Treasuring Our Differences

Editor’s Note: This piece was awarded an honorable mention in the Pulse writing contest, “On Being Different.”

I dread visits to the gynecologist. Even though I’m a healthcare professional myself—studying to become a physician assistant after years as a clinical-research coordinator—I struggle with the prospect of the impending visit on a deeply personal level.

The crinkly gown, the pressure of the cold speculum and the pinch of the tiny brush that scrapes the cervix. A pap smear was bad enough when I identified as a woman—but as a nonbinary person with gender dysphoria, these visits act as a reminder that I was born into a body I don’t identify with, and I find visits to my gynecologist unbearable.

The night before these appointments, I give myself a pep talk, take a deep breath and mentally walk walk myself through what’s going to happen. The morning of the visit, I struggle to eat breakfast; my stomach is in knots. I get into the car and start to sweat. The closer I get to the office, the more nervous I become; I start to panic. Once parked, I wipe the tears from my cheeks and take one more deep breath to collect myself.

Entering the clinic, I’m greeted by a sign that reads, “Welcome to the Women’s Clinic.” Immediately, I feel out of place. The front desk staff person, assuming that I am female, calls me by my deadname—the name I was given at birth, but no longer use.

I take a deep breath, reminding myself that I’m blazing a path for others like me.

“My first name has legally been changed to Finley,” I tell her. “I use they/them pronouns.”

I hand her my new driver’s license as proof. She gives me a look of confusion, then updates my chart. I take a seat.

Sitting there, I feel keenly aware that my difference is on full display. I wish that providers and their staff understood what it feels like for nonbinary persons to interact with a healthcare system that’s based on the gender-binary model. A system that doesn’t always accept me for my difference; a system that would be easier to navigate if I were cisgender.

When the medical assistant (MA) calls me, it takes me a minute to realize that I’m the patient being called, because she refers to me by my deadname.

“Do you mean Finley?” I say after the third try.

She looks down at her clipboard and responds, “Oh, yeah, sorry.”

It’s clear to me that this practice is not ready for my difference; I feel so alone.

In the exam room, I ask the MA to confirm what name is in my chart. I’m not surprised to hear that it isn’t Finley. After updating my chart (that’s the second time today), the MA takes a set of vitals and goes through my list of medications.

Then comes the moment I’ve been dreading.

She hands me a gown, asks me to get undressed and reminds me that the gown opens in the back.

“Can I keep my binder on?” I ask.

“No, I’m sorry,” she says. “The provider will need to do a breast exam.”

Reluctantly I remove my binder, put on the gown and wait for the provider to arrive.

I had completely forgotten about the breast exam and feel unprepared for the emotions that flood my body. Sheer panic sets in. I feel exposed and betrayed by my body. My breasts are the greatest source of gender dysphoria, and without my binder on, there’s no pretending they don’t exist. I stare straight ahead, not daring to look down and see the contours of my chest. I feel short of breath.

There’s a knock on the door. The provider, a nurse practitioner, walks in.

After the obligatory pleasantries, I explain that since my last visit. I have come out as nonbinary, then launch into an explanation of my gender dysphoria.

I let her know that being at a women’s clinic is not easy for me, and that the idea of a breast exam is causing me a lot of distress.

“I’m not comfortable with others seeing my chest,” I tell her. “I regularly perform breast self-exams; I have no concerns about any lumps or bumps. Is there any chance of foregoing the breast exam?”

“I’m sorry,” she says, “but the breast exam is required, so go ahead and lie back on the exam table.”

Seemingly oblivious to my distress, she offers no acknowledgement of my discomfort—makes no attempt to put me at ease. She doesn’t ask if I want a chaperone. She just proceeds with the exam.

She peels back the corner of my gown, and I feel her cold hands palpating my breasts. I’m doing everything in my power not to cry. My heart is racing, and I feel lightheaded. The minutes tick by. I close my eyes, waiting for the exam to end. I disconnect from my body and surroundings.

The pap smear is a blur.

“All right, you’re all set,” the nurse practitioner says. “I’ll call you with the results.”

I quickly put on my binder and get dressed. My heart slowly stops racing, and my anxiety subsides. I leave the clinic and head to work. Knowing that I won’t have to endure this experience again for another three years, I heave a sigh of relief.

These visits are infrequent, luckily; but every day I wake up and hope that this will be the day when my gender won’t be overlooked. I hope that the people I interact with will take the time to ask me how I identify, rather than making assumptions based on the tone and register of my voice. That I will be able to use a bathroom without being questioned. That I will be affirmed by all of my colleagues in medicine, not just a few. That my differences will be seen—and even valued.

My struggles have made me more sensitive to the challenges experienced by others. I’ve been so fortunate to have supportive colleagues who’ve shown me how empowering it can feel simply to be seen.

I never want my patients’ identities to be overlooked the way mine was during today’s visit to the gynecologist. And after days like this, I feel more committed than ever to providing the kind of health care that respects—indeed, treasures—my patients’ differences.