose weight divided by their height squared is greater than 30, not any of the more colloquial uses of “obese” like “too fat to be attractive to me” -- are more likely to get cervical cancer, and more likely to die from it. Sure, we could blame this on the very fact of obesity, because blaming things on obesity is a fun party game for some people, but then there’s the inconvenient fact that obese women are also way less likely to get regular cervical cancer screenings.
Since the Pap smear is a towering triumph of public health, with an incontrovertibly strong correlation between regular screenings and lowered cancer rates, it’s not too far-fetched to posit that fat women would be less likely to get lady cancers if they were more likely to get regular exams. And why, oh why, might you not get regular exams if you were a fat woman? Oh, probably because you’re too dumb to know you should eat right, and are probably lying about your habits, and have an unacceptable body that displays your moral weakness, and probably made yourself sick in the first place with all that binge eating I imagine you do. Now lie back and think of Oprah! <Puts on rubber gloves, prepares to get jiggy with your nether regions.>Yeah. Not so fun.I was really lucky -- all that happened was that a doctor made incorrect guesses about my habits based on my body, gave me advice he should have known was psychologically unhealthy, and then expected to be allowed all up in my business. He didn’t dismiss acute and serious symptoms because I “just needed to lose a few pounds”; he didn’t get angry that I was actually healthy; he didn’t try to talk me into pills or weight-loss surgery; he didn’t refuse to treat me, or show revulsion at having to touch me, or explicitly call me lazy or overindulgent. He didn’t wait to start the lecture until he got the speculum in. I’ve heard all those stories from real people, some multiple times. Not a single one is far-fetched.What he did do, which I still find unforgivable, is make me very aware that the next doctor could do any of those things. I’m now overdue for my annual, thanks to Douchey Howser, and I haven’t been able to bring myself to schedule a new one. Something as mild as a pre-smear dressing-down can seriously wreck your trust in doctors for a while. Some of the horror story experiences I’ve heard about could make you not want to go back for a lifetime.
And trust is critical, especially for doctors who are going to spelunk in your vag. I don’t recommend anyone avoid the GYN, of course -- I’m not kidding about Pap smears being a goddamn public health miracle. Do them. But this stuff makes people gun-shy, and with good reason. Which means doctors could be killing women by making check-ups into an exercise in shame. If you’re freaked out by the medical profession because you expect to be weighed and found wanting, the first thing to do is put the work in to find a doctor you can live with. It might suck for a while, but avoiding it means giving a couple jackhole docs the power to ruin your health.
When you do run into Dr. Jack Hole, M.D., though, remember that if he’s treating you like Fat Patient #87365, he's not treating you. You are therefore excused. If your doctor’s more interested in acting like an Internet comments box with a stethoscope than she is in your health, then it’s fine to leave her where trolls end up: alone.