I Asked for an IUD, and got a Side Helping of Medical Racism.

Ex-physician or not - finding safe gynecological care as a Black woman remains a crapshoot.

April 7th 2024

I haven’t done a poll but I’m willing to bet that the majority of people with a vagina can tell you there are few places where we feel more vulnerable than an obstetrician's or gynecologist’s examination table. No amount of polite chit chat in the office wearing only an oversized hospital gown seems enough to prepare you for the inevitable moment when you have to lie back, put your feet up in the stirrups, open your knees, and lay everything bare.

Many cisgender women, trans and non binary folks alike will walk into their doctor’s office carrying a heavy yet invisible load, including histories of sexual violence, abuse, birth or pregnancy trauma, and poor treatment from previous healthcare providers. Yet, if we want to be proactive about our sexual and reproductive health, be it through cervical cancer screening, testing for STIs, contraceptive planning, pre-natal visits, or anything else, we are required to show up and present our genitals nonetheless. We may do research when choosing a doctor: reading through their bios for any hint of something that may make them more relatable: a shared hobby, a shared alma mater, a research interest in an issue we are experiencing, a shared cultural, racial, or gender identity. In my case there were no Black gynecologists available at my local community hospital, so I chose what I hoped would be the next safest option: a non-Black woman of the Global Majority- in this case, Asian American. Once we’ve navigated a myriad of invisible barriers just to get to the doctor’s office, we trust that we will meet a doctor who will see and be mindful of our intersectional identities, and handle our precious and fragile stories with care.

Three days ago, that person stepping bravely into the doctor’s office was me. I was due my annual Well Woman check, and was also looking for a reliable long term contraceptive to ease me safely towards menopause while minimizing the risk of a surprise baby in my 40s. Turns out, none of the privileged identities I brought into the room with me — a former physician with three degrees, heterosexual cis-woman in a healthy marriage, stay-at-home-mom in a relatively economically stable household — could shield me from highly problematic comments of a doctor whose interactions with me were based on my most visible and high-risk identity: Black woman.

The modern speciality of gynecology is rooted in the abuse and oppression of Black women¹ ². Enslaved African women — who were subsequently deliberately erased from history — were subjected to multiple experimental surgeries without consent or anesthetic, while the white men who subjected them to this treatment have been memorialized in paintings, statues and medical textbooks in universities and hospitals throughout the Western world. Some gynecological instruments are even named after these men, the Sims speculum being one example³. The US has a gruesome history of forced sterilization of Black and Indigenous women⁴, and racist tropes⁵ about Black people not being able to feel pain in the same way as non-Black people were printed in certain medical textbooks as recently as 2017⁶. Just a couple of years ago, my Black husband was told by an older white nurse that he had “thick skin” when getting his covid vaccine. The concept of Black people having thicker skin than other races is a racist and long-disproven 19th century idea, which recent research revealed still persists in the attitudes of white medical students and lay people⁷.

So, after researching my long term contraceptive options, I had landed on the idea of getting a non-hormonal Intrauterine Device (IUD). In the appointment I asked my doctor about the possible complications- specifically the risk of the IUD migrating or rupturing the uterus. The doctor replied that if this happened she would need to retrieve it laparoscopically, and that “while she was there”, she would “probably just tie my (fallopian) tubes, as it would achieve the same goal as the IUD”.

When working as a physician from 2008 to 2016 — and even before that as a medical student— I was used to navigating around the inflated egos of surgeons. Bullish behavior in operating theaters, abrupt bedside manners with patients, and public shaming of junior colleagues was an everyday occurrence, baked into the culture at many different hospitals I worked at. While of course there were exceptions, I most often saw these problematic behaviors in older white men, who thought themselves untouchable. I watched as many medical students, nurses, and aspiring surgeons fawned in their presence, to stay in their good graces and retain access to power. So all that being said, I admit I was caught off guard when this small, usually cheerful, Asian woman casually announced that she would permanently sterilize me if, during a laparoscopic exploration of my pelvis looking for a lost IUD, she happened to be in the vicinity of my perfectly well-functioning fallopian tubes. There was no apparent regard for my consent, my bodily autonomy, or the fact that I had very deliberately sought out a reversible contraceptive method.

Still processing what I had just heard as I sat at the end of the examination couch, and knowing how inappropriate it was, I clamped my back teeth together and thought “you absolutely will NOT tie my tubes" to myself, but said nothing, wanting to just take the information leaflet to read later and leave the room as soon as possible. I made another appointment in a few weeks for the IUD insertion, on the basis that I could always cancel it if I changed my mind.

April 23rd 2024

Today was IUD insertion day. Having not had any brain space to go through the hassle of changing doctors, I tried my best to suppress the memory of the wildly inappropriate comment from a few weeks ago. After having my blood pressure and other vitals checked by the nurse, she left the room while I removed my clothes and folded them neatly on the chair. Now dressed in a humbling hospital gown, with legs akimbo and blood dripping from me on day 2 of my period, there I was again, at my most vulnerable. The doctor came in, got into position between my legs, and in a surprised tone immediately commented on the heaviness of my menstrual flow (um… inappropriate much?). Then she proceeded to try and insert the IUD. It didn’t work first time, or second time, and she had to use two or three larger sizes of dilator to open up my cervix, as I had had two caesarian births. With each of these contacts I tried to breathe through the discomfort. A few of the times I took a deep breath and exhaled through pursed lips, and she looked concerned and asked me if I was ok. I told her I was just breathing to get through it.

When it was done, she said I could get dressed, and told me “You have a very high pain threshold!”. Well this is just great, I thought to myself. A comment straight out of the “Black women don’t really feel pain” handbook. How on earth could she tell if I have a high pain threshold? She had clearly seen I was using deep breathing to navigate my pain and discomfort, but then told me I have a high pain threshold? Pain is an internal experience and there is no way she could accurately know my pain level or make a judgement about my “pain threshold” from just observing me. It was a brutal reminder that white supremacist ideas about Black bodies have permeated the consciousness of many physicians, including physicians of color.

May 25th 2024

I did report my experience in the feedback survey, and was pleasantly surprised by the prompt response and follow up by members of the department's administration team. I had video and phone calls with them in which they listened to the details of my experience, acknowledged the inappropriateness of her comments, and asked me what I wanted to happen next. I said they needed to provide further education for the doctor in question and the wider team, about the life-threatening dangers of internalized racism to Black women’s health. I said the whole team needed to be identifying and interrogating their internalized biases, and taking ACTIVE STEPS to address and correct them. I also said they need to employ Black gynecologists on the team, to which I received vague answers about “recruitment issues”. They arranged for me to see a different doctor for my follow up appointment next month. They later sent me a formal written response assuring me that they had spoken with the Dr and they were taking action to prevent this from happening again. That’s… fine, I guess. I wasn’t trying to sue the hospital or make her lose her job, I just wanted to ensure she knows better and does better for her patients in future.

June 4th 2024

I had my follow up appointment today and was hit unexpectedly by a wave of anxiety while waiting in the clinic room for my new doctor. I had to say some affirmations to myself and fight back the tears that were trying to leak from my eyes. The door finally opened and in came a young Indian-American doctor who seemed warm and friendly. She was able to check the threads of my IUD successfully, while making small talk to try and diffuse the awkwardness that accompanies any vaginal examination. When I left the room I went to find the head of department who had specifically asked me to circle back with her and let her know how my appointment had gone. However, she was on lunch, and I didn’t want to wait around.

A receptionist pointed me towards a specific door to exit the clinic, but when I turned the corner I saw my previous doctor and froze. I immediately retraced my steps and hid, trying to fight back tears while hoping she hadn’t seen me. I asked if I could go out the other door and the receptionist repeated her original instructions, with a tinge of annoyance that I was back asking her the same question. I had to be explicit and say that there was a Dr in the corridor that I didn’t want to see, so she said I could use the other door. As I walked hurriedly towards the elevator, tears spilled over and rolled down my cheeks. I began to ask myself what was happening? Where in my deep bodily trauma archives had that reaction come from? I felt so tender and had to really …

May 30th 2025

I just came back to this piece of writing today, a year on, as I try to book my next annual Well Woman exam. I found it cut off mid-sentence, just as you can see in the above paragraph. I guess I must have been pulled away by some other task that, combined with my ADHD brain, pushed it down my priority list. The urge to get all of the chaotic thoughts out of my head and into words must have been satisfied, at least enough for me to set it aside and go about my every day life for the next several months. Special shout outs also go to my therapist, husband, and close friend who all helped me access my righteous anger and deep hurt, and called out my self-gaslighting when I thought maybe I was “making too big a deal” out of what had happened.

Since my last appointment in 2024, the political landscape of this country has been transformed. Women’s rights to bodily autonomy that many of us had foolishly taken for granted have been challenged and undermined at State and Federal levels. Unfortunately, the USA has maintained its significant and longstanding lead in maternal mortality (especially Black maternal mortality), compared to other high income countries⁸ ⁹. As I type this, a 30 year old Black woman named Adriana Smith has been kept alive on life support in Georgia for the past three months, as an incubator for her unborn fetus, despite becoming brain-dead following a medical emergency when she was 9 weeks pregnant.¹⁰ This is against her family’s wishes, but is being enforced by the state of Georgia through its twice-repealed and twice-reinstated 2019 “heartbeat law”¹¹. Never have I been more grateful to have a 10 year IUD in my uterus.

So here I am, a year on, staring at my laptop screen at the available appointments for my next Well Woman check at the same local community hospital. This type of appointment usually involves a review of contraceptive needs, breast exam, internal vaginal exam, and a pap smear every three years. Sadly, the nice replacement doctor I saw last year doesn’t work there any more. There are (still) no Black gynecologists on staff, and there are now only two options: an older white female doctor who comes highly recommended — by my white friends — and an older Indian female doctor. And the earliest available appointments are all three months away. I did a brief online search for Black female gynecologists in my city and other nearby cities, to no avail. I feel angry and resentful towards the systemic historical and present-day barriers that have resulted in this situation.

So I’m left with no option but to take a deep breath and take a chance, hoping that whichever doctor next gets to see me at my most vulnerable, sees me in my full humanity. A Black woman, who is able and entitled to make decisions about my own body and fertility.

1. https://www.smithsonianmag.com/smart-news/mothers-of-gynecology-monument-honors-enslaved-women-180980064/

2. https://www.history.com/articles/the-father-of-modern-gynecology-performed-shocking-experiments-on-slaves

3. https://en.wikipedia.org/wiki/Sims'_vaginal_speculum

4. https://bpr.studentorg.berkeley.edu/2020/11/04/americas-forgotten-history-of-forced-sterilization/

5. https://www.mayoclinicproceedings.org/article/S0025-6196(21)00322-0/pdf

6. https://www.bbc.com/news/blogs-trending-41692593

7. https://www.pnas.org/doi/10.1073/pnas.1516047113

8. https://www.cbsnews.com/miami/news/black-maternal-mortality-rate-rises-as-other-groups-see-declines/

9. https://www.usnews.com/news/best-countries/articles/2024-06-04/how-the-u-s-compares-to-other-rich-countries-in-maternal-mortality

10. https://www.cbsnews.com/news/georgia-woman-brain-dead-woman-must-carry-fetus-to-birth-because-of-abortion-ban/

11. https://en.wikipedia.org/wiki/Georgia_House_Bill_481