The first time I visited a Planned Parenthood, I was twenty-eight years old.
I’ve been fortunate. I waited until adulthood to become sexually active and, when I did, I had an open-minded mother who was determined to do things right. From a young age she had told me, “If you have any questions, any at all, I am always here to answer them.” Of course the first time she offered I took her up on it: “Mom, what’s the difference between a circumcised and an uncircumcised penis?” My mother—bless her—sat me down on our worn couch and drew two contrasting pictures on a pad of lined yellow paper. I don’t remember any other conversations specifically about sex, but I do remember she was the only person I told after I lost my virginity, and she sat in the exam room with me during my first gynecology appointment.
Like I said, in many ways, I’ve been fortunate. I was fortunate to wait to become sexually active. I was fortunate to have a mother who answered my questions and encouraged safety above all else. I’ve also been fortunate enough to be a student and/or gainfully employed since the age of eighteen, which means I have always had insurance, and I have always been able to afford my healthcare.
But there are ways in which I have not been lucky. I, like so many women, have had abnormal pap smears. They’ve come and gone through the years. For me, HPV has been as common as a cold. Maybe even more common: I think if I added them up I would find that I’ve had more abnormal pap smears in the past eight years than I’ve had colds.
After I graduated from college—and left my amazingly sensitive and personable gynecologist in Vermont, who had held my hand as I cried on her exam table and told me, “Emily, there are so many things in life to get upset over; I promise you HPV is not one of them”—my luck with medical professionals seemed to run out.
I moved to Florida and was referred to an ob/gyn who basically insinuated that I was a whore. You want the exact wording? She said: “Do you use condoms regularly? Oh nevermind. If you did, you wouldn’t be in this situation, now would you?”
I never went to that doctor again.
After her I went to a gynecologist at the Cleveland Clinic in Miami who specialized in abnormal paps. She gave me such a painful colposcopy that I fainted on the exam table.
When I moved to Maryland, I found a gynecologist through my insurance company. When my pap smear came back abnormal for the first time in three years, she scheduled me for a colposcopy. She paged impatiently through my faxed records from Florida.
“I’ve had abnormal paps in the past,” I said. “They should all be in there.”
“Do you know what kind of abnormal paps?”
“I think low-grade. I’m pretty sure they’ve always been low-grade, because my doctors have always said they’d just keep an eye on it and re-pap in six months.”
“Well it would be nice if I could find those cultures in here because this time you have high-grade lesions.”
That is how she broke the news to me that I had precancerous cells in my body: angrily flipping through my medical record while my legs were spread open in stirrups and her nurse arranged the glass jars in which bloody tissue from my body was placed.
A month after that biopsy, my doctor scheduled a surgery to remove the outer layer of my cervix on which the precancerous cells were growing. My best friend drove me to the hospital and held my hand when the O.R. nurse put in an I.V. I had never had anesthesia before. I had never had an I.V. before. I had never had surgery before. When they wheeled me into the O.R. it was cold like a refrigerator.
“I can’t stop shaking,” I said to the nurse. She covered me with a warm blanket and held my hand against her chest.
“It’s okay,” she said. “It’s all going to be okay.”
For weeks after the surgery, I couldn’t stop bleeding. I called my doctor every day: “Should I go to the ER?” “Is this normal?” “When should I expect this to stop?”
I heard back from her a week later. She said, “Oh, didn’t I tell you? You shouldn’t exercise for at least six weeks. That’s probably the cause of the bleeding.” No, she hadn’t told me. I didn’t even see her on the day of the surgery. I couldn’t even tell you if she was the one who performed the surgery. The only thing the nurse who had discharged me said was that after a day of rest it would be fine to resume my normal level of activity, which meant I had been working out for two hours a day since the surgery.
So, even though I have been fortunate in many ways, in other ways I have not. While I may have never had something that can’t go away like herpes or HIV, I still envy the girls who get their annual pap smears and are none the wiser. I envy my friends who have had the same doctors since they were eighteen. As common as HPV is, somehow—blessedly—none of my friends have ever had it. Or, if they have, it came and went without being noticed, in between their annual pap smears.
Recently I left my job and moved to New Hampshire. I began working as a writer, which basically means I spend a lot of time tutoring and babysitting and transcribing and editing other people’s work and doing very little writing of my own at all. It also means I spend more than I earn each month. Thankfully I still have individual insurance, but now that I am in New Hampshire, I am out of network. I inquired recently about switching to a New Hampshire plan, but to do so would increase my premium by 33%. I don’t want to go into exact numbers, but that means that getting individual insurance in the state of New Hampshire would cost me half of my monthly income.
But this isn’t about insurance. That’s a whole different article (and believe me, I could write it: as a patient with a history of abnormal pap smears, I have to pay for high risk insurance—the type of insurance that people with AIDS and cancer have). This is about Planned Parenthood and Susan G. Komen’s recent decision to pull their funding from the women’s health organization.
Recently it was time for my annual pap smear. With my history, I can’t push my pap smears back by months or years. Even though women can now lengthen the time in between their pelvic exams to every two years, for the rest of my life I will have to get annual exams.
So, I called Planned Parenthood.
My local Planned Parenthood is in an old house situated on a main street. Unlike the clinic where I lived in Maryland, there were no protestors. There was no security outside. The sign was not hidden. The main floor of the building is the Planned Parenthood. The lower level is a massage clinic. They share a waiting room.
It was quiet in the Planned Parenthood when I visited. I was alone in the waiting room, and the young woman at the front desk apologized for taking too long with my paperwork. “I’m sorry,” she said. “I’m new.”
She handed me four sheets of paper on a clipboard to fill out, and I took them into the waiting room that had once been the front parlor. Instead of the typical medical history forms, the sheets asked me to answer a number of personal and pertinent questions no medical professional had ever asked me. They asked about my sexual health and my physical wellbeing. I answered questions about when I lost my virginity, about whether or not I use or had ever used recreational drugs, about which gender I associate with, about my plans for motherhood, about my fertility background, and about any pregnancies I had had in the past. Unlike other ob/gyn offices, there were boxes to check off for whether those pregnancies had resulted in abortion, adoption, miscarriage, stillbirth, or dependents. I answered questions about depression and eating disorders. I checked off whether or not I had ever been sexually abused, physically abused, emotionally abused. It was the most thorough and sensitive medical history I have ever filled out. I found myself wondering throughout whether a psychologist had worded the questions, they were that careful and open-minded.
When the nurse called my name and took me into the exam room to be weighed and measured she looked down at the sheets I had filled out. “I see you have a history with disordered eating. Would you rather I not weigh you?” I was stunned. No one has ever been sensitive to my issues with weight because no one has ever asked if I have, or have ever had, issues with my weight. For the first time in the history of all of my varied and terrible medical experiences, I felt like more than a patient: I felt like a person.
During my visit, the Nurse Practitioner sat next to me at her desk. We talked about sex and birth control. She told me not to double up my birth control more than two days in a row or else its effectiveness would plummet (I never knew that!). We talked about my previous ob/gyn visits and how traumatizing they were.
—she looked through my record and seemed confused.
“This doesn’t make sense,” she said.
“What? What doesn’t make sense?”
“I’m seeing that your pap came back abnormal in March of 2010 and that you had the laser surgery done in June of that year, but the culture for the biopsy in April of 2010 is showing no abnormal cells.”
For those of you who are lucky enough not to know, this is how the HPV rundown works:
- You get a pap smear.
- The pap smear comes back abnormal. The pap smear is just an indicator of something off on your cervix. A pap smear cannot tell you that you have abnormal cells on your cervix; it is simply an indication that further testing is needed. Women can have abnormal pap smears and have nothing wrong with them. Women can also have normal pap smears and have abnormal cell growth on their cervix. This is why it is SO IMPORTANT that you ask for an HPV test with any and all pap smears you have. If your pap smear comes back normal and your HPV test comes back positive, they will more closely examine your cervix to determine if any abnormal cells are present (see below).
- You are scheduled for a colposcopy, which is a closer look at your cervix, and a biopsy of your cervical cells.
- IF that biopsy comes back showing abnormal cells (either low or high grade), you and your doctor then decide how to proceed. Any doctor worth her salt will most likely re-pap for low-grade lesions. If she suggests doing anything more, seek a second opinion. These lesions usually go away with time. If you have high-grade lesions, the options get a little more varied. One option is to have laser surgery to remove the pre-cancerous cells. That is what I had done.
By this list, that means that I had a pap smear that came back abnormal, but, when I went in for a biopsy, there were no abnormal cells present, which means I never needed surgery. That means my doctor performed an entirely unnecessary procedure that lasers off the surface of the cervix on an otherwise healthy patient who was both young and of childbearing age.
Trust me, if I have issues carrying a child to term, I’m going to sue the shit out of her.
I realize that the issues people have with Planned Parenthood are not necessarily the procedures I would have done there. Their issue is with the other procedure Planned Parenthood performs: abortions. And while I didn’t see any shaking and startled teens either entering or exiting the building, I know that doesn’t mean that on any other and at any other time they aren’t there.
Yes. Some Planned Parenthood offices perform abortions. But you know what else Planned Parenthood does? It provides free and comprehensive healthcare to women. It not only provides medical services that many women in this country cannot afford to receive elsewhere, it provides them in a more humane, thorough, sensitive, and informative way than any other medical practice I have ever been in. After years of being able to afford “the best” medical attention that my insurance company could pay for, Planned Parenthood gave me the best health care I have ever received. It gave me better health care than even money could buy.
My appointment at Planned Parenthood was free. Based on my income, I owed nothing for my hour-long visit with the Nurse Practitioner. (By the way: an hour?! When was the last time you sat for an hour with your medical professional?) But I can tell you this, when I heard that Susan G. Komen was pulling their funding from Planned Parenthood, I, like so many, went onto their website and set up a monthly donation of $15 to be charged to my credit card.
Fifteen dollars might be three quarters of my weekly grocery budget, but taking care of women and making sure they receive affordable and informative healthcare is worth it. Maybe you’ve been relatively healthy all of your life, so you don’t realize that any other kind of healthcare exists. But believe me, believe my story: it does.
I think for many people in this country who are engaged in the debate, Planned Parenthoods are tiny offices tucked away behind security guards and protestors. I’ll admit, until I went there a few weeks ago, that was how I imagined it. Planned Parenthood was something other people used: young girls who had to keep their sexual health a secret from their parents, teenagers who had been raped and needed to terminate the ensuing pregnancies, wives who were abused and didn’t want their husbands to know they were having an IUD implanted to avoid getting pregnant, women who couldn’t afford insurance or doctors or the ten dollars a month for birth control pills. This is what I thought Planned Parenthood was.
On their website, Planned Parenthood writes, “We are all Planned Parenthood.” Even I, one of the lucky ones, am Planned Parenthood. I don’t need to hide birth control from my parents or check the box next to my phone number that says, “It is not okay for the office to say that Planned Parenthood is calling.” I’ve never had an abortion because I’ve never been pregnant because I’ve always been able to afford birth control. But any number of random acts or events in my past could have changed my medical history to something other than what it is. These things happen to everyone: to your sister, to your daughter, to your coworker, to your neighbor. If you have had sex—if you are having sex—then these things could happen to you. These things happen to good, smart, moral, clean, and careful people all the time.
Of course I hope you always remain healthy. I hope you only have blissfully consensual and safe sex for the rest of your life and never have cancer and never find cysts on your ovaries. But this is unlikely. The fact is that we all get sick, and we all die. We all are reliant on the healthcare system in this country. It is more than important. It is vital.
When, god forbid, something does happen to you—if you have pre-cancerous cells on your cervix or you find a lump in your breast or you experience painful cramping from ovarian cysts that can only be eased by birth control—I hope for your sake that there is a Planned Parenthood near you where you can receive comprehensive, caring, and affordable healthcare. Every woman and every man deserves that.
I encourage you to share your story. If you are outraged by the war against women's health, donate to Planned Parenthood.