Medical Fatphobia – The Ob/Gyn Should Not Be A BYOS (Bring Your Own Speculum) Party

I don't want to hear another word about how fat people have poorer health outcomes until fat people have equal access competent, stigma-free careI talk a lot about medical fatphobia (because medical fatphobia literally kills fat people,) and I’ve now heard from several super fat people who went for their annual visit to the gynecologist only to be told that the gynecologist doesn’t have the proper size speculum. In most cases, the person was just told outright that they couldn’t be helped (prompting them to e-mail me to see if I knew of any options.) But in one case the patient was told that specula that would work existed, and that if the patient wanted to buy one (the doctor suggested they could bring it in for an exam. Then the doctor refused to refund their co-pay, since they “shouldn’t have expected” that they could be accommodated. With a speculum. At the gynecologist. For a pre-scheduled pap smear.

This is such blatant and disgusting fatphobia that I can hardly put my rage into words. It’s not just specula – thought that feels like a particularly awful aberration since going to the gynecologist is such a stressful situation to begin with, and putting off the visit can mean missing/postponing a cancer diagnosis. But it’s also blood pressure cuffs, knee braces, higher weight capacity beds and chairs, longer needles for vaccinations and other procedures, and on and on and on.

In some cases the needed medical equipment doesn’t exist – larger size knee braces, for example, may need to be custom made. And that’ s completely unacceptable since it is a known fact that fat people do both exist, and have knees.

But in many cases, the items absolutely exist but the healthcare facility has simply chosen not to bother to provide competent care to fat patients. This is, obviously, inconsistent with any belief in “doing no harm” or anything resembling a community health practice.

Plenty of fat patients have been forced to participate in humiliating weigh-ins under the guise of it being “medically necessary” (spoiler alert: It’s almost never medically necessary) only to find that their healthcare practitioner cant’ even take a correct blood pressure because they haven’t bothered to spring for the properly sized cuff (which I found for $30 online from a medical supply company, and $12 on ebay.)

Size discrimination by medical facilities should not be allowed. Patients of all sizes should be able to sit and lie down as necessary for the care. They should be able to get an accurate blood pressure reading – something that is as basic as basic gets when it comes to medical care. Not bothering to have appropriately sized needles shouldn’t be a barrier to vaccination. A visit to the gynecologist should not be a BYOS party.

I don’t want to hear another damn word about how fat people have poorer health outcomes until fat people have equal access to competent, stigma-free care (and of course this is compounded for those who are subject to other oppression and bigotry in healthcare including racism, transphobia, homophobia, and misogyny.)

Fat patients deserve the same care that thinner patients get, there is absolutely no justification for anything less.

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14 thoughts on “Medical Fatphobia – The Ob/Gyn Should Not Be A BYOS (Bring Your Own Speculum) Party

  1. What a shameful display of unprofessional behavior by individuals that call themselves professionals. This article made me both angry but also sad. As far as poor health outcomes for fat people versus thin people, most of my observations for the 38 years I spent in the health industry, the majority of people with cancer and those in need of open heart surgery were “average” size or a bit larger. Just say in..🤔

  2. You know, I have had all those experiences at doctor appointments. I get the “Wrong size cuff…” every time, except the one time the chirpy nurse told me I was “almost in the regular size cuff..” Meaning my supposed weight loss efforts were paying off and I was almost small enough to fit a “normal cuff”. I didn’t say anything, I don’t care.
    They weigh me, and everybody else , every time you come in, even if you were in yesterday. I get up on the scale, while the nurse bemoans having to use to the thing at all, I don’t care, sometimes I even keep my water bottle in my hand. Last time I was excited because I was at 400, exactly. Whoo hoo! How often does that happen? Cool. Nurse probably has no idea what I meant…
    Whatever, I don’t care. I am almost fifty, I have been considered -obese-overweight-fat-chubby-heavy set-porky-vertically challenged-chunk style since I was five. It has always been an issue in the world I know. You think it might go away, not be an issue, be a non-issue until it is again. I’ve been spit on, beaten up, insulted by close family members and total strangers, I have dieted and exercised, but never to the point of OCD-life style change terms. I eat cake when I feel like it, I don’t like being overly full, I can’t eat when I am depressed, I like nice clothes, swimming and taking walks. I have low-blood pressure, low cholesterol and low blood sugar numbers, they’ve checked, to their continued annoyance.
    I survived junior high school. I am tentatively hopeful that this latest surge in the “I’m OK you’re OK” movement really takes, and that I can expect to be treated “like everybody else”. But I won’t hold my breath. I imagine I’ll be weighed every time I go to the doctor. I imagine I won’t care. I only really feel fat, unhealthily fat when I am sore from over doing something and have reach issues. Not very often. I don’t doubt my life would be a lot easier if I were thin. Rich would help too, but that isn’t my life.
    I don’t know, maybe they won’t weigh me one day, seeing fat as not medically significant. I won’t hold my breath. If people need to tie moral beliefs to visible physical characteristics, buttress up their own self-esteem, keep the fear of their own mortality at bay and what ever else condemning judgements serve for people they will continue to see me as a fat bitch, with all that little term contains…sickness and death, sickness and death, and for men rejection of them sexually.
    I don’t know. It is so common, so inevitable in a medical setting. Maybe it’s not that I “don’t care”, so much as I expect nothing else. Kind of sad that. To come to expect disrespect and blanket assumptions about yourself from others, “and even those in the medical field”. That is a group I least expect to be body positive, the whole history of medicine is pathologizing the body to make them the body saviors when they isolate and cure its ills. To most doctors and nurses a fat body is the template for all bodily ills. A biological magnet for every human “failing” from diabetes to cancer to heart disease to mental illness to poor choices to self-hatred to anti-social tendencies.
    I don’t know. Maybe things will find new perspective in this age of COVID-19…
    Stay home, stay well, lets hope they don’t find a way to tie this to adipose tissue as well….

  3. I had a very difficult time getting a transport to take my husband to the nursing home to die. Because his cancer had gone to his liver, he gained about 50 lbs of fluid back in the few days before he was to transfer. (Won’t even start on the rage I had because health care providers kept congratulating him on the 100 lbs cancer had taken off him!) SO that put him over the cutoff for being able to go on a “normal” gurney and doubled the crew they thought should move him. It took three separate tries to actually get him on a transport. Then there was a surcharge that more than doubled the fee.

    1. I’m so sorry for your loss, too. And just when you most need comfort, they piled on, as if you were not human beings, facing the worst thing in life.

  4. Reading your post made my blood boil. The speculum-size claim is pure bullshit. It is completely unconscionable. Providing medical equipment for ALL their patients IS THEIR FUCKING JOB. If we can buy specula on Amazon, why the fuck can’t they do so?! I hope the patient reported those assholes to their county’s human rights commission and/or medical licensing board.

    In the 90s I worked at an independent abortion and reproductive medicine clinic. We routinely saw women in excess of 400 pounds. We never had difficulty stocking and using appropriately-sized specula, blood pressure cuffs, etc. Our regular staff never shamed anybody for any reason. However, some physicians (all but 3 of our physicians were independent contractors, not regular clinic employees) insulted patients behind the scenes, such as when the docs were in the break room or medical center. One skinny male physician wondered rhetorically, “how did a woman that fat get pregnant?” I was astonished. “The usual way!” I snapped at him. He looked away and did not reply. Most of our docs, however, who had been with us for many years, were wonderful, caring people.

    Yeah, a lot of physicians are bigots. Their inflated egos don’t improve their dispositions either.

    If anyone needs size-competent and stigma-free gynecological care, go to your local Planned Parenthood. They respect size diversity. Full disclosure: I volunteer for Planned Parenthood.

    1. It’s a way to humiliate and dehumanize a woman to shame her into weight loss. Yeah, the lifetime of abuse hasn’t quite sunk in. Denied friendships, missing lovers and spouses, insulting TV ads, nudge nudge snark snark family members, fewer employment opportunities, less pay, more hassle, what they really need in a god like authority in a position of power over life and death (in some cases) to be chiding, insulting and dismissive to really hammer it home. Lose Weight Now! I’ve Told You How!
      I have been at the same teaching hospital clinic for twenty years, I have only seen the extra large BP cuff twice. Maybe I should BYO?

      You know what was really fun, getting an internal scan through my vagina, conducted by two giggly girls who looked to be about 18. “Can you get up on the cushion?” “Yes.” Squish, push, smile… Never did get the results. You just get used to being treated like shit… What a terrible thought.

      1. “It’s a way to humiliate and dehumanize a woman to shame her into weight loss …You just get used to being treated like shit… What a terrible thought.”

        That’s possibly the worst part of it, the expectation of being treated like shit. I wish everybody were confident and outraged when they visit a medical provider. Now I expect competent and professional care and attitudes when I see a doctor. I let them know if I don’t receive it. I do my homework before my appointments. I ask a lot of questions and request thoughtful answers.

        And if any yahoo has the balls/ovaries/whatever to comment on my body, they’re going to get an earful from me.

        Frankly, I don’t take shit from anybody anymore. Nobody should have to.

        (BTW, I’ve also had a transvaginal ultrasound. Talk about invasive! My tech was mature and professional throughout. I asked a lot of questions and she answered them honestly. It turned out that she attended the same college at which I used to teach. We were probably there at the same time. And yes, I’ve had a giggly-girl x-ray tech a few times. Ugh.)

        1. That’s what it was! Transvaginal, I was blocking it out! Not as bad as the, not sure that one, was a tissue sample, from cervix I believe, very painful (incest survivor) and the “kid” doing it, his first felt so bad, me on a table, over seeing doc, three nurses, stirrups, he felt so bad, when he came back to do the post-consult, he cried. He felt so bad.
          Sometimes I get the idea the male docs are more careful, while some of the women docs can be brutal, like “Well we’ve all got the same bits so!”
          Somehow, I think classism is involved too. If I had money, went to regular GPs I think I’d have a different experience than my indigent fat woman status permits. ?

          1. HE CRIED?! Wow. It seems as though you had to take care of him. And you had quite an audience. You may have had a biopsy or a colposcopy.

            Classism is always involved. The income disparity between physician and patient is profound. I too am poor; I grew up poor, attended college and grad school poor, and am poor now. I have always felt extremely self-conscious and ashamed about it. People tend to be highly critical of poor folks, at least in the US (I don’t know where you’re located.) Non-poor people often blame us for our poverty, as though we somehow deserve it even though the system is stacked against us.

            Again, I highly recommend Planned Parenthood. They accept insurance and have a sliding scale.

  5. Kittehs? I just got Aggie in Sept. Rescue from Phoenix. We’re in Spokane, Wa. She came in with a rescue flight, guy with a small plane goes and gets stray animals and brings them to no kill shelters.

  6. Congratulations on your new kitteh! May you both have many happy years together.


  7. I am sadly never surprised at the depth of cruelty from sadistic fatphobic medical “professionals”. I’ve heard that the two professions with the highest rates of sociopathy are police officers and body officers, ie “doctors”. The latter are appropriately named, as they are more likely to try to manipulate your body (doctoring) to their own ends ($$$$) than to heal you. I do have a question, though. Why would fat women need a larger speculum? The size/shape of one’s internal reproductive organs has no correlation with weight; what about a fat queer woman who hates penetration and therefore does not engage in it under any circumstances such that shewould sooner get a tooth pulled without novocaine than be on the business end of even a tampon?

    I have quite a few bones to pick with “gynecology” as a whole, but I’ll limit myself to one tame critique: If doctors who doctor around with men’s junk are called “urologists” not “andrologists”, then why do we call those who doctor women’s reproductive organs known as “gynecologists”? Simple, because in this shit culture women are seen as either breathing penis holes/baby ovens or worthless wastes of space. Fat women–among others–are doubly punished.

    (Btw, ever met a female urologist? Me neither.)

    I’d imagine that whatever benefit of getting all of these annual intrusive exams exist, they are cancelled out by all the health-destroying anxiety, pain, despair, humiliation, and even potential PTSD that they cause.

    P.S. To the woman who lost her husband to liver cancer, I am so, so, angry and sad at what you both had to endure. I hope against odds that there is some sort of justice in some form, and that karma or hell or something bites those doctors hard while you and your husband are reunited in a kinder, happier dimension.

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