As someone who is on a pathway to become a gynecologist, I have been reflecting upon my past experiences at the OBGYN. I’ve had good experiences, and unfortunately bad ones too. In this reflection, I want to talk a little bit about my OBGYN experience while I was in Japan researching reproductive biology and compare it to ones I have had back in the US.
On Valentine's Day 2014, a year before I left for Japan, I decided to get a pap smear and do those important tests that you're supposed to do to make sure your insides are okay. It was supposed to be an expression of self love. Female reproductive health is really important to me. It's the main reason why I went to Japan to research reproductive biology, and now the reason why I am in medical school. But even as a reproductive biologist, I'm still nervous about talking about my own body. I grew up in a household where talking about sexual things, even menstruation and pregnancy, was taboo, although college really helped me understand my body better. That was the first time I ever had to get naked in front of a clinician. It was the first time I experienced the awful duck lip speculum. It was the first time I experienced someone looking up my vagina. And, it was one of the worst experiences in my life. The clinician was incredibly insensitive, said some things that you would never say to someone doing something like that for the first time, and she made me bleed. For 2 weeks, my vagina was angry. So so angry.
It wasn't until I graduated and got a personal OBGYN that I was able to see regularly where I felt comfortable talking about my female problems. My gynecologist at the time, Dr. Worth, was so positive, affirming, and non-judgmental. She made me feel safe. This was when I found out about Japan. I was really worried about getting hormone pills in Japan, and rightfully so. After living there, I now know that it was virtually impossible to get them. So, before I left, I decided to get an IUD. Dr. Worth was so wonderful in explaining everything. It was really really scary but I'm so glad I did it.
A few months into my stay in Japan, my body got really mad at me. I've never had the experience of riding a bike in humidity until I got to Japan so you can imagine how angry my vagina was with me. I tried to ignore it because I thought the itchiness would get better by itself. Unfortunately, it got worse. I had been looking up OBGYN clinics in my area but I was too scared to go. With the language barrier and my awful experience in the past, I was scared.
But on that day, the pain was so unbearable that I knew I had to go. Interestingly in Japan, you don’t need an appointment to go to the doctor. Most clinics are walk-in friendly, but you would have to wait for hours depending on where you were in line. The nearest clinic was about 30 minutes away, so I took the train from Yamada Station to Toyotsu Station and entered the waiting room of Iito Lady Clinic.
Before I got here, I looked up the Japanese words for labia, yeast infection, itching, and IUD. Due to working in a reproductive lab, I learned the words/characters for other reproduction related things. I remember being so proud of myself for being able to understand the receptionist, especially since that was a huge source of my anxiety, and the health form she gave me. It was all in Japanese, and I used my phone Japanese-to-English dictionary to translate a few things, but I understood almost all of it. From questions relating to my symptoms, to my medical history, I actually understood it. I remember how the receptionist saw me looking up words and asked if it would be easier if she read it to me, but I said no because I needed the practice.
I don’t remember how long I had to wait in that pink and blue waiting room, full of pregnant women and their babies, but once it was my turn, the nurse said “Abbasi-san!” and asked me to go inside one of the consultation rooms. There, I met Dr. Iito, the head of the clinic. He was sitting at a table and I sat next to him and explained to him my symptoms. Dr. Iito was a very stoic man. I don’t think I ever saw him smile, and we saw each other at least a few times a year. After that, he told me to go to the examination room next door.
For those of you who have had an exam in the US, you may recall that the consultation room and exam room are the same room. It is pretty small, but has the exam table that you sit on, as well as a counter and a computer. In Japan, it was very different. I did a consultation in a separate room, and then had to open a door to the exam room. The moment I stepped in, on the right side, there was a very small changing area with a little basket that you could put your clothes in. Then, there was this fancy heated chair with a long curtain separating the chair from the area where the doctor was. I didn’t see the doctor at all. I didn’t see him “working” either. I was instructed to take my pants off and then sit down in the chair. The chair then automatically rotated towards the curtain and then spread my legs apart. I was shocked. In the US, you have to put your feet in stirrups and then you have to open up, which many people do not, and often the doctor has to say “please open” quite a few times. However, this fancy chair just does it automatically. Later, I questioned this. Sure it makes life easier for the doctor, but if someone was sexually assaulted, this machine may be very triggering.
After that, the nurse put the curtain over my legs and then Dr. Iito did the examination behind the curtain. Next to the chair was a monitor, where I could see Dr. Iito doing an internal ultrasound and I was able to see my uterus and ovaries. He then inserted antifungal medication for my infection, and that was it. It was strange because in the US, I would have a good conversation with my gynecologist as she was doing the procedure, but Dr. Iito didn’t say a word.
To this day, I still wonder why Japan does gynecological exams this way. Is it because patients are embarrassed that someone is looking at their “private parts” and therefore having a barrier in between is more comfortable? To me, I felt uncomfortable because I had no idea who else was behind the curtain. I didn’t consent to anyone other than the doctor looking at me, and yet I know that there were multiple nurses going back and forth in that hallway.
Around two years later while still in Japan, I had an opportunity to shadow an OBGYN. That day, I got to be on the other side of the curtain. It was disorienting because all you saw was a person’s naked lower half and a curtain. You didn’t see their face until after they changed and went into the consultation room. These women were not people, but just vaginas. Furthermore, the doctor I was shadowing did not ask the patients if it was okay that I was there. There was a scene in the Handmaid's Tale that reminded me of this experience. The way the protagonist June experiences her appointments with the doctor seemed so dystopian in the show, and yet it exists in places like Japan.
These personal experiences have shaped how I plan to practice medicine. My goal as a physician is to treat people as humans and do what is most comfortable for them. I was shocked at how I was treated in Japan, but it doesn’t have to be that way. If I do have a private practice in the future, I wouldn’t mind getting the automatic gyno-chair, but I will make sure that the patient presses the button when they are ready.
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