“To know what was once unknown, to shed light on what was once hidden, and to have a sense of ownership and ability to care for our bodies can change our lives.”
The Feminist Women’s Health Centre
Doesn’t it seem strange that our doctors or our partners probably know our genitals better than we do? Tucked discreetly between our legs, nestled behind the mound of venus, the vulva and vagina are still a source of mystery and confusion for most people who own them. At worst our relationship to our ‘private parts’ is characterised by fear, shame and even disgust. They are ‘unmentionable’ and ‘untouchable’ except in the context of sex or an obligatory doctors visit.
As a young girl/woman I don’t remember anyone ever telling me it was OK or even advisable to get to know my own genitals. It never occurred to me to get out a hand mirror until I was about 14 or 15. With the door locked and everyone else in bed I gave in to my teenage curiosity, but not without a a nagging feeling of guilt. I just wanted to know what I looked like ‘down there’, was I normal and how did everything fit together exactly?
Defending Our Bodily Autonomy
2017 could be a crucial year for sexual and (non)reproductive rights: in the US and Europe massive roll-back are on the cards and in Ireland it seems there is little hope of progress under the current government and we are to expect a visit from the Pope in 2018!
The day after Trump’s election the message went out to American women to get an IUD to ensure they would have their birth control needs covered for at least the next few years. Three days after his inauguration he reactivated the global ‘gag’ rule imposing severe restrictions on the use of US federal aid funds for overseas sexual and reproductive health/rights organisations that provide access to or information on abortion services. This is only the beginning of the roll backs to come, with the penalisation of abortion under all circumstances a favoured republican policy. Like it or not, US policies in sexual and reproductive health tend to have a ‘trickle down effect’ on the rest of the world. We need to brace ourselves for what is yet to come.
As our bodily autonomy comes under attack from conservative and fundamentalist forces one of the first ways we can resist is to become the experts of our own bodies, to take our primary health care into our own hands. Our first line of defence starts with our own bodies: recovering our bodily autonomy and taking our sexual health into our own hands. By getting to know our bodies and practicing self-care we can prevent and treat some of the most common gynaecological complaints from the comfort of our own home.
Sisters been doin’ it for themselves…
Gynaecological DIY has a long illustrious history in feminism, from the traditional midwives who for, almost our entire human history, have been the only people dedicated to curing women’s ‘ailments’, to the clandestine distribution of birth control methods when they were almost universally illegal, to the feminists of the 60’s and 70’s who pioneered safe DIY abortions and feminist gynaecological services in their rebellion against the institutionalised violence of the patriarchal medical industrial complex.
Carol Downer and Lorraine Rothman, two American feminists, championed the gynecological self exam in the early 1970’s as a key part of women’s activism for full bodily autonomy. They took plastic speculum’s to women’s self help groups and carried out cervical exams with the women present. This eventually got Downer arrested for ‘public indecency’ and practicing medicine without a license (she suggested a woman use yogurt to treat a yeast infection). The charges were dropped but the Downer and Rothman’s activism led to the establishment of feminist gynaecological clinics that went a long way towards taking the power for women’s health care out of the hands of the male medical establishment and back into the hands of women. Access to sexual health clinics and well woman centers has expanded to a great degree and the care offered has, in many cases (but not all), become more woman and LBGTQ+ friendly.
Perhaps the only downside to the expansion in care is that we have lost a bit of the DIY spirit of Rothman, Downer and their peers, preferring to leave our routine examinations in hands of our doctors during our yearly check ups. And yet, we can still learn and benefit from DIY gynaecology. Young women today are worryingly disconnected from their bodies. As has been mentioned before on this blog, in the UK at least, young women are far less familiar with there own bodies and far less likely to seek gynecological care than our mothers’ generations. While a monthly self check of our breasts is widely recommended, I have never been encouraged by a doctor to extend this routine to my genitals. In fact, I have rarely mentioned to any sexual health professional to what extent I practice gynaecological self care. In my experience very few appreciate a patient who demonstrates knowledge and responsibility over their own body.
The patriarchal medical industrial complex has not gone away, and if recent roll backs in reproductive rights and the continued medicalisation of birth and all other reproductive and sexual processes is anything to go by, it seems it is only taken deeper root. People everywhere are looking for alternatives and to regain their bodily autonomy whether it is in gynaecological care or at birth. Our generation has greater access to tools and information than perhaps any previous generation. There is a boom in alternative menstrual products, literature related to achieving a healthy menstrual cycle and even online courses in natural gynaecology. The gynaecological self exam is finally making a comeback!
Self exams of our breasts, vulvas, vaginas and cervix’s are an essential part of body literacy and a self care routine. They allow us to become familiar and comfortable with our own bodies, improve our sex lives, monitor changes throughout our cycle and spot anything unusual that might be going on: a lump, changes in our vaginal discharge or signs of irritation. We can prevent and treat mild infections, or seek professional care before a problem gets out of control. Knowledge is power and self-exams also prepare us better to face what can often be daunting and intimidating visits to the gynaechologist or STI clinic.
What you need: Surgical Gloves, a flashlight, a plastic disposable speculum, a mirror and lubricant, peace and quiet, time and privacy… and if you can get your hands on one a Gynecological handbook (for English speakers I recommend Our Bodies, Ourselves and for Spanish speakers el Manual Introductorio a la Ginecología Natural).
Always wash your hands first!
External exam: using a mirror and extra light if necessary you can explore the vulva and opening of the vagina.
Each vulva is different, varying in hues and skin tones, distribution of pubic hair, size and shape of the labia menora and majora and opening of the vagina. Learn what is normal for you and also look out for anything unusual such as small lesions, skin irritations, inflammations, infections, bumps or cysts.
Internal exam: Using a plastic speculum you can view the walls of the vagina and the cervix.
The Feminist Women’s Health Centre has an excellent 3-step guide to the self-exam:
“Before you start, practice opening and closing the speculum; and make sure you understand how to lock it open, as well as how to unlock and close the bills. Then sit comfortably; leaning back with your legs open, knees up, on a bed or couch with pillows behind you.
1. Put some KY jelly or water onto the bills (the rounded part ) which you will insert into your vagina) Take a deep breath. As you exhale, let your muscles relax. To insert the speculum, hold it in one hand, handles up, bills together. Using your other hand, spread the labia and insert the bills of the speculum as you would a tampon.
2. When you have inserted it as far as it will comfortably go, open the bills using the mechanism on the handles that you practiced with earlier. You will feel the speculum stretch your vagina open. Lock the speculum into place. Then you can let go of it. With both your hands free, you can now hold the flashlight and mirror. Shine the beam of the flashlight into the mirror so it reflects into the vagina lighting up the internal space. Or shine the flashlight directly inside. Adjust the mirror and flashlight so you can see inside. At the back of your vagina is your cervix. It looks like a small donut with a very small opening in the center.
3. When you are finished, unlock and close the speculum. Then slowly and gently pull the speculum out. You may smell the speculum to become familiar with your natural smell of secretions and examine the mucus picked up on the speculum. An acidic smell is not unusual. A yeasty or fishy odor may indicate an infection.
What You See
The cervix appears as a rounded or flattened knob about the size of a quarter or half-dollar. The hole or opening in the center is called the cervical os. If you cannot see your cervix, unlock the speculum , change the direction the bills are pointed, then reopen it. It may help to sit on a firmer surface, like the floor. If after a few tries you are unable to find your cervix, wait a few days and try again. The cervix moves somewhat during the menstrual cycle and may be easier to see in a few days.
Your cervix may be pink and smooth or it might have reddish blemishes. It can also be uneven, rough or splotchy. All of these are normal.
There may be mucus covering the cervix or coming out of the os. Mucus is natural. The character of the mucus changes throughout the menstrual cycle in response to hormones. It ranges from pasty-white (non-fertile) to clear and stretchy egg-white texture (fertile). It does not have a strong odor.
The cervix may have fluid-filled sacs on it that look like blisters. These are called Nabothian cysts and are not a problem. They are caused by a blockage in the mucus-producing glands of the cervix. In some women they come and go, and others have them for years. They do not need treatment.
You may see polyps, outgrowths of tissue that dangle on a stalk and protrude through the os. They may bleed easily but do not need to be removed unless they bother you.
Cervical bluing may be the first sign that a woman is pregnant. Fifty percent of women who are pregnant will have a blue or purplish colored cervix due to an increase in blood circulation. During pregnancy, the cervix may also look puffy and softer and the os more open.
What’s Not Normal
It is normal to have vaginal and cervical discharge. However, if any of the following are found during self exam, it may indicate an infection: green, gray or dark yellow discharge any significant change in the amount or consistency of discharge any strong odor unusual for you.”
(Feminist Women’s Health Centre, 2011)
And the when…
You can perform an internal and external exam at any time of the month, bearing in mind that if you are menstruating you may be extra sensitive to any internal pressure and may not be able to see the cervix or vaginal walls clearly depending on how heavy your flow is. It can be an interesting exercise however to monitoring the changes in your cervix throughout your cycle as way of keeping track of your fertility. To get inspired you may want to check out the Beautiful Cervix Project or Betty Dodson‘s wonderful vulva drawings.
I’m not generally into New Year’s resolutions but for 2017 I have pledged to make self-knowledge and bodily autonomy a personal priority. But personal transformation means little without social transformation, so my other resolution is to keep active and keep organising. If our control of our bodies is once again a central pillar of the white, Christian, capitalist, heteronormative, patriarchy, then let the battle commence.