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Urine HPV tests as an alternative to pap smears


trytounderstand

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trytounderstand

I've struggled for several years with wanting to get a pap smear but being unable to, as I live in an Asian country where doctors and hospitals refuse to perform pap smears or pelvic exams on virgins. I have phoned all the major hospitals in my city and been informed by medical practitioners that unless I have penetrative sex, I will not be given a pap smear for the rest of my life. 

 

Admittedly, I have never been physically intimate in any way with anyone, so I understand the rationale in my country of residence to not screen people like me. I've been advised by some to just lie and say I'm sexually active so I can get a pap smear, but I think it's very unwise to lie to a doctor. However, the fear of HPV/cervical cancer persists, so I've found that certain medical labs here provide HPV urine testing. It's paid for out of pocket but is my best option for now. 

 

There have been numerous studies in recent years about the efficiency of urine HPV tests. Although they may not be as effective as pap smears in every case, they are very close, according to studies. 

 

I just wanted to provide this information in case it's an option that may work for fellow ace folk who can't access pap smears due to their virginity status or for whom pap smears are too painful or traumatizing. 

Edited by trytounderstand
Edited for clarity
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SabeSparklexoxo
24 minutes ago, trytounderstand said:

I've struggled for several years with wanting to get a pap smear but being unable to, as I live in an Asian country where doctors and hospitals refuse to perform pap smears or pelvic exams on virgins. I have phoned all the major hospitals in my city and been informed by medical practitioners that unless I have penetrative sex, I will not be given a pap smear for the rest of my life. 

 

Admittedly, I have never been intimate in any way with anyone, so I understand the policy in my country of residence of not needing to be screened. However, the fear of HPV/cervical cancer persists, so I've found that certain medical labs here provide HPV urine testing. It's paid for out of pocket but is my best option for now. 

 

There have been numerous studies in recent years about the efficiency of urine HPV tests. Although they may not be as effective as pap smears in every case, they are very close, according to studies. 

 

I just wanted to provide this information in case it's an option that may work for fellow ace folk who can't access pap smears due to their virginity status or for whom pap smears are too painful or traumatizing. 

Thanks for the info. I had those done and they were painful af xD

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trytounderstand
5 minutes ago, SabeSparklexoxo said:

Thanks for the info. I had those done and they were painful af xD

So sorry to hear 😢. I was so afraid of the pain and also the trauma as I had been abused in childhood, but I  psyched myself up to do it only to be told no... TBH a small part of me was relieved. 

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SabeSparklexoxo
34 minutes ago, trytounderstand said:

So sorry to hear 😢. I was so afraid of the pain and also the trauma as I had been abused in childhood, but I  psyched myself up to do it only to be told no... TBH a small part of me was relieved. 

SAME XD

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Janus the Fox

That's interesting, as much of the western world seem to have the opposite issue, from what's been written on the boards.  A urine screen sounds much better for a 1st step to me, then a smear if something needs a further look on any necessary follow-up to me.

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everywhere and nowhere

I won't do pap smears anyway. I absolutely, fully, in a non-negotiable way refuse to ever undergo a pelvic exam, I would rather die than let anyone see or touch my private parts. And while really, neither is fine - neither forcing anyone to undergo this kind of examination (really, a basic request: people, stop shaming women who don't visit the gynecologist!!!!!), nor denying anyone possibility of healthcare they consider the best for them - I kinda feel that your country's policy is a tad better than Western disbelief in the existence of sexually inactive adults, which results in: 1. deciding that generally, pap smears are not recommended for those who have never had any kind of sexual contact, and 2. insisting that virgins submit to the test anyway, because those folks cannot wrap their head around the fact that sexually inactive people exist!

However, I wanted to point out one thing: if you have never had sex, you cannot have contracted the HPV virus. Pap smears test for presence of abnormal cells, not for presence of HPV. Actually, the vast majority of cervical cancer is due to HPV, so my own view is that only if someone has family history of non-HPV cervical cancer, testing might be prudent also for those who have never had sex (unless they feel mortal terror towards the procedure - you have a right to consider costs and benefits and decide that something else, for example your right to intimacy, matters more for you than your health - another request by the way: stop shaming people who consider something else than health the most important value in their lives). However, if someone has never had sex of any kind, urine HPV tests won't do them any good, because one can be sure in advance that the result will be negative.

P.S. @trytounderstand - I also wanted to point out that using the word "intimacy" as an euphemism for sex is a very bad custom and particularly for asexuals it might be a good idea to fight it. After all, we usually desire intimate contact in forms such as very personal conversations. Using "intimacy" to mean "sexual contact" implies that those of us who completely reject the possibility of trying sex also don't need any intimacy, and it's just not true. I'm an extremely nudity-averse, sex-averse person who chooses to be celibate for life, but I do desire verbal intimacy.

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trytounderstand
1 hour ago, everywhere and nowhere said:

I won't do pap smears anyway. I absolutely, fully, in a non-negotiable way refuse to ever undergo a pelvic exam, I would rather die than let anyone see or touch my private parts. And while really, neither is fine - neither forcing anyone to undergo this kind of examination (really, a basic request: people, stop shaming women who don't visit the gynecologist!!!!!), nor denying anyone possibility of healthcare they consider the best for them - I kinda feel that your country's policy is a tad better than Western disbelief in the existence of sexually inactive adults, which results in: 1. deciding that generally, pap smears are not recommended for those who have never had any kind of sexual contact, and 2. insisting that virgins submit to the test anyway, because those folks cannot wrap their head around the fact that sexually inactive people exist!

However, I wanted to point out one thing: if you have never had sex, you cannot have contracted the HPV virus. Pap smears test for presence of abnormal cells, not for presence of HPV. Actually, the vast majority of cervical cancer is due to HPV, so my own view is that only if someone has family history of non-HPV cervical cancer, testing might be prudent also for those who have never had sex (unless they feel mortal terror towards the procedure - you have a right to consider costs and benefits and decide that something else, for example your right to intimacy, matters more for you than your health - another request by the way: stop shaming people who consider something else than health the most important value in their lives). However, if someone has never had sex of any kind, urine HPV tests won't do them any good, because one can be sure in advance that the result will be negative.

P.S. @trytounderstand - I also wanted to point out that using the word "intimacy" as an euphemism for sex is a very bad custom and particularly for asexuals it might be a good idea to fight it. After all, we usually desire intimate contact in forms such as very personal conversations. Using "intimacy" to mean "sexual contact" implies that those of us who completely reject the possibility of trying sex also don't need any intimacy, and it's just not true. I'm an extremely nudity-averse, sex-averse person who chooses to be celibate for life, but I do desire verbal intimacy.

Thank you for sharing your thoughts. Especially about the use of the word "intimate", that's very helpful and totally makes sense. I've edited my post to specify physical intimacy. Agree with a lot of the points you brought out. For me I found it helpful to do the urine test for peace of mind, although I know it's not "necessary". In the West at least, pap smears are so strongly advised for virgins that I felt anxious and unsettled about not doing them, so the urine test was a happy medium.

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trytounderstand
1 hour ago, Janus the Fox said:

That's interesting, as much of the western world seem to have the opposite issue, from what's been written on the boards.  A urine screen sounds much better for a 1st step to me, then a smear if something needs a further look on any necessary follow-up to me.

I know right? I was confused at first by the hospitals, since I was so accustomed to the Western view. I was like OK I want to schedule a pap smear and please can I request your smallest speculum because I'm a virgin... And they were like hold on, you can't do a pap smear. I thought it was just an odd encounter and phoned other hospitals only to be emphatically told the same.

 

I found the urine test to be very manageable and a stress level I could easily cope with (I still got nervous as I do about all medical tests 😂). I would love to see the urine test become commonplace so that smears are only done as a necessary followup. I think many women would appreciate that. 

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everywhere and nowhere
20 minutes ago, trytounderstand said:

In the West at least, pap smears are so strongly advised for virgins that I felt anxious and unsettled about not doing them

This is what I wrote: the problem is that most people, including medical professionals, don't fully believe - or more precisely: don't acknowledge - that some adults don't have sex. That some people simply don't want to have sex and will not have sex regardless of other factors. They theoretically admit that pap smears may do more harm than good for people who have never had sex and therefore have very low risk of cervical cancer (by the way, it's a proven fact that nuns on average live longer than most women :)), but they are unable to make the logical next step because they just cannot imagine how a particular person might not want to have sex and freely choose a sex-free lifestyle.

At least I am strong enough that I don't feel unsettled about not doing pap smears. Not that I'm fully a tough lady who never breaks down: I experience extreme distress at the thought of this kind of examination, I can't even read descriptions. But at least I'm strong enough to feel certain that I have a right to make my own choices. Let's say that I value my own gut feeling above official recommendations: if I feel that I would literally die from this kind of examination, that I couldn't live with such a thing having happened, I won't adhere to any recommendations because my own wellbeing comes first. We should just recognise that people are not all the same and that there are no "right" or "wrong" reactions to this kind of examination. Women who experiece it as unpleasant, frustrating, uncomfortable, but manageable, aren't "right" and those who experience mortal terror at the very thought aren't "wrong". We just have a right to our own thoughtfeeling, a right which nobody can deny us. I don't even want to delve right now into the problems of "phenomenology of experience" because it is a deep and complex topic, one which touches what I call "extreme philosophy", but let's say briefly that I have a distrust of regularity-seeking, standarising psychology and believe that philosophy and art provide a better description of our inner life than science does.

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I think people underestimate the trauma that medial procedures can cause and how they affect people very differently.  What is just a normal procedure for some people can feel like and have all the effects of sexual assault to others.

 

I didn't know urine test pap smears existed - that seems like a far better option for patients who are not comfortable (physically or mentally) with a standard pap smear.

 

There is a similar issue with colonoscopies. There are non invasive fecal stool tests that provide nearly as good results.  Kaiser uses these, but most other providers want to do regular colonoscopies - part of me is suspicious that its because they can charge more for a procedure than for a lab test. Colonoscopies are traumatic for some people and even have some rate of causing serious injuries.

 

 

Specifically to the OP, in some ways your country may be right - a pap smear is more likely to be painful (and maybe traumatic)  for someone who has never had any sort of vaginal penetration before - which of course is not the same thing as "sex" but they may equate them.

 

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I really wish they'd adopt the urine tests here in the states.  I don't want to get into my story of my traumatic pap smear attempt, but you can read the thread here if you want.  Thanks for the idea--I will definitely bring it up to my doctor in hopes that something changes, since I will inevitably get asked about whether I can tolerate a pap every year until I die, most likely.

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A HPV test is technically different from a pap smear. Pap smears don't test for HPV, they test for abnormal cells. The vast majority of cases of cervical cancer are caused by HPV infections.

 

If you have not engaged in any sexual activity (oral, fingering, PiV), the chances of having HPV (that would affect your cervix) would be essentially nil. They aren't recommended for virgins since the risk is so low, the procedure doesn't offset the risk.

 

I don't know why it is pushed so heavily in North America, though they are increasingly moving away from such regular pap smears because the science just doesn't support it, and they can be incredibly uncomfortable for many female bodied people. They recommend them every 3 years now, increasing to 5 years I believe if no abnormal swabs have been found over some set of years. And there is mixed opinions on whether virgins should be having them at all, I think the opinions based on outdated information is where those suggestions come from though. We are just slow to make across the board changes to public health I think. 

Edited by MarRister
Fixing PAP so I don't get decapitated or something
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everywhere and nowhere
1 hour ago, MarRister said:

A HPV test is technically different from a PAP smear. PAP smears don't test for HPV, they test for abnormal cells. The vast majority of cases of cervical cancer are caused by HPV infections.

Yes, I mentioned the same above.

Although a correction by the way: "pap smears", not "PAP smears", because "pap" is not an acronym. Similarly, as @Snaolent Night wrote: "If you write ACE in all caps, I will decaps-itate you". ;)

1 hour ago, MarRister said:

And there is mixed opinions on whether virgins should be having them at all, I think the opinions based on outdated information is where those suggestions come from though.

I just - although I've already said that - have an impression that they simply don't believe that sexually inactive adults exist. They find it hard to apply the idea that pap smears may not even be recommendable for virgins in practice, because they don't believe in the existence of 25+ virgins. ;)

1 hour ago, bare_trees said:

I will definitely bring it up to my doctor in hopes that something changes, since I will inevitably get asked about whether I can tolerate a pap every year until I die, most likely.

I have hardly received them - I just remember meticulously tearing an invitation letter - but maybe it's because I just don't visit any physicians other than my dentist regularly. However, I have been shamed in social situations for admitting my nudity aversion and refusal to visit gynecologists. Why can't people just "live and let live"?

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This is good information to have! I'm also really happy to see people having this discussion because I'm in a similar situation right now. My doctor would do a speculum examination (not for HPV but to try and work out the cause behind some issues I've been having) but she really doesn't want to because I'm a virgin but it doesn't seem like there's a great deal of options for what else she could do from this point. I definitely wouldn't want to have one if I can avoid it but it would be annoying if they eventually say 'well, there's nothing else we can do, guess it will just have to be a mystery' just because they don't want to/can't do a speculum exam

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2 minutes ago, everywhere and nowhere said:

Although a correction by the way: "pap smears", not "PAP smears", because "pap" is not an acronym. Similarly, as @Snaolent Night wrote: "If you write ACE in all caps, I will decaps-itate you". ;)

I thought it looked funny haha, and now that I think about it it makes sense. Should have instinctually known it was named after some man 😝

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trytounderstand
7 hours ago, uhtred said:

I think people underestimate the trauma that medial procedures can cause and how they affect people very differently.  What is just a normal procedure for some people can feel like and have all the effects of sexual assault to others.

 

I didn't know urine test pap smears existed - that seems like a far better option for patients who are not comfortable (physically or mentally) with a standard pap smear.

 

There is a similar issue with colonoscopies. There are non invasive fecal stool tests that provide nearly as good results.  Kaiser uses these, but most other providers want to do regular colonoscopies - part of me is suspicious that its because they can charge more for a procedure than for a lab test. Colonoscopies are traumatic for some people and even have some rate of causing serious injuries.

 

 

Specifically to the OP, in some ways your country may be right - a pap smear is more likely to be painful (and maybe traumatic)  for someone who has never had any sort of vaginal penetration before - which of course is not the same thing as "sex" but they may equate them.

 

Totally agree with you about the trauma of medical procedures for some. I've experienced it with certain other "routine" tests and it can feel lonely wondering if you're the only one distressed by it.

 

If you live in the US or UK, I wonder if you can find urine hpv testing, as most of the studies are in fact from there. In my country, typically new tests like these become available quite some time after first being available in the west, so if I can access it here I hope those in other countries can as well. I think self-collected vaginal swabs and urine testing as alternatives to pap smears are gradually getting more attention. 

https://www.bbc.com/news/health-48092561

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trytounderstand
1 hour ago, sk8ergrandma said:

This is good information to have! I'm also really happy to see people having this discussion because I'm in a similar situation right now. My doctor would do a speculum examination (not for HPV but to try and work out the cause behind some issues I've been having) but she really doesn't want to because I'm a virgin but it doesn't seem like there's a great deal of options for what else she could do from this point. I definitely wouldn't want to have one if I can avoid it but it would be annoying if they eventually say 'well, there's nothing else we can do, guess it will just have to be a mystery' just because they don't want to/can't do a speculum exam

Wow, I'm glad I'm not the only one with doctors who won't do a speculum or other internal exam due to virginity. I experienced the same when I had what seemed to be a persistent UTI. There was some uncertainty about the diagnosis and some overlapping symptoms, and the doctor was going to do a pelvic exam but once she learned I was a virgin she said no and instead did a urine test and gave meds based off my main symptoms. I've only ever been offered external ultrasounds, they won't do anything internal.

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trytounderstand
3 hours ago, bare_trees said:

I really wish they'd adopt the urine tests here in the states.  I don't want to get into my story of my traumatic pap smear attempt, but you can read the thread here if you want.  Thanks for the idea--I will definitely bring it up to my doctor in hopes that something changes, since I will inevitably get asked about whether I can tolerate a pap every year until I die, most likely.

I read the thread, and I'm so very sorry you experienced that! It sounds extremely traumatic and I hope you're feeling better now. I can totally understand if you wouldn't want to ever do a pap smear again. I think there's a good chance that urine tests are available in the States, although currently they probably are not considered "real" hpv tests because they haven't yet been made part of regular screening. And they probably aren't covered by health insurance. But I think it's likely they are available because urine test studies started in the US and UK I believe, and it usually takes time for new tests to become available in my country, typically a few years after being available elsewhere. I think it's been around in the west since 2019. https://www.bbc.com/news/health-48092561

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trytounderstand
3 hours ago, MarRister said:

A HPV test is technically different from a pap smear. Pap smears don't test for HPV, they test for abnormal cells. The vast majority of cases of cervical cancer are caused by HPV infections.

 

If you have not engaged in any sexual activity (oral, fingering, PiV), the chances of having HPV (that would affect your cervix) would be essentially nil. They aren't recommended for virgins since the risk is so low, the procedure doesn't offset the risk.

 

I don't know why it is pushed so heavily in North America, though they are increasingly moving away from such regular pap smears because the science just doesn't support it, and they can be incredibly uncomfortable for many female bodied people. They recommend them every 3 years now, increasing to 5 years I believe if no abnormal swabs have been found over some set of years. And there is mixed opinions on whether virgins should be having them at all, I think the opinions based on outdated information is where those suggestions come from though. We are just slow to make across the board changes to public health I think. 

Yes! I was told if I'm not a virgin I could get a pap smear + HPV test so I won't need to test again for a longer interval. That's why the urine HPV test made sense to me, although like others have said for someone who has never had sexual activity the chance of having HPV in the cervix is nil. Still, it gave me some reassurance to have the test. I also don't understand why North America is so strong on virgins getting pap smears... By outdated information, do you mean the belief we should  smear test virgins or the contrary?

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28 minutes ago, trytounderstand said:

I read the thread, and I'm so very sorry you experienced that! It sounds extremely traumatic and I hope you're feeling better now. I can totally understand if you wouldn't want to ever do a pap smear again. I think there's a good chance that urine tests are available in the States, although currently they probably are not considered "real" hpv tests because they haven't yet been made part of regular screening. And they probably aren't covered by health insurance. But I think it's likely they are available because urine test studies started in the US and UK I believe, and it usually takes time for new tests to become available in my country, typically a few years after being available elsewhere. I think it's been around in the west since 2019. https://www.bbc.com/news/health-48092561

Thanks so much for your kind words.  Doing much better physically now, but still working through the psychological trauma.  But revisiting that thread reminded me how far I've come.  Thank you for the info as well!

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8 hours ago, uhtred said:

There is a similar issue with colonoscopies. There are non invasive fecal stool tests that provide nearly as good results.  Kaiser uses these, but most other providers want to do regular colonoscopies

i am a Kaiser patient, and resisted having a colonoscopy for years, using the fecal tests instead.  Six years ago, I was notified that my fecal test had revealed possible cancer.  When I did have a colonoscopy, it showed a large tumor that had almost obstructed the colon.  Obviously that cancer was present the previous year, when the fecal test didn't show it. 

 

It's everyone's individual decision about have a colonoscopy.  However, no one should think that a fecal test is just as effective as a colonoscopy.  

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trytounderstand
30 minutes ago, Sally said:

i am a Kaiser patient, and resisted having a colonoscopy for years, using the fecal tests instead.  Six years ago, I was notified that my fecal test had revealed possible cancer.  When I did have a colonoscopy, it showed a large tumor that had almost obstructed the colon.  Obviously that cancer was present the previous year, when the fecal test didn't show it. 

 

It's everyone's individual decision about have a colonoscopy.  However, no one should think that a fecal test is just as effective as a colonoscopy.  

Agree with this. I've also chosen colonoscopy over fecal testing for the same reason. 

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1 hour ago, trytounderstand said:

By outdated information, do you mean the belief we should  smear test virgins or the contrary?

Yeah the idea that pushing mandatory cervical screening tests on those who have not had any form of sexual contact I think is outdated. The risk level just isn't there, and it is quite an invasive test.

 

It may come down to, in part, medical professionals not believing that people haven't had any sexual contact (in any form) and an attempt to 'simplify' guidelines. But it seems like a needlessly uncomfortable (sometimes downright painful) test to give to someone who's risk is probably lower than just the general risk for other cancer types that are not screened for regularly (but don't quote me on that, I can't find any actual statistics on it). 

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nanogretchen4

It is usually possible to do pap smears and other pelvic exams involving a speculum on virgins with no difficulty. I cannot help getting the feeling that the countries that flatly refuse to do penetrative exams on virgins think that hymens as supposed "proof" of virginity are very, very, very important, and that an unmarried woman would be better off dead than to have her precious hymen damaged in any way. Never mind that most hymens do not cover the whole opening anyway, are able to stretch during first intercourse and therefore remain as "intact" as they ever were after starting penetrative sex, and are often gradually reabsorbed by the body for no reason but natural development and aging.

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2 hours ago, Sally said:

i am a Kaiser patient, and resisted having a colonoscopy for years, using the fecal tests instead.  Six years ago, I was notified that my fecal test had revealed possible cancer.  When I did have a colonoscopy, it showed a large tumor that had almost obstructed the colon.  Obviously that cancer was present the previous year, when the fecal test didn't show it. 

 

It's everyone's individual decision about have a colonoscopy.  However, no one should think that a fecal test is just as effective as a colonoscopy.  

I didn’t know they were not as effective. Good to have all the information to decide

 

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9 minutes ago, nanogretchen4 said:

It is usually possible to do pap smears and other pelvic exams involving a speculum on virgins with no difficulty.

As someone who could hardly use the smallest size tampons without discomfort and who's hymen tore at age 27 even when it is supposed to be less prominant through age/activity, I certainly don't think it would have been possible for me to have had a pap smear done with "no difficulty" not to mention it would have been incredibly mentally stressful for me when I was younger as well. Hell, I find it quite uncomfortable (nearly painful) now as someone who has had sex numerous times now.

 

It may very well be that the doctors are trying to 'protect' the hymen in whatever country the OP is from, which is unfortunately misguided, but I don't think it is fair to say it can usually be done with no difficulty. But if a patient is requesting it, I do find it odd they would refuse altogether. 

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everywhere and nowhere

@MarRister - I too can't use even the smallest tampons and my vaginal corona (I prefer this name) is still there because it just hadn't had opportunities to tear. Physical activity? I do that - within the limits set by my low physical fitness. Even long before I had the injury which, later, left me with knee joint degeneration, I already had problems such as being unable to run, to do floor bend... Even at kindergarten age my joints were already stiff enough that I could never perform floor bend correctly (that is, without bending my knees). And someone's asking about splits, which are know for endagering unsuspecting vaginal coronae? ;) This kind of exercise has always been way outside the range of movements possible for me.

And anyway, it's also a mental issue: I feel extreme, mortal terror at the thought of undergoing this kind of examination. As I wrote, I would rather die than let anyone see or touch my private parts. And I won't let myself be shamed for my boundaries. After all, I'm not doing harm to anyone else with my nudity aversion, and possibly not acting in one's best interest is, fortunately, legal.

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22 hours ago, trytounderstand said:

Wow, I'm glad I'm not the only one with doctors who won't do a speculum or other internal exam due to virginity. I experienced the same when I had what seemed to be a persistent UTI. There was some uncertainty about the diagnosis and some overlapping symptoms, and the doctor was going to do a pelvic exam but once she learned I was a virgin she said no and instead did a urine test and gave meds based off my main symptoms. I've only ever been offered external ultrasounds, they won't do anything internal.

It feels like a pretty big gap in the medical field if they truly can't do these kinds of examinations because of virginity 😕 I've only had an external ultrasound so far too and the results were inconclusive. The only reason it even came up that I've never had sex was because she orignally thought it might be an STI so I wanted to rule that out quickly without wasting time but now I'm just annoyed that it's apparently closed off this way of trying to figure out what is wrong. My doctor's main concern about doing one seems to be because of how much more invasive/painful it would be which I appreciate but I don't want it to be a barrier to having one if it comes down to it - I would have been contacted to schedule one when I turned 25 anway!

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