"woman's health internal examinations"

I recently had several internal examinations (cervical cancer screening, IUD fitting and pelvic ultrasound) and have been faced with lack of respect for my body integrity.

The screening was done by a nurse at my GP surgery. she used a speculum too large for me and when I told her that it was really painful she took it out but could only put a bit of gel to ease the insertion as there was no smaller size available at that time. she said she would try to open it to the minimum but she still open it more than what was OK for me even though I told her that it was painful and was visibly in pain. the smear itself was painful as well but was upset me was to be lied to as both the NHS letter and the nurse described it as "not painful/a bit uncomfortable or awkward".

For the IUD fitting, I looked at the size of the speculum before the exam began and asked for a smaller one. the doctor tried to convince to try the "big" one first and thought that I was scared about the fitting, I had to justify my request by explaining what had happened during my screening before the doctor agreed to use a smaller speculum. It was still painful but after my explanations the doctor was gentle and the nurse present very kind so it made it better. 

I was then referred to an ultrasound to check the IUD position. I was very shocked when I received the referral letter saying "transvaginal ultrasound" as the doctor had not specified it to me. the leaflet attached to the letter explaining the procedure was also confusing as it mentioned that virgins would have to drink water and have an external exam: which suggest that both exam techniques are equivalent... So I called the clinic that had referred me to the ultrasound as well as the hospital at which I had an appointment to find out if I really needed the internal (transvaginal) scan. apparently, they did not have any detail from my doctor specifying which scan or what level of accuracy was needed so they told me that if I came with a full bladder they would try externally first. the external scan turned out OK but the staff had not been informed that I was having it externally, told me to undress and tried to convince me to have it internally. when asking for explanations I was told that the internal one is the standard regardless of the exact condition being diagnosed and staff dismissed my concerns about how invasive/painful/violating it can be, as if I was a stupid person wasting their time.

Most of the staff I spoke to were kind and professional but the procedure itself is very disrespectful to patients as unnecessarily invasive/painful and patient choices should be respected right away without need for the patient to argue/explain itself/convince the staff.

I would like the process to evolve this way: - asking patients what size of speculum/probe they are comfortable with and not inserting anything before the patient has had time to see the device and clearly agree.

- or always using the smallest possible speculum/probe

-letting the patient insert herself whatever device is needed (speculum...) so that it is at their own pace

-specify in the referral if the ultrasound strictly has to be internal (only for conditions which truly require it)

- and either making the default/standard pelvic ultrasound external or giving a clear choice and clear information about both techniques and letting the patients decide. keeping the internal exam as a backup option if trying externally failed (as it is usually done for early pregnancy ultrasound)

- ask staff to respect patients decision RIGHT AWAY rather than making patient defend themselves and justify their request.

-correct the NHS official letters and leaflets so the level of pain is described more realistically (i have never seen a doctor pretend that a blood test is not painful so i don't understand why cervical screening for example, in witch plastic needles are scrapped against a very sensitive body part, is referred to only with massive understatement!!)

women health internal exams are invasive by nature and should only be performed when strictly needed. women should not be lied to by doctors/nurses/NHS about the necessity of a certain procedure, the level of pain... and their concerns and choices listened to and respected.