When a pelvic exam is traumatic

If you happen to’re a survivor of sexual assault or trauma, medical visits could heighten anxiousness, notably in the event you’re involved {that a} pelvic examination will probably be carried out. As an obstetrician-gynecologist, I’ve had sufferers who skilled sexual assault confess that they’ve prevented or delayed searching for medical care as a result of their anxiousness surrounding pelvic exams. Even for girls with out a historical past of sexual trauma, pelvic exams and a go to to the gynecologist could also be embarrassing or painful; for girls with a historical past of sexual trauma, it may be insufferable.

Statistics inform us that considered one of out of each three ladies has skilled sexual violence. The #MeToo motion empowered ladies to talk out about their experiences. Discussions engendered by the motion linked us to folks moderately than simply to a quantity, subtly shifting how we as a society take into consideration and course of sexual violence. On social media, the hashtag #triggerwarning alerts viewers to probably disturbing info. Nonetheless, little dialogue has centered on the intersection of trauma and well being care.

What does analysis inform us?

Research have discovered that survivors of sexual assault have greater charges of hysteria in comparison with the overall inhabitants. They might even be affected by post-traumatic stress dysfunction (PTSD), which might make them really feel as if they’re being re-traumatized by a pelvic examination. Whereas taking the preliminary step to proceed with a gynecologic go to or pelvic examination could really feel insurmountable, there are methods that well being care suppliers and sufferers can strategy this go to to make it really feel secure for survivors.

A examine revealed in Obstetrics & Gynecology centered on survivors of sexual assault who had been pregnant and analyzed what helped them all through the being pregnant and in the course of the time of supply. These ladies needed their well being care suppliers to find out about their historical past of sexual trauma. On the time of supply, they needed to know who can be current within the labor and supply room. They usually needed to have the ability to management how a lot or how little of their our bodies they uncovered.

How will you discuss to your physician about trauma?

Communication is essential to the physician-patient relationship, particularly when a affected person has a historical past of trauma. In my apply, I would like my sufferers to really feel empowered to tell me of their historical past, with out ever feeling the necessity to delve into specifics or particulars. They’ll select to ascertain rapport previous to present process a pelvic examination, even when that necessitates a number of visits. They’ll dictate the tempo of the pelvic examination and inform me in the event that they want a break or really feel overwhelmed.

Because the affected person, it will probably really feel tough to ask this a lot, however as a ladies’s well being doctor, a method wherein I can tackle a girl’s anxiousness a couple of pelvic examination is by giving her management over the examination and over her physique. I recognize it when sufferers voice their issues. I all the time inform my sufferers, notably these with a historical past of sexual trauma, that they’ve management over their our bodies and the examination, and that my workplace is a secure area for them.

Questioning what to say?

Possibly you’re questioning what to say. Folks could begin the dialog in several methods. Listed here are some concepts that will assist:

  • You would possibly begin by saying, “I really feel anxious once I come to the physician.”
  • You might say a couple of phrases about what worries you: being touched, needing to undress, having a pelvic examination.
  • You’ll be able to select how a lot to clarify. “I’ve skilled sexual assault. I’d moderately not discuss concerning the particulars, although.”
  • You’ll be able to even maintain it imprecise: “Pelvic exams are tough for me due to my historical past.”
  • You’ll be able to share any concepts you have got about methods to make you snug throughout a pelvic examination or any medical examination. Please additionally share something that you just’ve discovered useful. “It’d assist in the event you clarify steps earlier than doing them. I hope you’re keen to go slowly, cease for a break, and even cease the examination if I begin feeling overwhelmed.”

If you happen to’re a survivor of sexual violence, I encourage you to brazenly talk together with your well being care suppliers. If you happen to’re a supplier, pay attention rigorously and do all you’ll be able to to create a secure area that permits ladies to acquire the care that they want with out compromise.


Boston Space Rape Disaster Middle has a cellphone (800-841-8371) or internet chat hotline and presents a variety of assets to folks within the higher Boston space.

The Nationwide Sexual Violence Useful resource Middle has an inventory of teams that provide on-line help for sexual violence survivors.

RAINN presents info on recovering from sexual violence, a nationwide hotline (800-656-4673), and entry to native assets.

The Voices and Faces Challenge hosts writing workshops for individuals who have skilled gender-based violence referred to as The Tales We Inform.

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