Navigating Sexual Health Appointments After Assault
Esther Holmes | 20 May 2023 | WWYW Articles
As a survivor of sexual assault, pelvic exams terrify me.
Let’s be honest, for those of us who have a vagina and a cervix, a pap smear, or cervical screening test is not the most pleasant of experiences.
For many survivors, having another person examine sites where sexual trauma occurred is a traumatic experience. In some cases, this will be within the first hours, or days of the assault.
For others, it could be after a much longer period of time has passed.
There is no limit of time, or number of exams you can have, that will make this easier (unfortunately, the saying “time heals all” does not take PTSD into consideration).
Below, I will draw upon my own experiences to discuss how I, a person with a vagina, who has undergone IVF and given birth twice, have learned to navigate my trauma within the medical system.
I want to preface this by saying I am not an expert, I do not have training in the psychiatric field, and these are just my personal experiences and ways of dealing with these situations. At the end of this article, I have listed the numbers of professional services that can provide you with support.
In the medical landscape, there are a number of people who at times, will request to look at, or touch, your genitalia. In Australia however, there are currently no specific lists, or standards to direct you to a trauma-informed care provider.[1]
While all health professionals cover basic trauma care in their training, understanding the impact of trauma, and how it affects all aspects of daily life, both long and short term requires further professional development. [2]
Not all healthcare professionals have or are willing to obtain this extra training.[3]
So what does It mean for you?
Disclosing your sexual trauma can be difficult. We are not always ready, safe, or comfortable divulging our trauma to others. However, in the context of sexual health appointments, I feel that it is a necessity.
My experience with sexual assault has been one I have shared with my health care providers (GP, fertility specialist, midwives and obstetricians).
Choosing when, and how much information you share is completely up to you.
I choose to talk about it at the very start of my appointments.
I tell them my triggers, my boundaries and what I need.
“I need a female to be performing the exam, I need a chaperone and I need to be conscious the whole time.”
This communication can be verbal, written, or you can have someone you trust communicate it for you.
When, how, and how much you divulge is your choice.
Knowing, and being aware of your rights is also important.
You have the right to:
● Request the gender of the provider, or person conducting the exam. [4]
● Have a say over who is in the room. If you are not comfortable with someone’s presence, you can request they leave. You can also request a support person or chaperone, this can be a friend, family member or another staff member.[5]
● Ask the provider or person doing the exam any relevant questions.[6]
● Ask the person doing the exam exactly what will happen before, and during the exam.[7]
● Ask the person doing the exam to slow down or stop at any point in time. [8]
● Refuse having an exam. [9]
Your healthcare team should always make you aware of these rights in addition to respecting and supporting all the decisions you make.[10]
In terms of the nature of pelvic examinations themselves, I have found that knowing what to expect is something that is very useful in learning how to navigate trauma within the medical system.
A typical pelvic exam will consist of four main exams. These will be discussed each in turn below:
External genital exam:
The external genital exam involves the provider visually examining your vulva and labia for abnormalities and STDs.[11]
Speculum exam:
The speculum exam involves the provider inserting a lubricated speculum into your vagina to separate the walls of the vagina, allowing them to examine your cervix for atypical discharge, lesions, or STDs. [12]
Pap smear:
The pap test follows the speculum exam (with the speculum still inserted in the vagina) and involves the provider taking a sample of cervical cells to screen for cancerous and precancerous cells in the cervix.[13]
Bimanual exam:
After the pap test is the bimanual exam which involves the provider inserting a gloved, and lubricated finger into the vagina while pressing down on the low pelvis with their other hand to check the size of your ovaries and uterus and check for painful areas.[14]
Remember, if at any point you become uncomfortable, or want the exam to stop - tell your provider.
Make sure to ask questions and voice any concerns with your provider. You can write these down, have them on your phone, or have your support person talk for you.
If you would feel more comfortable keeping your socks or a skirt/dress on during your exam, feel free to tell your provider that. You can also ask for a sheet or towel to be draped over your legs.
There are also multiple possible positions you can be in for many portions of the exam, so be sure to choose which you feel most comfortable in — not the position your provider is most comfortable in.
Again, communicate how you feel the most safe.
You can change your mind or change positions any number of times you need.
Staying present or grounded during the exam is also helpful.
If you’re unable to stay present or experience a flash back - communicate this with your provider.
You can ask them to stop, slow down, or give you a moment.
There are different grounding techniques that work for different people, such as deep breathing, meditation, listening to music, or talking to your support person.
There is no right way, or wrong way to have a pelvic exam after an assault.
Sometimes it may be easier, other times it may be harder.
Be kind and gentle to yourself, you are a survivor.
If you or someone you know is struggling and in need of support, please reach out to 18000 Respect on this number:
1800 737 732.
Additional Professional Services:
>NSW Health Sexual Assault Services
Local support numbers available at this website: <https://www.health.nsw.gov.au/parvan/sexualassault/Pages/health-sas-services.aspx>
>ReachOut : <https://au.reachout.com>
Ph: 1800 656 463
>NSW Sexual Violence Helpline; <https://whnsw.asn.au/faqconc/131/>
1800 385 578
References
1. See generally, ‘Australia’s first female-only trauma clinic opens’, JSL Media, (online at 29 November 2022) <https://australianseniorsnews.com.au/health/australias-first-female-only-trauma-clinic-opens/> Cf Sarah Lawrence, ‘Trauma informed photography course gives abuse survivors a new perspective, boosting self esteem’, ABC News, (online at 12 August 2022) < https://www.abc.net.au/news/2022-08-12/ballarat-photography-helps-abuse-survivors-trauma-informed/101318130>
2. For more insight please see Kellie Scott, ‘ How sexual assault survivors can feel in control during cervical screenings’, ABC News, (online at 12 August 2022) < https://www.abc.net.au/everyday/sexual-assault-survivors-feeling-in-control-cervical-screening/12383294>
3. See ibid.
4. See generally, NSW Government, ‘Your healthcare rights and responsibilities’ (2011) 0(0) NSW Government Health 3, 19.
5. Ibid.
6. Ibid.
7. Ibid.
8. Ibid.
9. Ibid.
10. See ibid.
11. ‘Pelvic exam 1: Assessment of the external genitalia’, Physical examinations II (JoVE Science Education, 2023) < https://app-jove-com.ezproxy.newcastle.edu.au/v/10144>
12. Susan Peirce, Alistair Ray & Grace Carolan-Rees, ‘Diagnostic reliability of sterile speculum exam for rupture of membranes’ (2013) 92(9) Acta obstetricia et gynecologica Scandinavica 1116,1117.
13. Harun Bingol, ‘NCA based hybrid convolutional neural network model for classification of cervical cancer on gauss-enhanced pap-smear images’ (2022) 32(6) International journal of imaging systems and technology1978, 1980.
14. Rachel Wiebe Skouta & Elsie Duff, ‘Bimanual examinations in Asymptomatic Well women: Interpreting current practice guidelines’ (2014) 10(8) Journal for nurse practitioners 623, 624.
