Tag Archives: Body Impolitic

Trans Vaginal Ultrasound Equipment Doesn’t Care If You’ve Had Sex–But Some Doctors Do

Laurie and Debbie say:

A transvaginal ultrasound (TVUS) is a procedure where a technician inserts an ultrasound probe into your vagina (about 2-3 inches in) to take a picture of what’s going on in your uterus. It’s an invasive procedure that can be disturbing or even traumatizing, and at the same time it’s a very useful diagnostic tool.

We were shocked to learn that a significant number of doctors refuse this procedure to women who haven’t experienced penetrative sex. In the United Kingdom, the policy is clear:

According to the guidance from the British Medical Ultrasound Society, “if a patient has not had penetrative sex, they are still entitled to be offered, and to accept, a TVUS [transvaginal ultrasound] in the same way that cervical screening is offered to all eligible patients.” 

“The concept of virginity plays no part in the clinical decision making for a TVUS, and the examination should be offered by the ultrasound practitioner, when clinically indicated. It is, however, acknowledged that health tests such as cervical screening and TVUS may be more uncomfortable for patients who have not had penetrative sex, and therefore the ultrasound practitioner must be extra vigilant if they are to proceed.”

Nonetheless, Women’s Media Center reports that women are being told that they can’t have the procedure, and some are being told that they will “lose their virginity” if they do have it. So let’s set the record straight:

Medically, there is no such thing as virginity. Many, but not all, women have hymens, generally thin pieces of tissue that spread across the vaginal opening. The first time something is inserted into the vagina, this piece of tissue can break and bleed (usually not seriously) … unless it’s not there, incomplete, or is more than typically stretchable. There is so much variation in hymens that there is absolutely no validity in using their presence, absence, or condition to judge the sexual history of anyone with a vagina. But, of course, that doesn’t stop the patriarchy, including the medical profession.

To the extent that virginity means anything, it’s cultural, and very self-defined. In that sense, it’s rather like “race,” a genetically meaningless concept that nonetheless is used to control too much of our lives.  We each know what “having sex” means to us, and we can each determine (if we care) when we “had sex” for the first time. We can decide that that only means consensual sex. We can decide it only means one kind of sex. We can decide that we had several “virginities,” and we lost them at different times, alone or with different partners, or never. No doctor can tell what our sexual histories are by looking between our legs.

Nonetheless, we did a little research, and the problem is also prevalent in the US. Caroline Reilly has an excellent article in Teen Vogue (from 2019):

One patient told me she was told they “simply could not do it because [she] was a virgin.” Another told me that because her doctor knew she hadn’t had vaginal sex, they said “well they can’t do a transvaginal, so it will just have to be external.” Patients reported having comments made to them about the transvaginal ultrasound ‘damaging’ patients who hadn’t had vaginal sex and one said the doctors were “very focused on whether I… was a virgin, which was really disorienting as I was in extreme distress and pain.” I spoke with patients who felt their diagnoses were compromised as a result of this practice, and who had to travel to a hospital further away to seek proper care.

The Women’s Media Center article is short and informative; Reilly’s is long and packed with thoughtful responses and nuances about both how this does work and how it should work.

Stephanie Tillman is a certified nurse-midwife who writes and speaks on issues of informed consent, patient empowerment, and trauma-informed care. She says that for a patient to be asked about their sexual activity, and to have that answer justify withholding a proceeding is not “appropriate medical care,” – that what should occur is a conversation between a provider and their patient to most comprehensively inform a patient of their options, recommendations, and their rights. This, she says, is called shared decision making; it involves making sure a patient has all the information they need to “engage in informed consent.”

Just as TVUS shouldn’t be refused to patients, it also shouldn’t be required. It can be traumatic, and it can be uncomfortable. If they can refuse a procedure to “virgins,” they can forego it for someone who doesn’t want it. Here’s Reilly again:

… aligning this procedure with something sexual in nature is … problematic and harmful for patients. It takes the same stigmas and taboos that shouldn’t even be part of a conversation about sex in the first place and infuses them into a vital and routine medical procedure. It’s important for patients to know that not only can you not have a transvaginal ultrasound withheld or forced on you because of your sexual history – you shouldn’t even be asked.

There are cases where your sexual history is your doctor’s business–if you think you might be pregnant, or have an STD, or some other cases. This isn’t one of them; if you are in this situation, advocate strongly for yourself and, if you don’t think that will work, take a feisty friend with you to the appointment for support.

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Debbie is no longer active on Twitter. Watch this space to follow her on Mastodon.

Follow Laurie’s Pandemic Shadows photos on Instagram.

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The Threat Posed by Women’s Bare Arms

Michelle Obama in front of an American flag, in a simple black dress with bare arms

Debbie says:

Like every progressive in this country, and most in the world, I’m getting hard to shock. The Missouri legislature has shocked me, however, by adopting a dress code (introduced by a Republican woman legislator) that forbids women (including elected women) to appear on the legislative floor with bare arms.

You think immediately of Margaret Atwood’s Gilead, or of Victorian fashions and dress codes, but it turns out that this isn’t a fictional or ancient issue; it’s been around for much of the current century. One of the focal points appears to be that dread symbol of women’s strength and confidence, our former first Lady, Michelle Obama. I don’t remember following this at the time, but Mrs. Obama appeared at formal events with bare arms, and that caused a minor news flurry. Here’s a CBS piece from 2009, President Obama’s first year in office:

Never before, surely, has a set of bare arms launched so much discussion than in the weeks since Mrs. Obama appeared sleeveless at her husband’s speech to Congress in chilly February. Certainly not in equally chilly January 1963, when Jacqueline Kennedy wore one of her many sleeveless outfits to her own husband’s State of the Union address.

Noveck goes into various fashion analyses of Mrs. Obama’s arms, including the theory that talking about them distracts from the work she was actually doing as first lady. Of course, one of the reasons that her arms got attention and Jackie Kennedy’s didn’t is that, unlike Mrs. Kennedy, Mrs. Obama is Black and thus subject to vastly more scrutiny and criticism. It’s also true that Jackie Kennedy was first lady before the 1970s feminist wave, and fewer people were nervous, scared, or hypercritical–emotions which always arise when women proclaim strength.

The problem arose again in Canada, in very similar terms to today’s issue in Missouri, in 2019. According to Tina Lovgren at CBC News, the British Columbia legislature enforced what they called a “conservative contemporary dress code” forbidding bare arms, and also chastizing women who weren’t wearing slips so you could see that they had two legs (!) under their dresses.

The Obama controversy seems to have been mostly short-lived, though it reared up again now and then through the 8 years of the Obama presidency. The British Columbia dress code appears to still be in force today. The Missouri code, however, is perhaps more likely to get longer-lasting attention, in part because it is one of dozens of examples of Republican over-reach. While they scream about governments having “no right” to control the use of natural gas (which causes very significant health effects), they delight in using government to control bodies: Black and brown people’s bodies, pregnant people’s bodies, trans people’s bodies, and now female legislators’ bodies. Forbidding bare arms may be one of the least life-threatening forms of bodily control … and it’s also emblematic of what they believe they have the right to do.

Throughout Western history, women’s fashion has been a battleground in culture wars, a tool to control women’s power, and a marker for moral panics. Dress codes are a way of tracking how these movements progress–and Missouri has just issued another giant red flag, which must not go unnoticed.

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Debbie is no longer active on Twitter. Follow her on Mastodon.

Follow Laurie’s Pandemic Shadows photos on Instagram.

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