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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