Wednesday, October 10, 2012

Sexual Assault Survivors Don't Want to Go For Pelvic Exams...So I Don't Want To

I am a rape and incest survivor and a RN. I’ve helped with thousands of pelvic exams and hundreds of deliveries. To a nurse or health care provider, looking at female anatomy, or nether regions (or whatever you want to call your vulva, cervix, etc…) gives us as much of a thrill as looking at a set of  tonsils… boring. And here you thought your anatomy might be something special. WRONG . (I've even seen a woman with two uteruses... just what is the plural of uterus..oh well, double the amount to look at...darn more paper work and, yes, still boring).

The only thing exciting about a vaginal exam is when a baby is about to be born; frankly, it is all about checking on where that little one is at (nothing personal ladies … we want that kiddo out almost as much as you do... it is the paperwork... we nurses hate the paperwork).  However, for the incest or rape survivor a pelvic exam is a BIG DEAL. I know it is. I’ve put mine off my pelvic exam for over 10 years. This is not the healthy thing to do.

Why? If I know so much about pelvic exams, why did I put mine off? That’s a good question. It isn’t really about the health care providers. It is about trust. It is about trusting a stranger not to hurt me while I’m in a vulnerable position. I don't want foreign objects shoved into me. I don't want more than one person in the room. I sure as heck don't want student observers! It certainly isn't fear of the unknown, as I've helped with these exams. 

I’m still in therapy so I’ve talked about it to my therapist about the upcoming exam. 

Lucky therapist... I'm sure a male therapist just loves talking about gynecological exams...Any way, my therapist continues to remind me that this is my choice and I am in control. I shouldn’t let those who have hurt me in the past prevent me from staying healthy now.I'm also afraid that I'm going to have a flashback in the middle of the exam. To say that would not be good would be the understatement of the year. Well, I guess I'll have to tell the doctor to wear a football helmet in case I start pounding on her head. At least I have a month to figure out how to deal with in case of flashback issue. I think that is my primary worry at present.  However, I’m still worried about the exam that is coming up next month.

I decided to do some research online hoping to find a survivor that had a pelvic that was feeling the angst over the appointment that I am feeling now and survived her appointment. Luckily, I found one so I’ve re-posted her article here. I hope this helps you as it did me. I’ll let you know how mine goes after I have it mid-November.

Don’t forget, if you get your period to reschedule your exam.  If you have trouble figuring out when your period is due, use the period calculator to help you.


There are many online resources about pelvic exams, but they're not always reassuring. As a woman who was raped many years ago I went online to find reassurance, and what I read had the opposite effect. But I'm happy to say that the exam was fine, I didn't notice any discomfort, there was no pain and I felt respected. Here's how I prepared for it.
I should start off by saying that I went through successful therapy after being raped and I have a normal sex life. But the thought of getting a pelvic exam was horrifying. I dreaded the idea of trusting a stranger not to hurt me while I was in a position that doesn't inspire a sense of control. I cried every day during the week leading up to the appointment.
The key to a good pelvic exam is communication. The very first thing you should do when you schedule the exam is to let the people know you have been raped or assaulted. These people know damn well what this means, so don't be worried about being judged in any way. Telling them about your history will allow them to schedule in more time for you. You can use so that time to ask questions and relax, while they will have the time to be extra gentle and careful. When I arrived at the center I also reminded them again of my history. If you don't like to talk about it, then slip them a written note.
Try and figure out for yourself if there are any particular things you are worried or scared about. Is it the thought of pain? Are you scared of being in the vulnerable position? Are you afraid you are not in control and can't make the exam stop once it starts? These concerns will probably depend on your history and are rather personal, so only you can try to determine what prospect scared you the most.
Don't let the exam begin until you raise these issues with your physician and talk about it. I decided that I would not get into the chair and be in a vulnerable position until I felt confident that the physician understood me. For me there were two major concerns: pain, and the fear that the physician wouldn't stop when I told them to. I wrote my concerns down on paper so that I wouldn't forget if I panicked.
To minimalize the possibility of pain I decided that for every stage the physician should use lubricant — no lube, no exam. There is no medical reason lubricant cannot be used. Lube is standard in some health centers but not all, so ask for it if this worries you. There are also differently sized speculums, so ask for a smaller size if you think you need it.
The most loaded question emotionally was whether the physician would stop when I asked her to. I didn't like to ask or think about such a situation. I'm happy I did ask though, because her answer was brilliant. She answered that I was in total control and she would stop as soon as I asked her to. She said the position might not feel empowering, but that if I said stop she would listen immediately and the exam would end.
Another concern I had was the chair, especially the stirrups. I asked the physician whether I had to use them. She told me I didn't have to, but it would help me achieve a comfortable position that would make her job easier, and the examination more comfortable for me. I translated ‘more comfortable' as ‘less chance of pain,' and I was still more worried about the pain than the weird position. I was sure she would stop the exam when I asked her, so I decided I was okay with the stirrups. If they would mean less discomfort I'd happily use them. She also told me how to sit in the chair, and where I held tension. Next time I will definitely ask the physician how to lay down/sit well. She also told me what she was about to do, before she actually did it. This felt very empowering for me and next time I will ask my physician to do the same.
If you have a physician who doesn't address your concerns, which seems to rush you and doesn't seem to work with you, then find another physician. There will be plenty who will understand that with a history of assault you may need a bit more time and you will have concerns specific to you, and they will be happy to reassure you. Because I told them about my history and how nervous I was, they took precautions to make me feel more in control and less scared even without me asking. For instance, they also covered up the whole stack of speculums.
So what did I actually feel during the exam? Very little I didn't feel poked or prodded. The only poking they do is on your stomach at one point and that just feels silly. The first part of the exam uses a speculum. They come in various sized because every woman is different. Remember, you can ask your physician to start out with a smaller sized one. I didn't feel a thing when the physician placed the speculum inside me. It was a little cold, but that was all. When folded these things are TINY, smaller in width than a finger or a sextoy. The speculum does open, but not very far. When I finally sensed something going on, it was already over. I heard a metal sound and that was it. It was a split second between ‘hey I actually feel something' and ‘oh it’s gone and now she tells me it's placed.'
When the exam reaches this stage they will take cells from your cervix. The physician said I might feel something like a menstrual cramp. I would describe it as a twinge — seriously, just a twinge. It's a little strange, like butterflies in your stomach, but not painful nor uncomfortable.
After the speculum adventure it's time for the bimanual exam where they use their fingers. Again, thanks to lubricant and the professional aim and angle of the physician, I did not notice much. No pain, no discomfort. The only part I noticed was when she pushed my stomach, three short pushes. I just looked puzzled, wondering if that was it. If you do feel pain, you should let your physician know. You are there for a health check, so if you feel pain you should tell them. For me this was the last part of the exam. The whole thing was comfortable and respectful, which is what everyone deserves. Remember, if your physician is not sympathetic to your needs, don't do the exam. Don't convince yourself to try it if you don't trust your physician. Find another one who will help you safeguard your health — physical and mental.

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