Consent in the Doctor’s Office

When I was in my late teens, I had barely formed friendships with other youth, much less developed a sexual relationship with anyone, male or female. So I had little awareness of sexuality, much less any need for birth control, and had never had a pelvic exam. Once I entered college, my parents pressured me to get a job. I had a female friend who was in the National Guard Army Reserves and popular and extroverted enough to do well with its male-dominated atmosphere. Her example combined with the appeal of making money for college convinced me to follow her into the National Guard. Before I knew it, I was in a Guard-arranged doctor’s appointment having my very first pelvic exam.

Twenty years later, I worked as a reproductive health counselor in a women’s health clinic. I explained to countless girls and women what happens in a pelvic exam and the necessity of relaxing the opening to the vagina to minimize any potential discomfort. Twenty years later, I was also paid to be a gynecological teaching associate, letting hundreds of men and women, future health care professionals, practice pelvic exams on my body and giving my consent and taking responsibility to relax my vaginal muscles to avoid pain. I explained to those future providers how they could help any woman\’not just me\’feel comfortable, safe, in control of the exam and able to stop it if needed. But twenty years earlier, as a young woman who knew little about my body and sexuality or anything about pelvic exams, I lay on the exam table in the doctor’s office without any idea what was going to be done to me.

I can’t recall the doctor’s face. He never looked up, slowed down, or stopped as I screamed out in pain when the speculum, which felt like a steel rod, opened up inside of me. But I do remember the look on the face of the nurse in the corner of the room: she was expressionless. I have no idea what was going through her mind, but certainly there was no compassion to speak of.

I compare that experience to how, as a reproductive health counselor, I held the hand or touched the shoulder of each woman, coached her about breathing and reminded her to relax the muscles at the opening of the vagina. With my eye contact, I would show all the compassion I felt for her. When the pelvic exam or inserting the speculum didn’t go painlessly, I was the first to say, “I am so sorry that it hurt, and I often tried to talk it over with the woman after the exam, explaining that I knew it could be difficult to relax sometimes but there was hope that the next time could be painless.

During one patient visit, I knew the doctor was ready to insert the speculum, but I could tell the woman was not ready. I put my hand between the speculum and the woman’s vulva and said, “She’s not ready.

Today, as a sexuality educator, I believe that if consent in the doctor’s office is not important, then it makes it less likely that it will be taken seriously in every other part of our lives. Consent is not just important when our genitals are being touched. It is important when we are being touched anywhere on our bodies. I’ve worked for over five years as a caregiver for individuals with HIV/AIDS, and it has always been my belief that any touch\’touching someone’s arm or putting lotion on a resident’s legs or helping clean someone’s entire body with a shower or bed bath\’is a significant intimacy to pay close attention to, in order to ensure respect and consent. I also believe in the potential sacredness of interactions that involve no touch\’whether talking to or just being silently present with someone during a moment of their living or dying.

I have explored touch, intimacies and healing modalities of all kinds with a deep desire to embrace all aspects of myself (sexuality, emotions, thoughts and spirit) as part of my own personal healing as well as to facilitate my writing and sexuality education activities. I can say unequivocally that it matters less where we are touched than how we are touched. I will also go on record to say that my experience in that doctor’s office decades ago felt like rape. Being an advocate for consent in our sexuality, relationships and all parts of living and dying, I affirm that consent matters everywhere and every time in our interactions at work, at home, in the street and in the doctor’s office.


Susan Miranda

Susan has a master’s degree in human development with an emphasis in women’s sexuality. Since 1989, Susan has taught seminars on unlearning homophobia, biphobia, and sexphobia and on various topics related to sexual healing and sacred touch. In the past, she has worked as a gynecological teaching associate for the medical community, a reproductive health counselor at a women’s health clinic, and a caregiver for people with AIDS. Susan has published articles on the body and sexuality in the Minnesota Women’s Press and in the anthology Our Choices, Our Lives: Unapologetic Writings on Abortion (iUniverse, Inc., 2002).

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