“Try angling it down,” the dark-haired woman suggested to her student. The student maneuvered a bit, then said, “Is that it?” Both women peered in close, their heads nearly touching the object of study. The instructor made a quick adjustment to the student’s work, and the student immediately gasped, “Oh! There it is!” She looked up at me. “It’s glorious!”
From my vantage point above them, I chuckled. Apparently, finding my cervix was as exciting as observing a desert sunrise and as difficult (at least initially) as bringing microscopic cells into focus under a lens.
It wasn’t difficult to understand how I’d wound up on a birthing table in the middle of a hospital teaching lab in Colorado. One of the local forensic nursing teams- the people who collect evidence off someone’s body after asexual assault or other crime- had won a Violence Against Women grant to train forensic examiners for rural and underserved communities across the United States, and the best way to teach evidence collection is live models. Ever eager to do something to help The Cause, I’d filled out my W9 without hesitation and prepared to join my first training session on International Women’s Day. What a great way to celebrate, I thought.
The ever-terrifying speculum, courtesy of wikipedia.org
Forensic examiners play an incredibly important role in the aftermath of a sexual assault. Their examination is equal parts medical and crime scene, with the result that their findings- analyzed by a crime lab- play the role of DNA evidence if a case is taken to prosecution. Additionally, they are treating their patient as they go, dosing them with Rocephin and Zithromax for gonorrhea and chlamydia exposure and checking for injuries that might need more than a few hours to heal. Perhaps their most important role, however, is that of the supporter. Patients receiving a forensic exam- which involves bright lights, blue dye, photography, and a full pelvic exam - are put in charge each step of the way. Where the sexual assault has taken away the person’s choice and bodily integrity, the forensic exam seeks to restore that. Nothing is done without the patient’s explicit consent, and everything that is done is performed with incredible sensitivity to their current situation.
For example: have you ever had a gynecologist gently push your knees open at the start of a pelvic exam? It’s not a big deal when you’re just there for a PAP, but when you’ve just been assaulted, that innocuous and medically universal gesture is threatening. The medical professionals I was assisting were practicing holding their arms out wide: “Open your knees to my hands whenever you’re ready.” What a difference the wording change makes! From there, every step was talked through: “These are my hands-” as she moved her hands down my thighs- “and now you’ll feel my fingers on your labia. I’m checking for external injury. How are you feeling right now?” The constant check-ins, which minimize the triggering of a startle response during an actual exam, continue to give the patient control. The subtext of the “This is what I’m doing” speech is always, without fail, “Are you still okay with this?”
When I told friends what I was doing for the hospital, most of them looked some degree of horrified. It wasn’t the idea of being bare-arsed to the world that bothered them, but rather that the first day of the two-day live practice was entirely pelvic exams. For many cis women, and I’m sure some trans women too, pelvic exams are incredibly uncomfortable experiences best kept at one per year. The idea of novices repeatedly poking at us with speculums is certainly nerve-wracking. It was for me, although I tried not to show it. The students themselves were already so afraid of hurting me that some of them were examining me with shaking hands. And for the most part, they did fine; not spectacularly well, although they certainly improved by the end of the day, but I walked away without injury or any real pain.
What I did walk away with, however, was an incredible sense of empowerment. So many of us walk into those pelvic exams with only a minimal comprehension of what goes on: speculum goes in, brush goes in, everything hurts for a moment, and then speculum goes back out. Watching my instructor train the other students meant that every step of that exam was broken down as it was performed on me: speculum goes in at an angle to avoid crushing the urethra and is then angled down toward the cervix, speculum opens around the cervix and essentially “rests” on it for the exam, and in a forensic exam, it’s a swab instead of a brush which goes in and collects potential evidence from around- not on- the cervix. Then speculum opens and “scoops” the cervix back down, and speculum slowly closes as it’s pulled out at that same angle it entered with. By the end of the third exam, I could tell where the students needed to go to find my cervix- not because I was sore, but because I’d been shown how it should feel. I had the vocabulary to explain what went wrong when one student forgot to open the speculum before trying to take it out. All those biological structures that so readily remain mysterious were, over the course of that day, rendered familiar. If only all pelvic exam patients could leave the room feeling that good!
To me, forensic nurses do some incredibly important work in our communities. It is their efforts that tie perpetrators to their crimes and which give victims that first step back towards regaining control over their bodies. Many of them also take the time to educate the public (and certainly juries) to dispel some of the more pernicious myths around sexual assault- for example, that a victim will always be injured. They advocate for policy changes in their hospitals, states, and nations to give victims as many rights as possible. When training each other, too, they even educate their models. What I hope is that the twenty-odd students I worked with that day will walk away to fill that role in their communities. Based on what I saw from my vantage point on the table, they’re well on their way.
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