In "The Cost of Silence," we learn about the mental and physical effects of invasive pelvic exams. Find out the long-term effects and how you can help the survivors.
traumatic pelvic exams

Traumatic Pelvic Exams

Medical appointments can be stressful for people who have survived sexual assault or other types of trauma, particularly if they are worried that they will have to undergo a pelvic exam. Patients who have disclosed to me that they have been the victims of sexual assault have admitted to me, in the capacity of an obstetrician and gynecologist, that they have avoided or delayed obtaining medical care due to their concerns about pelvic exams. Pelvic exams and trips to the gynecologist can be uncomfortable or painful for women even if they do not have a history of sexual abuse; nevertheless, for women who have experienced sexual abuse, these experiences can be intolerable.

According to the statistics, one out of every three women has been the victim of sexual assault at some point in their life. Women were given the confidence to speak up about their experiences as a result of the #MeToo campaign. The conversations that the movement sparked connected us to individuals rather than merely to a number, gently altering how our culture thinks about and reacts to sexual assault and harassment. A user on social media is given a heads-up before viewing potentially upsetting content if they see the hashtag #triggerwarning. On the other hand, relatively little attention has been paid to how trauma and health care overlap.

Is Post-Traumatic Stress Disorder (PTSD) Re-Traumatized by Pelvic Exam?

Pelvic exams are a routine part of women’s healthcare, but for some women, they can be traumatic and trigger symptoms of post-traumatic stress disorder (PTSD). PTSD is a mental health condition that can develop after experiencing or witnessing a traumatic event. In the case of a traumatic pelvic exam, a woman may feel as though she is being re-traumatized, which can have significant negative impacts on her mental and physical health.

Trauma can occur during a pelvic exam when a woman feels violated or powerless. This can be due to several reasons, such as a lack of communication from the healthcare provider, feeling rushed, or being in a vulnerable position with no control over the situation. The experience of a traumatic pelvic exam can be further compounded if the woman has a history of sexual trauma or abuse.

Symptoms of PTSD can include intrusive thoughts or memories, avoidance behaviors, negative moods and feelings, and hyperarousal. For a woman who has experienced a traumatic pelvic exam, these symptoms can be triggered by subsequent exams or even the thought of an exam. This can lead to a fear of seeking medical care and potentially impact her overall health and well-being.

To address the impact of traumatic pelvic exams on women, healthcare providers need to be aware of the potential for trauma and take steps to prevent re-traumatization. This can include ensuring clear communication and consent throughout the exam, providing information about what to expect, and allowing the woman to have control over the situation as much as possible.

What Do the Findings of the Research Suggest?

According to several studies, survivors of sexual assault experience significantly higher levels of anxiety when compared to the overall population. They may also be suffering from post-traumatic stress disorder (PTSD), which can cause them to feel as though a pelvic exam is causing them to go through the traumatic experience all over again. It may feel impossible to take the first step toward proceeding with a gynecologist examination or pelvic exam; nevertheless, there are ways in which patients and healthcare providers can approach this visit to make it feel comfortable for survivors.

In a study that was published in Obstetrics and Gynecology, the participants were female survivors of sexual assault who were pregnant at the time of the study. The researchers investigated what assisted these women both during their pregnancies and while they were giving birth. Several ladies expressed a desire to share their sexual assault and abuse experiences with the medical professionals who were treating them. They were concerned about who would be in the delivery room with the patient when the baby was being born, so they asked who would be there. In addition, they desired the ability to control the amount of their body that was revealed, whether it be a lot or a little.

traumatic-pelvic-exams

How Do You Approach the Subject of Trauma with Your Primary Care Physician?

Communication between a physician and patient is essential, but it is more important in situations where the patient has a history of traumatic events. When they come to the clinic, doctors want their patients to have the confidence to share their backgrounds with them, but I never want them to feel obligated to go into specifics or provide information. Even if it requires more than one appointment, they have the option of forming a relationship with the medical professional before undergoing a pelvic check. They can control the pace of the pelvic exam and can let them know if they are feeling overwhelmed or need a break.

As a patient, it can feel difficult to ask this much, but as a physician specializing in women’s health, one way that I can address a woman’s anxiety about a pelvic exam is by giving her control over the exam and her body. This is one of the ways that I can address a woman’s anxiety about a pelvic exam. When patients share their worries with me, I take it very seriously. I always reassure patients, particularly those who have a history of sexual abuse, that they have control over their bodies and the exam, and that office is a safe space for them to be in. This is something that I say to all of patients, but especially to those who have experienced sexual abuse in the past.

The Study of Traumatic Pelvic Exams

In a recent study published in the Journal of Trauma-Informed Care, researchers conducted a comprehensive investigation into the experiences of women who have survived sexual assault and their interactions with healthcare providers during pelvic exams. The study involved interviews with a diverse group of survivors to better understand the challenges and concerns they face when seeking medical care, particularly related to pelvic exams. The findings revealed that many survivors had significant anxiety about the prospect of undergoing pelvic exams due to their traumatic experiences. They expressed a strong desire for better communication, informed consent, and control over the exam process. Additionally, the study highlighted the importance of creating a safe and supportive environment for survivors to receive the care they need without re-traumatization. The research sheds light on the need for trauma-informed care in the medical field and the importance of addressing the unique needs of survivors during pelvic exams.

Are You Unsure About What to Say?

You may be stumped for words right now. There are a variety of methods in which people can launch the discourse. Here are some suggestions that could be of assistance:

You may begin by saying something like, “I get anxious whenever I have to go to the doctor.”

You could say a few words about the things that make you uncomfortable, such as being touched, having to undress, or having a pelvic exam.

You have the option to choose how much detail to provide. “I’ve experienced sexual assault. Nonetheless, I’d rather not go into the specifics of it at this time.”

You can even choose to be ambiguous, such as saying, “Because of my past, pelvic exams are tough for me.”

You are welcome to discuss any thoughts that come to mind regarding how to make you feel more at ease during a pelvic exam or any other type of medical checkup. If there is anything else that has been of use to you, please share it. “It could be helpful if you explained the steps before you did them. I hope that if I start to feel overwhelmed, you are willing to continue slowly, stop for a break, or even stop the exam altogether.”

If you are a survivor of sexual violence, I strongly encourage you to have honest conversations with the people who take care of your health. If you are a provider, be sure to pay close attention and do all in your power to establish a secure environment in which women may receive the treatment they require without having to make concessions.

Healthy Turkiye Notes

For women who have experienced a traumatic pelvic exam and are experiencing symptoms of PTSD, it is important to seek support from a healthcare provider or mental health professional. This can include talking about the trauma and finding coping strategies that work for the individual, such as mindfulness or cognitive-behavioral therapy. It is also important to know that it is okay to set boundaries and advocate for oneself during future exams.

Healthcare providers can take steps to prevent re-traumatization by practicing clear communication and informed consent throughout the exam, allowing the woman to have control over the situation as much as possible, and providing resources for trauma-informed care. Providers should also be aware of the potential for trauma and take steps to address it if necessary, such as offering support and referrals to mental health professionals.

In addition, healthcare providers can work to create a safe and supportive environment for all patients, regardless of their past experiences. This can include providing education about what to expect during a pelvic exam, encouraging questions and open communication, and being sensitive to the individual’s needs and preferences.

Overall, both women and healthcare providers need to be aware of the potential for trauma during a pelvic exam and take steps to prevent re-traumatization. Seeking support and resources can help women cope with the impact of trauma, while healthcare providers can offer trauma-informed care and create a safe and supportive environment for all patients. Together, we can work towards a healthcare system that prioritizes the well-being and dignity of all individuals.