CARNAL NATION

Many people hold a deep respect for my work as a gynecological teaching associate (GTA)—or at least they do once they find out what that means, exactly. GTAs are the women who use their bodies to guide medical students through pelvic exams. Often, we're on the receiving end of their first attempt to use a speculum or find a cervix. We like thinking that we're helping the medical field one vulva at a time. But unfortunately, just as our vulvas lay hidden under the drapes, our work is often hidden, downplayed and sometimes outright dismissed. Even our job titles are obscure; GTA sounds like a new competitor for Jet Blue! And if you try to avoid acronyms, you're still stuck having to spit out a mouthful. "Gynecological teaching associate" is a verbal hoodie, cloaking our purpose from the world.

Only healthy people will be ideal candidates for GTA work. This is not an easy job; to many people, pelvic exams, and especially the speculum part of the exam, is intense. This means that the women who offer themselves for this position, regardless of their history with sexual violence, have to be incredibly strong, mindful, and adept. To go through this exam time and time again, and still be able to give pointed feedback on approach and technique takes some strong ovaries.Lack of knowledge about our role in the medical community is far from our biggest problem. Sometimes the problems occur when others get past the concept of our job, and get into the nitty-gritty of the actual work. After being employed in a dozen different programs over the past five years, I've been awakened to the fact that some schools value their GTAs more than others. You can see it reflected in the way that they train us, in the way that the medical staff interacts with us and, yes, even in the paycheck that is delivered to us.

It's interesting to me how some individuals and institutions can demonize GTA work. They approach the concept like we're some dirty little secret to be discreetly talked about, or like we're corrupting, deflowering, and perverting their delicate, developing medical providers. Do I sound harsh? Sometimes I come across that way, but considering some of the stories gathered from my colleagues, you'll understand why.

"Why would a woman like you want to do this job? Were you raped or just abused?" This is a common question put forth to many a GTA. I can understand it from the general public, but when it comes from the mouth of a hospital office manager, well, it sounds like a value statement. But this incident highlights a common assumption in the field: that GTAs must be "damaged goods," because, clearly, no healthy person would willingly undertake this job.

On the contrary, only healthy people will be ideal candidates for GTA work. This is not an easy job; to many people, pelvic exams, and especially the speculum part of the exam, is intense. This means that the women who offer themselves for this position, regardless of their history with sexual violence, have to be incredibly strong, mindful, and adept. To go through this exam time and time again, and still be able to give pointed feedback on approach and technique takes some strong ovaries.

In another incident, a colleague of mine filed a report against an STD course instructor after a horrific practice exam took place. During the exam, the GTA's legs were forced open, the speculum was jammed in and when she indicated that she was in pain, the doctor informed the students that the "patient" was indeed not in pain. She acted as if it was her vulva being pried open, and not the GTA's! It's hard to believe that the instructor would be so cavalier in conducting the pelvic exam, but this isn't even the shocking part of the story.

No, the worst part is how the hospital responded to the complaint. Instead, of trying to figure out what when wrong in the program, the hospital administrator asked the GTA if she'd ever been raped. Hmmm..what does that imply? Are they trying to say that a woman who has been raped is "histrionic" (read: crazy)? Maybe they just meant that she must be "oversensitive" to the exam. Since one out of every four women has been the victim of sexual assault, I think that it would be in the best interest of hospitals to insure that their doctors are practicing techniques that are comforting, so that their one in four patients don't freak out in the future?

I'm sad to conclude this story with the fact that a new policy was enacted. Now, women who apply to work as GTAs at this particular hospital must be asked if they have ever been raped. And if the answer is yes? No job for them.

I shouldn't have to tell you that it's fundamentally wrong to inquire into a person's past sexual trauma, not to mention illegal. One cannot and should not discriminate against another person because of their history with sexual abuse. Secondly, the fact that she is "oversensitive" to flaws in technique could indeed make her a better educator. The doctors themselves call this an "invasive" exam; who better to train the next generation of doctors than someone who has already been invaded?

So the next time you run into your local GTA, instead of making assumptions as to why she entered the field, ask why she wanted to make the world safer for vaginas. I'll bet it will be a much better (and healthier) conversation.