[Caveat lector and caveat mater: this is an explicit post about my sexuality.]
At some point in the last decade I crossed a meaningful line. Some women pass it early in their adult lives, some after decades. Some women skip back and forth across the line. Some will, happily or tragically, never even approach it. The demarcation?
# of people who have seen my adult* vulva** sexually :: # of people who have seen my adult vulva medically
Yes, I should put footnotes and references at the bottom, but well, I want you to read them now, so here they are.
* If you include all of the folks who have seen my childhood vulva – and I don’t mean in the sexual abuse way – but in a parental or caregiving non-sexual way – it would be a remarkably high number. Just think about the number of diaper/toilet training episodes with grandparents, aunts/uncles, babysitters, nannies, daycare providers and preschool teachers. Thus, I will confine the ratio to adult years.
** I know that today’s girls are encouraged to talk confidently about their vaginas, and while I agree with the empowerment, I want to take a cue from Emily Nagoski (Come As You Are) and point out that the vagina actually does not include the clitoris or parts of the female genitalia – really it just includes the, well, vagina. To me, there is something wrong with making girls believe that the vagina is their sexual focal point. It sets them up for failure and ignores the most pleasurable of their sexual organs. For that reason, I prefer the term vulva because it is inclusive of all the exterior elements of the genitalia including the labia, the clitoris, the urethra, and vaginal opening. I might even extend it to include the perineum.
A couple of weeks ago I developed what I thought was another yeast infection. Several over the counter medications, two prescriptions, an email exchange with my uro-gynocologist, I was still irritatingly itchy. So Thursday late afternoon, I found myself in a waiting room. My normal uro-gyn was out of town, so I waited to see a different gynecologist in the network. One I hadn’t seen before. After a surprisingly complimentary examination, from a professional mature male gynecologist, I went home with some prescription cream.
I had just added another doctor to the medical column. I don’t know how other women feel about their gynecology visits, but I’ve become fairly stoic about spreading my legs for complete strangers. I’ve joked for a few years now about not being able to count the number of people who had been up in my business. Actually, I had never stopped to quantify it or even consider what it meant. I thought now, maybe I should.
My gynecological visits began in my late teens and became regular in my twenties. In Bloomington, I likely visited annual the clinic to see a predictably male doctor for my standard pap and pelvic exam. I do not recall these visits. I cannot imagine that I handled them differently than most non-dating teenagers would, heart pounding, face flushed with shame, dreading the, “could you scoot down just a little bit further, please? Just a bit more? Yep, keep scooting…there you go” followed by the cold speculum. I suspect I have simply blocked them from my memory.
Sometime in my early twenties when I became sexually active, I switched to the Planned Parenthood clinic. I recall being surprised by the first female doctor, one who prefaced every touch with an explanation of what she was touching. Still, with the paper blanket and bright light separating my lower half and doctor from sight, it was easy to close my eyes and pretend like it nothing was happening.
Sometime in my mid to late twenties my sexual count exceeded my medical count. Considering that I did not have a standing doctor but instead saw whoever was in the clinic at the time, traversing that bridge held some consequence. It was official. I was a wanton woman.
Naturally, the way in which one group spent time with my nether regions varied considerably from the other group. I look back on the awkward early fumblings and my initial, acquiescent and insecure self, and I suspect that few of the early sexual partners actually looked at my vulva at all, let alone what lay behind my labia. A little fingering, some time getting a condom on, and then in for the plunge. In my head, I flattered myself with the idea of being a seductress, of controlling the sexual situation, but in practice the power I claimed was the ability to make the other person gratified rather than myself. The attention paid to my own body and pleasure completely secondary. On my own, I masturbated and was familiar tactically with where my clitoris and vagina were and to a lesser extent where in my vagina pressure felt most pleasing. With others, though, it was not until my very late twenties, that I ever even guided someone to find those places or to tend them at all.
Ah. It is time to take a short break and assess something with brutal honesty. I dated two women before meeting Sandy and flirted with another after. The first I dated in Bloomington in my early twenties. We went out a half a dozen times graduating from sweet kisses to naked showers and manual sex. When she pressed me for oral sex – to give it to me (not asking me to give it to her) – I balked. No man had even considered doing that to me, and for inexplicable reasons at that time, the prospect was enough for me to break up with her. During my therapies in 1998-1999, I was certain this was due to my childhood experiences and exposure, but my memory is fuzzy, and I recognize it could just as easily have been a byproduct of my societal and religious upbringing. Regardless, I broke up with her in part because the relationship was too frank, and in part because I couldn’t face having a face other than a doctor in that place. The next woman I was with was in San Francisco, sometime between 1997-1998. Unlike the frenzied and fraught encounters I had with men, this relationship developed very delicately and playfully, like a dance. It started out as a friendship, then we were hugging more, holding hands occasionally, then a gentle, questioning kiss. She was clearly in charge and found me amusing in some way. We progressed to the same point and while I was willing to entertain the next step, and I did tentatively (and I am certain very inadequately) provide a couple of times; I was still equally reluctant to receive. Neither of us were romantically inclined to the other, so our relationship quickly retreated back into a quirky friendship and then petered out altogether. In many ways, it was more of an exercise than a relationship.
Shortly after that time, things began to change for me sexually. I began dating James – a doctor – who albeit closeted at the time – was perfectly attentive to my vulvar contents. Followed by Gavin, a man married for twelve years and intimately familiar with the female physique. Then finally, Sandy, who in his own insecurity (about which I was largely unaware), was the most accommodating of lovers. The shrouded layers of shame and insecurity about my own genitalia began to fall away, and while I still often led each encounter, I was more and more willing to view my role as not only taking power in pleasuring another, but one in which I could in turn receive pleasure.
The last woman I wanted to be with was sometime shortly after our first year of marriage. She was a student of one of my technical training programs. We sparked. At this time, pre-children, I had yet to develop many female friendships. We went out for drinks a couple of times after class. She was married as well, had a kid and was probably a decade older than me, so to my mind, it was tantalizing to flirt, without actually being dangerous. After our last class together, we went out again. As we were leaving, she kissed me in the alley and invited me to her friend’s empty apartment. I was stunned. I stammered that I was monogamous with my husband. She explained that she was monogamous with her husband with men, but not with women. I walked away, and we never spoke again. I shut a door that night. Coming back to the central theme, the number of people who would see my vulva sexually (even if only prospectively) had stopped incrementing.
My medical number had some ground to make up, and it began a few years later when we got pregnant with Eliot.
Pregnancy is a brutal experience on so many fronts. Everything I’d ever read or seen – with the exception perhaps of a few comedians’ routines, had led me to believe that there would be something magical about another life growing inside of me. Magic implies spiritual, celestial, deep bonding emotional; cue new age music, right? Of course, I did not have any close female friends with children to dispel any of those myths, so imagine my confusion when what I felt was not magical at all. What I felt was that I was growing another creature inside of me. Seriously, think about that concept for a moment. Consider Alien or X-files while you roll it around in your head. Something was inside of me, getting bigger, messing with my insides, completely ruining my digestive system, and would some day need to come out. The creature needed to be monitored regularly and that meant that instead of seeing a doctor or nurse practitioner once every year or two, I was now going in monthly for pelvic exams, vaginal ultrasounds, etc. And unlike any prior visits, accompanied by my husband. My worlds collided when I had our first 8 week vaginal ultrasound. I was still draped, but instead of hiding in some mental cave, he and I were both peaking up looking at the screen in awe. Secretly I wonder if the frequency and types of appointments you experience in the final weeks of pregnancy, especially if you go overdue, are designed to prepare you for the indignities of childbirth. Every few days going in to have your cervix examined, litmus testing for water leakage, non-stress tests with varying providers, by the time I was in labor in delivery, I probably had had up to ten different doctors, nurses and technicians up in my business. Then four hours of prep followed by 24 hours of labor, or put another way, four shift changes, each with a nurse, and two different on call OBs. My medical number probably gained the advantage that day, especially after the stitching and wound care needed in the hospital the next day or so. Let’s call it somewhere in the twenties or thirties.
And that’s when it all could have just stopped. I really liked my OB, and I would have been happy to go back to annual gynecological exams with her alone. And if I hadn’t developed dyspareunia (painful intercourse), grown a few cervical lesions, suffered from multiple miscarriages, began seeing a reproductive endocrinologist (RE), delivered another baby, and then had complete pelvic floor prolapse, it might have ended there. But, sigh, it did not.
I honestly don’t know how to quantify the number of people who I exposed myself to between 2005 and this appointment Thursday in late 2015. During the infertility years, I saw two different REs, my OB, a specialist OB, and God knows how many nurses and ultrasound technicians who used the vaginal entrance to assess follicle counts (let’s say +10). I had three procedures under anesthesia to remove dead fetuses or collect eggs (+6-8). It’s possible that the entire teaching hospital was invited to watch the procedure. But realistically if you include Auden’s labor (two hour prep, 12 hour labor and delivery, two shift changes, two on call OBs, and another round of stitches and post procedure checks) (+>6) , I had probably doubled the number of people who had spent time under the drape medically.
I would have loved to have just stopped there. Honestly, given how much my body fell apart after Auden’s birth, I wondered if I’d want anyone, including Sandy, to minister to my vulva ever again. But since that was not fair to either Sandy or I, I did a round of pelvic floor physical therapy (+1), then saw a different gynecologist to get fitted for a pessary (+2 to include the nurse practitioner). That held me (up) for another couple of years. I stopped seeing my OB and began seeing a new GP who now performed my annual visits (+1). Then in 2014 I got sick with the gallbladder and pancreatitis, which thankfully never required me to remove my underwear and put my legs in stirrups, BUT, unfortunately, caught the attention of the gastroenterologist who suggested I have a colonoscopy that summer (+2 including nurse). I went into the procedure thankfully anesthetized because having dozens of people probe my vagina didn’t bruise my vanity quite the same way as having someone probe my anus. I would have been hard pressed to keep my chin up had I been awake.
As I mentioned in a prior post, at the end of 2014, I opted to work with a urogynecologist to tackle the problems of my prolapses, stress incontinence, and, hopefully, the dyspareunia. What I failed to mention in the prior post was the complete humiliation of having to have the act of voiding evaluated and measured. If it hadn’t been for the respect that both the surgeon and attending nurse (+2) paid, I would have wilted from the indignity of it. But, as a result of those measures, we moved forward with the corrective surgery (+>3) including the hysterectomy and the insertion of a mid-urethral sling. Almost predictably at this point, my recovery failed to go as planned, so I went home catheterized (+1) and after several days of not being able to urinate on myown, Sandy and I went back into the office to learn how to self-catheterize. Legs spread wide, the nurse (+1) and Sandy peering at my fully exposed vulva, with a mirror positioned so I could see what I was doing, I was coached to insert a soft plastic tube into my urethra. The nurse verbally guiding me asked, “do you see it there?” and Sandy is nodding his head and smiling as helpfully as he can, and I honestly had no idea what I was looking for. A couple of “right theres” from both the nurse and Sandy later, I finally found my own body part. At the age of 45. It’s not that shocking unless you think about not being able to identify your own epiglottis for 40 years. But there I was, awkwardly armed with a lubed catheter, finally taking a good, solid look at my own vulva (+1).
I soon became the viewer in the medical column with the greatest count. For over a month, I had to catheterize myself every time I needed to pee, then for another couple of months I achieved the ability to partially void (yeah, me) so I could go back to work and only had to catheterize for a full void in the morning and evening. Surprisingly, even after hundreds of catheters, I was never skilled enough to be able to do it by touch alone, so up to six times a day I squatted over a mirror, pulled back my outer and inner labia and probed my urethra. I got to know my body in a way I never had before. I discovered that I have a small, but deep clitoris, that my perineum was longer post-surgery, and that the opening of my vagina was more sensitive on the anterior side. By the summer I was able to stop catheterizing. (Now it only takes up to five minutes of deep breathing and meditating for me to completely empty my bladder – another round of applause, please).
Unfortunately, I still had the dyspareunia, and I developed a new kind of incontinence – urge incontinence. It was intermittent, aggravated by infections, either urinary tract or yeast. So, in June, the urogynecologist recommended another round of pelvic floor physical therapy (with the same PT thankfully). I have a few more sessions and a re-evaluation with the urogynecologist this coming Tuesday. If all goes well, I may be able to pause the medical count for at least a few years. I am certain that as I hit menopause I will have more visits in my future. But as Thursday’s visit illustrated. I will manage it with aplomb.
One of the classic symptoms of depression is the loss of sexual drive. Throw in some anti-depressants and you have the recipe for complete asexuality. Fortunately for me Wellbutrin does not have that side effect, and I have come to understand in recent months that my sexuality or lack of its expression is one source of my melancholia. So with the help of my PT exercises, deep tissue releases, and frank discussion, coupled with the valuable insights from Emily Nagoski (Come As You Are) and Ester Perl (Mating in Captivity), I have just recently begun to survey my vulva with both curiosity and comfort. In a way, a door opened, and I added one more to the sexual column.