Cervical Abnormality

I gave birth without drugs, without any cervical checks, or anyone poking or prodding my cervix to do it’s job. It’s job in that context was to open up. From a closed tight muscle, only open enough to let a little blood down each month and some semen up on the handful of occasions that I was trying to get knocked up, to a wide enough stretch to pass a human skull through it. Yes, a small, infant skull, but still, at least 10cm. And my cervix did it’s job without any difficulty or hesitation. 

The terrifying visual analogies of cervical dilation of vaginal child birth. The cervix opens from a closed muscle, through the stages of cheerio, penny, banana, ritz cracker, babybel cheese, chipits cookie, pop can, baseball, donut and finally... bagel.

On a few occasions, as a greedy bottom, my cervix has reminded me that it is there. A slight irritation found when my hunger to be filled met the back wall. I liked getting filled; fists, massive silicone ramrods and the sort of tall-can size cocks that test the capacity of a magnum. 

Maybe this training contributed to the ease with which I shot out all 7.5 pounds of bone, blood and attitude that grew into my audacious and precocious kid. She rarely holds back, just shows up, full on, when she is ready. Surely that force and confidence was a contributor in the 10cm stretch too, as she wouldn’t really let something like my body’s musculature stand in her way if she had somewhere to be, she never has. 

I have always been very responsible with my sexual health. I got my first PAP test at the planned parenthood in Halifax at 19, within a year of becoming regularly sexually active. I had not yet had P.I.V. sex and wouldn’t for some years to come, but I built the habit of giving myself a full round of tests every year for my birthday and kept that up, regardless of if I had been with one partner over that year or 50. (During years when I was on the higher end I would get tested more often, but the PAP is an annual thing, so it would be saved for my birthday test.) My first experience getting tested was affirming; my much older girlfriend assured me that it was the right thing to do, and brought me to the appointment where I saw a queer-coded, purple haired nurse who talked me through it all and helped normalize it all. 

A few years later I was back in Victoria and called the Island Sexual Health clinic to book appointments for myself and my sister, who had been sexually active for a while, but was too nervous to book the appointments. In calling for the 2 of us, after my voice had lowered a bit from testosterone, the assumption of the clinic was that I was calling for a husband/wife arrangement. We had the same last name. I sounded to them like a man. I said we each needed a PAP. The receptionist said kindly, “Sir, I think you may be confused, but you don’t need a PAP test, but we will schedule one for your wife.” I explained, “Actually, I am not the one who is confused, she is my sister not my wife, and yes, we both have cervixes, and will both be getting PAP tests thank you very much. Oh and BTW, lots of trans guys would very happily take your confusion as all the excuse they need to never get another PAP test, you really need to be more careful about making these kinds of assumptions.” When we arrived at the clinic we were handed our intake forms. A pink for my sister, and a blue for me. I then had to again explain, in front of everyone else in the waiting room, that I needed the pink form, then take the pink form, sit with the pink form in the waiting room, fill it out and return it to the desk. If I had been shy or stealth at all, that may have been my very last time accessing such care. 

Instead I used that experience as my career direction moved into sexual health. I started teaching youth about HIV and HepC, getting tested, reducing harm and negotiating consent. I moved into more broad community education on these topics, which sometimes involved training care providers

Getting tested for HIV, HepC, and other STIs is an important part of being a sexually responsible individual. Get tested for yourself, get tested for your partners, get tested for their partners. We are all interconnected.

Sometimes during this period of building multiple relationships with care providers, where I would be both a patient and collaborator. I was a part of a budding movement for by-and-for trans clinic services. I started getting “abnormal” results. 

I was abnormal. I have always been abnormal. I have a connective tissue condition, a queer gender, a broad spectrum of desire. My body has never performed in the ways it was expected too. I’ve always been taller, bendier, more sensitive and more weird than anyone ever really knew what to do with. 

I assumed that “abnormal” results stemmed from lab techs not knowing what cervical cells looked like on a hormonally transitioned person. I asked other trans friends if this was common, and I thought I had found a trend. Looking back, I think probably too few of those guys were getting PAP tests at all, and my tracking of this systemic anomaly was haphazard and imprecise. 

The documents that provided my access to health care had their own abnormalities. At some point in the creation of the BC One Card, a melding of drivers license and health card systems resulted in the M mark I had on my drivers license migrating to my health care files. I didn’t sign up for this, and found out about the change when I was contacted by my doctors office. They were upset because the province was refusing to pay them for services rendered, specifically my most recent PAP test. I had to take my drivers license, health card, change of name certificate and the letter I have kept on file since starting hormones in 2007 explaining that I was medically transitioning down to the Service BC office. I laid them all out on the counter and explained the billing error. The attendant first insisted that I couldn’t have multiple pieces of ID with multiple gender markers, but eventually followed me as I explained that there was no accurate marker available. The gender marker that may offer me safety buying alcohol in a rural or remote community isn’t the same marker that will grant me access to the health care I need.  Even today, three years since the X marker has been available, billing problems can still come up in accessing care the province considers gendered.

Fast forward to a clinic where the care providers knew me as a fellow service provider. Up on the table, legs in stirrups, between the swipe and the swab, I was asked about the size of my cock, the typical effects of testosterone and my surgical histories and desires. The timing of how the multiple relationships piece was navigated often lacked grace on the part of those in the power position.

I would mention my anomaly theory to care providers. Each year when I would return for another test, I would explain that I didn’t place a lot of weight in the tests, as I didn’t trust that they knew how to read the results, since they always came back “abnormal”. I don’t remember ever being offered any follow up diagnostics, just another “abnormal” result, and assurance that I should return the following year to test again.

I moved around. Over 10 years, I had these tests in 3 different health authorities, at one trans specific clinic, 2 sexual health specific clinics, and with at least 3 different doctors and 2 nurse practitioners before I was finally sent for a colposcopy

I wasn’t sure what to expect, my orientation to the procedure was that it was “like a PAP test”. So I rode my bike to the hospital, checked in and waited. Waiting in these clinics is always awkward, cause even though the days of pink intake forms are gone, being now a hairy, bearded, flat chested masculine appearing person, waiting in the gynecological waiting room is an out. Any chance of discretion is gone when trying to take care of one’s “lady bits”. Which for me, they aren’t. Having an in house baby factory never really felt like a gendered trait to me, until I needed to access rigidly gendered health care. In the pre-pandemic days I might have brought a friend along, who could at least take some of the pressure off with both company offered, and the assumption that “she must be the patient”.  But during covid, no extra companions are welcome in hospital settings. So I found myself just life-lining through the “text a friend” option, while I somewhat absently moving my body through the required steps. 

A gynecological exam table waiting to be boarded, stirrups out and up, for positioning the legs in the utmost open wide position.

I got up onto the table and legs up. Anytime I am loading into the stirrups, a comment is always made about my height. Every time. I am a bit longer than most medical equipment is built for, and the need to scooch further, no, a bit further, has always been remarked on. This time, with everyone in masks, the subtle facial gestures that little bit harder to read, I winced through the application of iodine and vinegar to the cervix. I checked out when they pinched a chunk out with long tweezers. They asked if I was OK and I nodded. Was I actually OK? No, of course not. But I didn’t really feel like I had a whole lot of say, or that my discomfort would really make any of it unfold any differently. I just wanted it to be over. Nod. Smile. It will be over soon. The doctor said that he didn’t see anything strange. All looked normal from where he sat, but that the results would take 3 or 4 weeks to get.

Still somewhat disassociated, I got on my bike and rode home. By the time I got my bike in and up on its hook, it hit me. Not a pain exactly, but a bizarre deep internal discomfort. To feel a piece of you has been taken out, from this outside in, inside out place, barely ever felt, now very presently felt, it was deeply unsettling. I fell into couch lock and watched an entire TV series, only getting up to let a friend in who brought me ice cream. I was grateful that she had undergone a vaginoplasty a matter of months earlier, and might understand the discomfort of inside-out parts better than most. 

 Before I got the results I got a call from my PCP clinic with another date for the same clinic. “This must be a mistake I said, I had that test already. I told my NP that it was brutal and unpleasant and I didn’t wish to do it again.” 

You are scheduled for a LEEP procedure, they said. 

So I googled. Always a dangerous prospect, to webMD yourself into panic, but I wanted to know more about what I was being scheduled for. Googling LEEP brought up a page from the Cancer Society. Not off to a great start. The more I read the worse it sounded. Essentially a hot wire that would slice and instantly cauterize the outer surface of the cervix. 

My reaction shifted. Take it out. Take it all out. I am not going to have any more babies, I don’t want to have to maintain the wellness of a body part I don’t need anymore. I can just be done with this if I let them take it all out. The appointment to discuss hysterectomy with a gynecologist finally came through, but not until a full month after the LEEP. 

I finally got to discuss with my NP, the first of all my care providers to send me for follow up after a string of upwards of 10 annual “abnormal” results. As I discussed how all these things add up with my NP, the decision was made that I should still have the LEEP. The cells on my cervix are classified as CiN 3, which on a 3 level scale is the most serious. CiN 3, precancerous cells don’t always turn into cancer, but when they do, it usually takes about 10 years. There is no real way of knowing how far into that 10 year countdown I am, but it’s possible I am already at year 10. If it took 6 months to get an O.R. date for a hysto, we could be removing tumors. Which could have taken advantage of the rapid cell division of the cervix and spread. The cells could be doing that as I type this. There is no time to wait. 

So I am going in to have my cervix cauterized with a hot wire. I am expecting it to be horrible. I don’t want it, but I don’t want cancer less. Everything about my relationship to consent, and wanting to only take things into my cunt that I am enthusiastically excited for has to be set aside. 

It feels like a betrayal. And not one that is happening just in this moment, but one that has been happening and building for a decade. Why did I subject myself to all of those scrapes? Every pink intake form and invasive line of questioning? If what it was supposed to be screening for was just dismissed, swept under the rug, rationalized away by my transness. Excused abnormality because I am “abnormal” to a ciscentric medical system.

As I do research about cervical health, hysterectomies, PAP tests and everything else that is wound up in all this I am still bombarded with the overwhelming assumption that these are matters of women’s health. Every single website and article that discusses these things, (except for the transcare site which addresses hysterectomy as a part of transition without any pathologies of pre-cancer, cancer, or reproductive history) believes that their audience are women. The Cancer societies public messaging to encourage PAP tests and cervical cancer awareness is all written to women. The clinic calling to confirm my LEEP test even made it clear on the voicemail they left for me, “HER appointment is on Wednesday at 8:30 and SHE will need to be there….”

Long Ago, before I was ready to tell anyone that I was trans I was nervously watching Southern Comfort in the basement of my girlfriends parents’ condo. I held my finger on the “switch channel” button. I did my best to choke back the tears as I watched this man, an elder in his trans community, an organizer, a pillar, dying from ovarian cancer because he couldn’t find any doctors who were willing to treat him. It was one of the first trans masculine stories I had come across, and in those days, it was pretty much that and Boys Don’t Cry that were out there. They were tales of utter devastation. Which I haven’t really related to that much, my trans experience has been overwhelmingly affirming and positive. I have had a lot of opportunities to ride waves of growing understanding, competency and legal protections. But sometimes, the waves crash and pull you into the undertow before you get to ride them in. Here’s hoping that I can find my way back to the surface. 

Can't swim safely, but also can't not swim. Proceed with extreme caution.
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