A feminist

I love what Dr Jen Gunter writes, on abortion, empathy, privilege, feminism, and incidentally on trans people.

An advert on facebook led me to an article from last month’s NYT on vaginas. Male partners sometimes criticise healthy vaginas as too loose, or smelling wrong, or tasting wrong, as a way of controlling women and making us feel insecure. This is not OK. I decide how I want to look. Women may actually harm themselves trying to make their vaginas acceptable. As a gynaecologist, Jen Gunter hears a lot of women describing the men’s manipulation.

In the comments here, I see different lines on “Not all men”. It gets clearer to me how that is offensive. Indeed, not all men rape women, and perhaps some men have never pushed women’s boundaries or wronged them in any way, but when a woman complains of shitty male behaviour, why should a man feel the need to say not all men? That’s irrelevant, she is not complaining of all men, but some men. The man may not be saying it never happens, but is derailing: it happens, it matters, and we should consider the experience of it, rather than judging the way it is shared. And, why feel any need to protest, if you do not feel guilty? What she wrote was “This is a form of control men often use”- not, all men; not, women don’t do something similar, though women may have less power in a relationship so might not, so much; but, men do it. Let us agree it is a bad thing, and try not to ourselves.

I dislike the line that “men suffer the same way”. Yes; but she was not claiming a right of retaliation, only saying it happens and is wrong. Someone signing a woman’s name accused Dr Gunter of an offensive, gross mischaracterization of an entire classification of people based on gender. That was not what I perceived. “Not all men” becomes a way of saying SHUT UP rather than a reasonable response.

She is worth reading for the facts on late abortions: after 25 weeks, a woman with a wanted pregnancy but health problems making continuing pregnancy too dangerous would have a C-section or induced labour. The child would be cared for. Concealed pregnancies, perhaps of a frightened teen or a rape survivor, are very rare. Sometimes a foetus has severe defects but the mother elects to carry anyway; but a foetus lying horizontally cannot be delivered vaginally.

She continually calls for our empathy. Some women don’t want a C-section in this situation for baby who can’t live. I think you can understand that. And Some women just can’t bear continuing. Imagine everyone touching your belly asking if you are having a boy or a girl and you know your baby has no brain? I have heard that story. It breaks people.

This post is particularly good on empathy, privilege, and thinking your way into someone else’s situation. You can’t experience the same situation, every situation is different, yet you should be able to imagine theirs. Assuming what someone else felt or might have felt based on your own experience (or wanted experience) is the opposite of empathy.

Once as a resident I rolled by eyes when discussing a woman who was presenting for her third abortion. I mean really, I thought. She’d been sent home after both of her previous abortions with 4 months of free birth control pills and here she was just six months later. My attending, an older man, took me aside and reamed me for that display of privilege. I’ve never forgotten that. In fact, it prompted me to design a study to look at that very question, why do women have repeat abortions? Guess what it turns out is a big factor? Domestic violence. Though empathy may be too much of a stretch for Republican authoritarians concerned for their own moral rightness.

I checked whether she had anything on transgender. She mentions it in passing, but always in a friendly way. The agency tasked with enhancing the “health and well-being of Americans” now believes that certain religious beliefs are more important than health care. This could apply to contraception, abortion, vaccines, addiction medicine, sexually transmitted infection screening, and transgender care just to name a few… government planning will be all based on some non science ideas such as life begins at conception, pre marital sex is wrong, anything but marital sex between cis women and men is wrong. If we think too much about the hostile people it colours our view of humanity. Here is a woman working for the rights of women, who is positive about trans people, and uses our words such as “cis”.

Pressure to change sex

Scare story in the Daily Mail: NHS pressured our kids to change sex: Transgender backlash as desperate parents accuse overzealous therapists of ‘blindly accepting’ children’s claims to have been born in wrong bodyDoctors fear being sued after the NHS signed a ‘memorandum of understanding’ banning staff from challenging patients who believe they are born the wrong sex. YouTube, Instagram and Tumblr make trans cool, encourage teens to threaten suicide or self-harm if their parents oppose them, show where to find binders and hormones “and other sex change aids”, whatever those might be, and spark a social contagion. Adolescents are “heavily influenced” by messages they send to one another. NHS Scotland and NHS England have signed a Memorandum of Understanding banning staff from challenging patients who believe they are born the wrong sex. Doctors fear being sued, and a psychotherapist called Bob Withers cautioned that the memorandum could prevent therapists from exploring patients who say they are transgender but are suffering from other mental health conditions. He says it means the psychotherapist cannot look at the psychological reasons for the gender dysphoria.

So much for the Daily Mail. What is the truth? Here is the Memorandum. It commits the NHS and other bodies to ending conversion therapy, defined as the assumption that any gender identity is preferable to any other, leading to attempts to change or suppress gender identity or sexual orientation. Gender identity includes all binary, non-binary and gender fluid identities.

Personally I find non-binary and gender fluid identities preferable, as they give people more freedom. My identity as a TS liberated me to be myself, at the cost of undertaking the transition I understood an M-F TS would undertake. Non-binary or gender fluid permits maximum variation in gender expression without preventing any surgery or hormone treatment. It’s not “I am trans therefore I want hormones” but, given that I have this identity and these desires, might I want to transition, or to have medical treatment? What desirable or negative effects might that have? We move beyond one size fits all- I am TS, therefore I have hormones then surgery- because that is restrictive.

The memorandum goes on, gender identity is not a mental disorder; but people uncertain of their gender identity might seek psychological help. Some people may benefit from the challenge of psychotherapy and counselling to help them manage dysphoria and to clarify their sense of themselves. Clients make healthy choices when they understand themselves better. Withers and the Daily Mail are wrong: counselling for self-understanding is still possible.

There may be grounds for exploring therapeutic options to help people unhappy about their transgender status live more comfortably with it, reduce their distress and reach a greater degree of self-acceptance. So professionals may explore hormone or surgical treatment, within the guidelines for that. The real problem is that there is little funding for specialist assessment or mental health treatment. Adolescents get referred to the Tavistock clinic, whose waiting lists grow.

Joy and terror

If you are insane, you might as well roll with it. There is beauty in my insanity. I will love it, not fear it.

Something good happened to me on Wednesday. I have been thinking of my friends- if I become homeless, which of them might let me use a spare room? It would be unsatisfactory, and possibly only one might, possibly not him; no, I could not ask her, and certainly not her…

if I become homeless-

and there has been a reprieve. I am less likely to be made homeless, at least for the moment, I will continue to be able to pay rent, I may even find a job I could do and support myself. The benefits system is not uniformly hostile, sticks not carrots, withdraw money on a whim, but might be a little, inefficiently, more concerned with appearance than reality but a little- supportive. And the support might be enough to get me supporting myself again.

I sobbed without weeping. I read that this is contemptible and hypocritical, they pretend to cry, these horrible people, but really, they produce no tears so they are OBVIOUSLY TRYING IT ON. Well, that was a politician who had been caught out, clearly a bad person who the journalist reasonably despised, but still. Sobbing without weeping is Bad. Except I was doing it when alone, so no-one to fool but myself. The pressure and terror had been too ghastly to face head on, and now it was slightly less, a reprieve but not a release.

It is not quite as bad as I had thought.

I feel depressed, and I feel I lack energy. After doing a washing in the morning, often I want to do no more than just watch TV in the afternoon. Might the GP help? Well, having let me down badly twice from a combination of arrogance and ignorance, and in one exhibiting a lack of care which I felt indicated dislike, and possible contempt for me as a trans woman (nothing could ever be proved), my GP practice is the last place I would like to discuss depression and lack of energy. I feel all they could do is prescribe an antidepressant. I feel my depression arises from my difficult circumstances, and when I have been depressed before because of circumstances antidepressants have done no good. I feel my GP would be at best useless.

I sat in the Quaker meeting and felt my yielding softness. How hard it is to see it as a blessing, where Manliness and strength and decisiveness and leadership are praised, especially in men. It has felt that there is no room for my softness. I will give it space. This is what I need. I will give it to myself.

Three people ministered, well, I think, and at the end I had a sense of complete Joy and complete Terror, both at the same time. I have a strong will, high intelligence, and a heart full of Love, and the World I face is not as unremittingly hostile as it sometimes seems- it is beautiful, as well as implacable. Such strong, different emotions were hard to hold in, and I shook and gasped. And I had a strong sense of my loveableness and acceptableness- by God, by me- even possibly by the world. If I can accept myself, I can accept others.

I applied for a job, as usual screwing myself up to the sticking place to do it just before the closing date, and after feeling so het up I could not go to bed. It would be difficult. It might be possible, it might be the most wonderful thing in the World.

Transgender medical care

I am on several trans facebook groups. One is for activists, and discusses trans in the media. Another is a support group, and there are two strong themes there- how long the poster has to wait for my psychiatric referral, and how wonderful it is to have their operation at last. Often people give daily updates when they are in hospital: they are so happy! You would see your GP and say “I am trans.” You want NHS psychiatric referrals to confirm this, because that is the way to get hormones and surgery; anyone can change their name and clothes. You see a psychiatrist locally, who refers you to a specialist gender clinic. Before you see the gender clinic, you are certain of what you want. You are trans, and you need a medically supervised transition. Your friends online, and perhaps IRL too, tell you that is what they want and how wonderful it is finally to have it.

You have the idea transition is the answer to your problems, and then you join trans groups which confirm that. All you hear is confirmation, and the idea that true trans folk need Gender Confirmation Surgery is still strong even if we also hear that not all trans folk have it.

Problems with dilation come up now and again, but not enough to convince pre-op people that there are serious difficulties.

You see a psychiatrist and say you know you are trans, and have known this for years, or for all your life. Ideally that psychiatrist would explore with you- who are you, really? Why do you want this? What is it in you that you call “trans” or “female” or “feminine”? But you see them for an hour once every six months, and that is impossible in the time available. It needs a depth and direction of psychotherapy they are not equipped to offer, even if you were in a place to participate in it.

There are also psychiatrists who will see patients privately. Mine used hormones as a diagnostic tool: he would prescribe them to every patient who consulted him. He said fantasists would balk at taking them, and never come again. I feel desperate people would know that this was what they were supposed to do, and take the hormones.

I, being desperate, knew this was what I was supposed to want and took the hormones. If you transition, they help you pass.

I transitioned in April 2002 at work. I thought, even though I don’t know if in five years I will be trying to live as a man, I need to do this now. I did not want The Operation immediately. I found I wanted it more and more as time went on. I had it in February 2004. In Autumn 2003 I was depressed, and my GP gave me more and more Citalopram. In February I ceased being depressed, and remained not depressed though the GP steadily reduced the anti-depressant. I thought that was proof that the operation was right for me.

And now I say I was poisoned and mutilated, the operation is a sham, a con, we want it because of social pressure and minimal medical intervention confirms we can have it because we really want it. There is no place for a psychiatrist to probe beneath the desire for the operation, even if they wanted to. We resent the delay, and resent the “gatekeepers” who might stop us having the operation we want. I did.

This is the way to happiness and acceptance! I knew I was not a man, I repeatedly curled in a ball on the floor weeping “I am not a man, I am not a man, I am not a man, I am not….” At the Sibyls we talked of it. We knew transition was terribly difficult, and we might not make a go of it, but there was no question that it was the difficulty stopping me, not any doubt that “I am trans therefore transition including surgery is right for me”.

How could I refuse the way to happiness and acceptance? I knew I wanted it, at a time when I was unclear about wanting anything else.

The social pressure is still there. There are a variety of messages- here I read Gender non-conforming kids – such as boys who like dolls or girls who hate dresses – aren’t trans. Trans people feel a disconnect between the person they’re seen as and expected to be and the person they actually are. What neat boxes! Why should anyone imagine they really knew which box fitted them?

I was poisoned and mutilated. Transgender medical care did not protect me from that. It could not.

Self-discovery while presenting male would have been difficult. Transition without hormones would too. I would not have passed as well. The operation removed my depression, and meant I could swim and wear trousers comfortably. It was good for me, and so this second-best, good enough is so enduring. We know what we want, and are desperate to get it.

Gender Incongruence of Adolescence and Adulthood

Would you rather be diagnosed with “Gender Incongruence” than “Transsexualism”? The International Classification of Diseases, which is worldwide unlike DSM which is for the USA only, is being revised. It may influence the DSM. Rather than being classified as a “psychiatric disorder” GD, or GI, might be placed in a separate chapter for “Sexual and gender related health”.

How you frame a diagnosis affects what people think of it, and what you do about it. If it is a psychiatric diagnosis, is it merely that psychiatrists are most qualified to make it, or does it stigmatise you? I believe I am a woman, or at least I want to express myself as a woman, and perhaps alter my body. The medical help I want is hormones and surgery, and counselling support to manage that change successfully and comfortably. Together, these alleviate my distress. From the point of view of fourteen years after transition, I want people to have assessment to find whether anything underlies that distress and desire, and to explore less dramatic options for alleviating distress, but from the point of view of immediately before transition I had made up my mind, and would call that assessment “gatekeeping”, which is oppressive. We know what we need. Give it to us.

Should distress (or “dysphoria”) be part of the diagnostic criteria? Well, that is a way to take away stigma from sexual fetishes. Getting aroused by high heeled shoes or whatever is perfectly healthy, and not a diagnosis for a classification of diseases. Only distress might justify medical intervention- not to make the patient normal by taking away the desire or arousal, but to alleviate the distress. That is an imperfect analogy for us. Doctor, I am not distressed at all by wanting to transition, only by society’s norms that I should not, and because of how difficult it is. I am not mentally ill. Medical intervention is justified because I am gender incongruent.

Making distress irrelevant, and focussing on the need for hormones and surgery, makes other outcomes apart from transition seem less appropriate. Then I would have found that liberating; now I find it disturbing.

Is a psychiatric or other medical diagnosis a stigma? I don’t think diagnosis is more of a stigma than being trans itself is. Cis people realise doctors are involved: if they accept me, they accept that; and if they do not accept me, that makes it no worse. The diagnosis might reduce stigma- if I transition, people might think I was being unwise, but having a doctor go along with it might reassure them.

We experience discrimination. I don’t feel adjustment of the narratives we use to explain ourselves will alter that, much: I do my best. This is what I want to do. This is who I am is the necessary basic narrative- if you can’t say that, no narrative will reassure you except temporarily; if that does not let others empathise and accept you no other narrative will.

I am pleased that I suggested “incongruence” as a diagnosis in 2012, and that the ICD is now catching up. What I want for our kind is:

from society- acceptance, however we choose to dress or present
from doctors- discussion of all the options, understanding of all the pitfalls of “work male, play female” and support to do that if chosen; and making us take full responsibility for hormones and surgery so giving them to us if we ask. A Real Life Test- you can be rewarded by hormones and surgery if you express female for a year and Never Lapse- is completely the wrong answer. Instead we should be encouraged and supported to play and explore.

Medical treatment needs paid for. We need our medical treatment, including surgery, quite as much as any other person needs medical treatment. Single payers or insurers should pay for it.

marie-bracquemond-under-the-lamp

The doctors

What should we want from doctors?

In creating DSM V, experts distinguished unusual behaviour from distress arising from that behaviour. A paraphilia is only a disorder if it causes suffering for the patient. The distress arises from the disjunction of what the person desires, and what s/he thinks s/he should desire. Unfortunately, the distinction has not always been observed: it was thought the distress arose from the desire, so the treatment was to change the desire. That was the basis of my own aversion therapy in 1992: the psychologist offered me a choice, and could have sought to make me more comfortable with the desire, but instead sought to increase my disgust, and change my desire to other channels. Better to seek to change desire than squash it. But desiring women is compatible with cross-dressing.

The issue as I see it now is not fitting how “Men” are supposed to be. Cross-dressing, cross-dreaming or identification is a way of coping with that, symptom not cause. Sexual arousal is incidental.

The Danish Girl makes the doctors monsters. One points radioactive sources at Lili’s genitals because science, and because he has this expensive equipment which must be used for something. One calls her schizophrenic and wants to lock her up. One performs the first SRS under medical conditions, but then implants a womb so that she dies from organ rejection. The Franken-doctor’s reputation would have been so great had the operation succeeded!

Doctors want to fiddle around and do something rather than leave well alone. Or- doctors seek to make the person better able to cope with life, but don’t always see the best way to do that. Surgery is better than trying to make the trans woman more Manly.

Self-acceptance is the cure. We come to enjoy our coping strategies rather than being ashamed. They become less compulsive, less isolating. I don’t know whether this is in the air or I am just more aware of it. T-Central’s latest share is a review of a book along those lines. I would highly recommend retiring from gender to anyone who is feeling like the spectrum or the binary doesn’t fit. Many people look at me strangely when I tell them, but the decreased pressure of having to perform a gender makes up for all the misunderstandings.

Would anyone want surgery if it were not the path to being acceptable to the general public? I don’t know. Seeking to pass as a woman is seeking to fit in with gendered society. That means hormones and hair removal is a surrender, compromising being me in order to fit in. Of course, everyone compromises to fit in, from speaking differently at work and in the pub, to following fashions rather than creating them.

Norethisterone

Should I be taking norethisterone? It is synthetic progesterone, and (if the difference between the green pills and the white pills means what I think it means) I take it twelve days in every 28. Why should a trans woman take hormones, anyway? What good do they do?

My friend is a retired doctor, as is her husband. I wanted to discuss my emotional lability, and the possibility of a hormonal effect on that, with a friend before the psychiatrist in November. She thought her husband would be more up to date on endocrinology. I thought, oh, do I have to? Telling a friend is one thing, telling yet another person that I have never met-

I cycled by country roads, luckily picking the right private farm road, and entered their beautiful house. The garden is glorious. I meet this man, and really do not want to. We shake hands. Over lunch I admire the art work- this 4′ high fish is welded together of bicycle parts- and having sensed my discomfort she suggests he go out of the room, she could consult him if she really needs to: yet such was his gentle charm that now I would like him present.

The whole problem is life passing me by (does everyone think that, or only most of the people most of the time?) while I sit at home with little motivation and no felt ability to earn money to support myself. And I feel so lonely yet want to hide away. But the smaller problem, which might be addressed by hormone adjustment, is my emotional lability. I would like to discuss this with you without bursting into tears. I would like to discuss Quaker problems with an overseer without crying or getting angry.

He says, there is not always a medical solution, and one of the GP’s roles is to protect patients from specialists. An endocrinologist will seek a hormonal solution, a psychiatrist a psychiatric one. Mmm, sometimes leave well alone is the best answer. I started the norethisterone after the endocrinologist saw blood results, and after the psychiatrist suggested testosterone for motivation.

Godward, an Offering to VenusHe says, the point of norethisterone in HRT is that oestradiol alone risks cancer of the lining of the womb, and norethisterone clears it out reducing that risk. So there should be no need in me. Now, I wonder, what of motivation, did the specialist know something he did not? Or not? One of his patients on norethisterone had been quite unreasonable emotionally- he happened to see it, she admitted it- and on this sample size of one he was wary of it. Though proper peer reviewed studies may be no more reliable.

There you go. One possible thing worth trying. Not an answer, even though hormones affect mood: premenstrual syndrome is not merely a male chauvinist myth, and I feel, well, premenstrual. I could try and see if I felt more labile when taking the green pills.

We discussed my wider issues. On defences, he noticed that when I seemed to be coming to an important point, I would digress into a long story.

I feel valued. I feel cared for. It was lovely, talking of my stuff to sympathetic hearers for two hours.

 

Medical model

I was styled by SophieWhat do doctors do, exactly? They cure physical illness, but with disability it is more complex- they help patients conform to an ideal as well as possible. Synaesthesia seems at best a distraction, but many synaesthetes like their peculiarity and seek no cure. Messiaen used it in his music, producing colours only he could see but sounds many enjoy. Mental illness is cultural with medical responses: what level of boisterousness is classed as manic? Plastic surgery is given for preference, even where there is no physical or mental need of it.

Trans women could fit three separate categories here. I am a woman, so my deformed, enlarged clitoris is reduced, to look like any other woman’s. I am mentally ill, with the chronic delusion that I am female, so unusually the doctors help me conform to my delusion in the hope it will make me function better. Or I am well, but want to alter my body so should have plastic surgery if I want it.

I was styled by Sophie 1I say the sickness is in society and not in me. I am effeminate and unmasculine, and this is a bad thing- or at least I hear enough messages that it is bad, for me to be distressed at how feminine I am. You might think society is more accepting than that, but a friend recently expressed to me his distress at being thought unmanly. He thought the solution was to become more manly, rather than to find people who would accept him as he is- like the two of us who heard him, at that moment. Perhaps he will change, and see the solution as self-acceptance; and perhaps he will veer between these two paths, uncomfortable on both.

Whether I am a man or not, I am more comfortable dressed feminine calling myself Clare. If others were completely happy with feminine men, I would not need to, and perhaps never would have. I might have retained my gonads. This fashion blog, where I got the pictures, thinks that is OK now. I notice evidence otherwise.

We don’t fit in, so get sent to Doctors, who have to do something. How to alleviate distress? “Therapy” to make me more Manly does not exist, though some treatments might get me suppressing my nature, to my harm. I don’t think I am mentally ill, but within the normal range of feminine to masculine. Are there ways to thicken my skin, get me able to tolerate messages I should be more masculine, that I am wrong in some way? What we have in Britain is a path where those who persist in expressing ourselves female are allowed to have hormones and plastic surgery to help us better approximate a female appearance; or deal with the issues in our own way, without the treatments. In Iran, where homosexuality is seen as wicked but transition permitted, some people who would function as gay men here get gender reassignment.

I needed to accept my femininity. Without the cultural judgment that such femininity is womanly, a psychiatrist might have seen that self-acceptance was the way to alleviate my distress, without the need for transition.

But transition is the path the doctors prescribe. They like to do what all the other doctors do. That is the Hunter v Hanley test of medical negligence- did s/he do something different?

Big data

File:Google’s First Production Server.jpgWhether I should opt out from the NHS health data sharing scheme is an emotional not a rational decision. I opted out.

I see the point of it. GP and hospital records go to the Health and Social Care Information Centre in Leeds, where they may be analysed to see what health provision works best. “Free text”- what the GP notes about symptoms- would not be sent to HSCIC. Diagnoses, test results and prescriptions would be.

I thought the data would be used for research, but the “Clinical Practice Research Datalink” already gives information to researchers.

My email archive gives a complete record of me, in my real name. Someone has a record of all I have bought at the supermarket in the last three years, and is able to sell that information. My data is out there already. Then again, my GP said she wished they could opt out all their patients, rather than have us opt out individually. She has concerns about the data protection. I have concerns about large Government computer systems, which have made a mess of every new benefit for the last twenty years. But, mainly, I don’t trust them, so I opt out.

Mmm. Do Buzzfeed quizzes record your responses for advertising? What about personality tests?

——————–

I am lying in bed feeling powerlessness and terror, after two things on facebook which remind me of two separate-

I went to the GP to ask about counselling, as recommended by the psychiatrist, and my “while I’m here” was about breathlessness cycling. I have no crushing pain in the centre of my chest, I just get out of breath cycling where I had cycled quite happily last year. She said, well, exercise more, you have exercised less in the winter weather.

File:Charles De Wolf Brownell - Tree and Sailboat, Lyme, Connecticut.jpgSo, yesterday, this started a thought in me: my way is to withdraw. Cycling up that hill, get a bit breathless: stop cycling and moan about it. Then I thought, no, my way is to get the bit between my teeth and battle on despite multiple discouragements, to the end. Like then.
-But that was last century.
(Thoughts of reverting go through my mind. Don’t go there.)

One friend is dying of cancer, palliative care only, one will stay in hospital tonight for tests and fears cancer. Life is a slow tragedy with one end. So-

More exercise could do me good, spiritually: that moment minute or hour when I push on though I want to stop.

———————

-Too low for a racer, too high for a tourer, not much use to anyone really, said the man looking at my bicycle gears. In about 1988. I remembered it, and thought, I am the kind of person who remembers small slights for decades, and tortures herself with them. Then I thought, character revealed in one comment- why was he cycling Lands End to John O’Groats alone, again? Perfect memory for a writer. Being positive takes effort.

Am I the only one who sees others posting things like “stay away from drama and negativity” and worries it is all about me?

I have acquired a meditation stool. So I will still be uncomfortable, bored, distracted or confronted by bits of myself I don’t like in meditation, but my feet won’t go to sleep.

The geese form pairs and fly low, circling over the river, honking constantly, for the joys of Spring.

Breast screening

breast screening 1I had my breasts squeezed, pinched and photographed today.

Women aged 50-70 are invited for screening every three years, and some women aged 47-49 are invited as part of a study of screening older and younger women. I am an atypical subject for such a study, but, well, why not?

That was what the letter said, though the leaflet says something different: from 2012 the screening programme will be extended to women 47-73, this was decided in 2007 and is now being rolled out. Whatever.

How do I feel about medics touching me? My GP, who has a lovely manner, offered to show me how to examine myself, and I fled: the thought of taking my top off and being touched upset me. I stiffened- if she had touched my clothed arm it would have bothered me.

In 2003 Tim, my friendly Endocrinologist, referred me to a gynaecologist whom I saw three times. He was really really lovely. Just nice. I told him how uncomfortable and difficult I found dilation, and wept. I wanted to talk without crying but could not: I could get the words out if I sobbed in between. Then crying opened me: I could feel my hurt and talk, and he was gentle and understanding.

I saw a surgeon when I was considering implants. I thought I could just be examined, but felt shy when it came to it. He offered a female chaperone, and though I had thought I would not need this, I was glad of it. Sitting with my top off- I can’t respond quite as rationally as I might otherwise.

I cycled a mile to the mobile trailer at the outpatients’ clinic. A woman entered me on the system: hello, how are you? How are you? Oh, not many ladies ask that, I’m fine, she said. I sit in a breast screening 2cubicle where I was invited to take off my bra- indeed I would not like a communal waiting space. There are old magazines.

I go into the end room where the Mammographer asks me to take off my top, and shows me the machine. I remember Josie telling how her breast was squeezed between two cold metal plates- but that was last century, this machine uses plastic. Without intending, I go into a half-trance, so that she can place me as she wishes. I go quite passive. I do not want to make eye contact. She takes some time arranging me just so- it is worse, she says, when people try to cooperate. It pinches. It is uncomfortable, though no worse than seeing the dentist. I will get results, she says, in two weeks.

Some women will have treatment for a condition which would never have caused them problems. 3% of women will have the serious worry of needing further tests, but not needing treatment. Lives get saved by early diagnosis.

I asked if she could show me how to examine myself, but she is not trained to do so. I should ask my GP’s practice nurse. What a job, doing that all day.