Published on Canadian Women's Health Network (https://cwhn.ca)

Home > Printer-friendly

Getting Through Medical Examinations - A Resource for Women Survivors of Abuse and Their Health Care Providers

Text Size: Normal / Medium / Large

An Introduction

Do you avoid certain medical procedures like Pap smears, because you find them upsetting?

Are you a health care provider needing information about providing care for women with a child sexual abuse history?

Child abuse is a very sensitive issue and is often very difficult to hear or read about. Many women have difficulty using the health care system because of a history of abuse. These survivors may avoid necessary health care or find medical procedures traumatizing. This web site is intended for women with an abuse history and their health care providers. We recognize that some of the following content may be disturbing as it involves situations of past abuse. Whether you are a survivor, know one, are a professional who works with survivors, or are simply interested in sensitive practices in care, we hope that this site provides you with some helpful resources and tools

Survivors and the Health Care Encounter

Do you find that you get anxious before a doctor's appointment?

Do you put off or even cancel your yearly check up?

Do medical examinations trigger memories from the past?

Do you ever "space out" or dissociate during a medical examination you find particularly difficult?

Many women have difficulties or fear medical examinations or procedures. Medical examinations can include a complete physical examination with your physician, surgeries, dental procedures, or breast, rectal or pelvic examinations. If you have been abused, you may find medical examinations particularly upsetting. Many women find similarities between medical examinations and past abuse experiences. Some similarities include:

  • being in a horizontal position
  • being touched
  • being alone in a room with someone of authority
  • having an object (like a needle, tongue depressor or vaginal speculum) inserted into your body

 

What survivors can do to prepare themselves:
  1. Find a health care provider with whom you feel comfortable and trust. Many women survivors prefer female providers, especially for reproductive health care and where invasive procedures are involved like ultrasound that may require an instrument placed in the vagina and any breast procedures.
  2. Knowing your rights and your needs will help you be more assertive and confident. For instance, you have a right to refuse or stop a procedure or examination. Often a women's healthcare centre may be useful in helping you learn about your rights.
  3. Make an initial appointment to talk with the doctor about the procedure or examination, your concerns and difficulties, and what will help you get through it. You can ask questions ahead of time about procedures that will be performed (like what will be done, what you will see, feel, and smell). If you do not have an opportunity to have a talking appointment before your examination, tell your doctor that you find these examinations difficult. You do not have to disclose that you have a history of abuse.
  4. Learn some stress-reduction techniques and coping strategies like deep breathing. As one woman said, "I try to relax… I look around the room a lot. If something does catch my eye…it will keep my focus there. It will help me relax…make things go a lot easier."
  5. Wearing something that has pleasant associations for you such as your favourite scent or outfit may be helpful. Carrying something comforting, like a Walkman with music you like, may be helpful.
  6. Before you get undressed, talk with your doctor about what you need to make the examination easier for you. Make an agreement beforehand that if you are too uncomfortable at any time you will ask, or give a signal to stop and the doctor or nurse will stop.
  7. Here are some suggestions that may help during pelvic (or other) examinations:
    • Ask to have the top of the exam table up so you can see the doctor or nurse. This may give you more of a feeling of empowerment.
    • If you think it would be helpful, ask to see a vaginal speculum and how it opens and closes. Ask the doctor to use the smallest speculum available.
    • Keep your eyes open. This will help keep you in the present.
    • Ask the doctor to drape you so you can see her or him during the examination. Maintaining visual contact also helps keep you in the present.
    • Ask the doctor to explain what she or he is doing and why both BEFORE and DURING each part of the exam.
    • Use self-talk like "I can get through this. I trust this person".
    • You have the right to have a support person with you during the exam, if that is helpful. You may have to arrange this ahead of time with your care provider.
  8. After your appointment, plan something pleasant for yourself such as meeting with a friend, counsellor, or support person. One woman stated, " I needed to take really good care of myself afterwards, do a lot of self-comforting. " Another said, " We have coffee after…[that] brings me back to reality and that helps."
  9. If you are having surgery, visit the hospital or operating room before being admitted. Do not be afraid to tell the nurses looking after you that you find some of the procedures difficult. You do not have to disclose that you have a history of abuse.
  10. Finally, keep in mind that these are only suggestions based on what has helped other women survivors get through medical examinations or procedures. What works for one person may not work for another. There is no right way of doing this. You are the best judge of what will be useful to you.
  11. Remember, clearly discussing concerns you have about procedures with your health care provider should help ensure that you feel more comfortable and gain some sense of control over what happens to your body.

Health Care Providers

Have clients ever indicated that certain medical tests or procedures were especially difficult?

Have there been any particular medical conditions or behavioural clues with clients that have made you wonder about a background of abuse?

Have any clients voluntarily disclosed that they are survivors of childhood abuse?

Despite the prevalence of abuse in society, child sexual abuse is not adequately dealt with in professional schools. Increasingly, we know that several profound, long-term effects may result from childhood abuse and in turn, may influence current encounters with health care providers without the awareness of one or both parties. Some of the long-term effects of child sexual abuse include post-traumatic stress disorder (PTSD) symptoms, psychological problems, interpersonal problems, self-abuse, pain, and other somatic complaints. In an effort to provide appropriate care for survivors, it is essential for health care providers to understand the origin of somatic symptoms, and to consider an abuse history in patients with multiple complaints without an organic cause.

Studies have found that health examinations requiring touch by a person in a position of power can present difficulties for women with a history of child sexual abuse and in some cases may even trigger PTSD symptoms. With prevalence rates as high as one third of women, it is important to retain a high level of awareness regarding the possibility of an abuse history with all patients.

Our research study 1 [1] showed that health care providers would like more information and specific way of addressing child sexual abuse issues in practice. There are many ways you as a provider can make the medical encounter easier for both you and patients with an abuse history. These suggestions are categorized by health care providers groups:

Research Summaries

Related Articles

 

About the Researchers

Sari Tudiver, Ph.D is a researcher, writer and consultant on women's health. From 1993 - 1999, she worked as the Resource Coordinator at the Women's Health Clinic in Winnipeg, Manitoba, a community health centre run by and for women, where she was responsible for developing consumer information on a wide variety of women's health issues. An anthropologist by training, her research interests include the international pharmaceutical industry, reproductive and genetic technologies, and the impacts of a history of childhood sexual abuse on women's lives. She is the Associate Editor of A Friend Indeed, an international publication on menopause and midlife and a founding member of the Canadian Women's Health Network. She now lives and works in Ottawa, Ontario Canada.

Lynn McClure R.N. M.N. has worked as a nurse practitioner at a community health centre in Winnipeg for over 20 years. She has an interest in women's and community health services and continues to be involved in primary care delivery, research, and occasional teaching. Collaboration with others in research that has practical implications for the service setting, is a particular interest for this health care provider.

Tuula Heinonen, D.Phil. has worked as a social worker in health care before becoming an academic in 1993. She is currently Associate Professor at the Faculty of Social Work, University of Manitoba where she teaches undergraduate courses on social work practice, health and international social development and graduate courses in qualitative research. Her research interests include women's health, culture, social work practice, transitions, and healthy communities.

Christine Kreklewetz M.Sc. is an interdisciplinary Ph.D. candidate at the University of Manitoba. She attained her Master's degree in Family Studies. She has worked as a clinical therapist for several years with First Nations Peoples in the North. Her areas of research expertise include sexual abuse and violence within a family context including incest survivor mothers and parenting, incest offenders, and the intergenerational transmission of incest. She has also worked on research projects involving early childhood school transition and program evaluation for at-risk children and youth. Her current work is focusing increasingly on qualitative research, feminist research, and the effects of sexual abuse on women's health.

Loredana Clemente RN, MN has worked in an expanded nursing role for over 5 years. She was among the first to complete a masters degree in Advanced Practice Nursing at the University of Manitoba, Faculty of Graduate Studies. Her research and clinical interests include childhood sexual abuse survivors and women's health. She currently holds a position as a Primary Health Care Nurse Practitioner in the North Eastman Health Association, the regional health authority for the North Eastman Region and she represents the region for women's health provincially.

Dawn Shiloh B.A with research interests conducted in the fields of suicide, child abuse and hysterectomies. Medicine's treatment of women's health issues, and in particular the high rates of hysterectomies as a means of treating many non life threatening conditions, is a newly found concern for her. She is working on a book about her experiences as an abuse survivor and the impact a hysterectomy can have on someone with that history. Dawn has contributed artistically to a monument to survivors of child abuse to be located in Toronto, Canada in 2001. As an abuse survivor with recent health problems, she has had much personal experience with the difficulties and treatment women can receive within the health care system.

Carol Scurfield M.D.CCFP has been a family practitioner at the Women's Health Clinic in Winnipeg, Manitoba for 15 years. Her interest is primarily in women's health, concentrating in the areas of adolescent health care, reproductive health, and menopause. She has been very involved in the legalization of midwifery in Manitoba and is completing a Masters of Community Health Sciences on the topic of child sexual abuse.

Other Helpful Links

A Burden to Share: A personal account of the Effect of Childhood Sexual abuse on Birth [11]

Abuse Issues in Pregnancy and Labour: When your client discloses her abuse history, what do you say? [12]

Abuse Bibliography for Gentle birth web site [13]

Breastfeeding and the Sexual Abuse Survivor [14]
Kathleen Kendall-Tackett, From: LEAVEN, Vol. 33 No. 2, April-May 1997, p. 27

Child abuse survivors monument [15]

Childhood Sexual Abuse and Its Effects On Childbirth [16]

Choosing a Family Physician for Survivors [17]

Client handout from Gentle birth website [18]

Crisis in the Perinatal Period [19]

Dental tips for survivors [20]  

Doctor, I'm an Abuse Survivor, and I Want To Tell You Something [21]
By Kasey Drake [22]

Handbook on Sensitive Practice for Health Professionals: Lessons from Women Survivors of Childhood Sexual Abuse [23]

Health Consequences of Abuse in the Family: A Clinical Guide for Evidence Based Practice [24]

Helping Survivors Through Labor [25]

Helping Survivors of Sexual Abuse Through Labour [25]

Impact of Past Child Sexual Abuse on Breastfeeding [26]

Penny Simkin [27]

Post Traumatic Stress Disorder Within a Primary Care Setting: Effectively and Sensitively Responding to Sexual Trauma Survivors by Serena Clardie, MSW, LCSW   [31]  

Pregnancy to Parenting: A Guide for Survivors of Child Sexual Abuse [32]

Sexual Abuse in Childhood and Dental Fear [33]

Sexual Abuse in Childhood and Dental Fear - An Interview with Clinical Psychologist Dr Carmen Santos [34]

Victims of sex abuse refusing Pap tests [35]

Women Survivors of Childhood Abuse: Knowledge and Preparation of Health Care Providers to Meet Client Needs [36]

Discussion Forums

Reading List

Austin, W., Gallop, R., McCay, E., Peternelj-Taylor, C. & Bayer, M., (1999).
Culturally competent care for psychiatric clients who have a history of sexual abuse. Clinical Nursing Research, 8(1), 5-25.
Bala, M., (1994).
Caring for adult survivors of child sexual abuse. Canadian Family Physician, 40, 925-931.
Barry, C., Britten, N., Barber, N., Bradley, C. & Stevenson, F., (1999).
Using reflexivity to optimize teamwork in qualitative research. Qualitative Health Research, 9(1), 26-44.
Chalfen, M., (1993).
Obstetric-gynecologic care and survivors of childhood sexual abuse. AWHONN's Clinical Issues in Perinatal and Women's Health Nursing, 4(2), 191-195.
Clark, T., McComas, J. & Potter, C., (1999).
Conference. Physical Therapy, 79(3), 262-269.
Courtois, C. & Riley, C., (1992).
Pregnancy and childbirth as triggers for abuse memories: Implications for care. BIRTH, 19(4), 222-223.
Courtois, C., (1993).
Adult survivors of sexual abuse. Family Violence and Abusive Relationships, 20(2), 443-446.
Creedy, D., Nizette, D. & Henderson, K., (1998).
A framework for practice with women survivors of childhood sexual abuse. Australian and New Zealand Journal of Mental Health Nursing, 7, 67-73.
Doob, D., (1992).
Female sexual abuse survivors as patients: Avoiding retraumatization. Archives of Psychiatric Nursing, 6(4), 245-251.
Dyehouse, J., (1992).
Abuse of women in the health care system. In C. Sampselle (Ed.), Violence against women: Nursing research, education, and practice issues. Series in health care for women (pp. 219-234). New York: Hemisphere Publishing Corporation.
Farley, M. & Keaney, J.C., (1997).
Physical symptoms, somatization, and dissociation in women survivors of childhood sexual assault. Women & Health, 25(3), 33-44.
Finkelhor, D., Hotaling, G., Lewis, I. & Smith, C., (1990).
Sexual abuse in a national survey of adult men and women: Prevalence, characteristics, and risk factors. Child Abuse and Neglect, 14, 19-28.
Flournoy, J., (1996).
Incest prevention: The role of the pediatric nurse practitioner. Journal of Pediatric Health Care, 10(6), 246-254.
Friedman, L., Samet, J., Roberts, M., Hudlin, M. & Hans, P., (1992).
Inquiry about victimization experiences: A survey of patient preferences and physician practices. Archives of Internal Medicine, 152, 1186-1190.
Gallop, R., McKeever, P., Toner, B., Lancee, W.& Lueck, M., (1995).
Inquiring about childhood sexual abuse as part of the nursing history: Opinions of abused and nonabused nurses. Archives of Psychiatric Nursing, 9(3), 146-151.
Gary, F., Sigsby, L. & Campbell, D., (1998).
Feminism: A perspective for the 21st Century. Issues in Mental Health Nursing, 19, 139-152.
Grossman, F., Cook, A., Kepkep, S. & Koenen, K., (1999).
With the phoenix rising: Lessons from ten women who overcame the trauma of childhood sexual abuse (pp. 171-188). San Francisco: Jossey-Bass Publishers.
Gustafson, D. (2000).
Best laid plans: Examining contradictions between intent and outcome in a feminist, collaborative research project. Qualitative Health Research, 10(6), 717-733.
Hays, K. & Stanley, S., (1996).
The impact of childhood sexual abuse on women's dental experiences. Journal of Child Sexual Abuse, 5(4), 65-74.
Heinonen, T., Merrett-Hiley, A., McClure, L., Tudiver, S. & Kreklewetz, C. (1997).
Perception and utilization of health care services by women survivors of childhood sexual abuse: A preliminary study. Report of research for the Manitoba Research Centre on Family Violence and Violence Against Women, University of Manitoba, Winnipeg.
Hendricks-Mathews, M., (1993).
Survivors of abuse: Health care issues. Family Violence and Abusive Relationships, 20(2), 391-406.
Holz, K., (1994).
A practical approach to clients who are survivors of childhood sexual abuse. Journal of Nurse-Midwifery, 39(1), 13-18.
Jacobson, A. & Richardson, B., (1987).
Assault Experiences of 100 psychiatric inpatients: Evidence of the need for routine inquiry. American Journal of Psychiatry, 144(7), 908-913.
Jayaratne, T. & Stewart, A. (1991).
Quantitative and qualitative methods in the social sciences: Current feminist issues and practical strategies. In Fonow, M. & Cook, J. (Eds.) Beyond methodology: Feminist scholarship as lived research, (pp. 85-106). Bloomington, IN: Indiana University Press.
Kendall-Tackett, K. & Marshall, R., (1999).
Victimization and diabetes: An exploratory study. Child Abuse and Neglect, 23(6), 593-596.
Kitzinger, J., (1990).
Recalling the pain. Nursing Times, 86(3), 38-48.
Kitzinger, J., (1990).
The internal examination. The Practitioner, 234, 698-700.
Kitzinger, J., (1992).
Counteracting, not reenacting, the violation of women's bodies: The challenge for perinatal caregivers. Birth, 19(4), 219-221.
Lazare, A., (1987).
Shame and humiliation in the medical encounter. Archives of Internal Medicine, 147, 1653-1658.
Lechner, M., Vogel, M., Garcia-Shelton, L., Leichter, J. & Steibel, K., (1993).
Self-reported medical problems of adult female survivors of childhood sexual abuse. The Journal of Family Practice, 36(6), 633-638.
Malterud, K., (1993).
Strategies for empowering women's voices in the medical culture. Health Care for Women International, 14(4), 365-373.
McKegney, C., (1993).
Surviving survivors: Coping with caring for patients who have been victimized. Family Violence and Abusive Relationships, 20(2), 481-494.
McKinney, N. & Frank, D., (1998).
Nursing assessment of adult females who are alcohol dependent and victims of sexual abuse. Clinical Excellence for Nurse Practitioners, 2(3), 152-158.
Padgett, D. (1998).
Qualitative Methods in Social Work Research. Thousand Oaks, CA: Sage Publications.
Paxton, C., (1991).
A bridge to healing: Responding to disclosures of childhood sexual abuse. Health Values, 15(5), 19-56.
Read, J., Stern, A., Wolfe, J. & Ouimette, P., (1997).
Use of a screening instrument in women's health care: Detecting relationships among victimization history, psychological distress, and medical complaints. Women & Health, 25(3), 1-17.
Roberts, S., (1996).
The sequelae of childhood sexual abuse: A primary care focus for adult female survivors. The Nurse Practitioner, 21(12), 42-52.
Rose, A., (1992).
Effects of childhood sexual abuse on childbirth: One woman's story. Birth, 19(4), 214-218.
Roy, R. (1998).
Childhood abuse and chronic pain: A curious relationship? University of Toronto Press: Toronto.
Sandelowski, M., (1986).
The problem of rigor in qualitative research. Advances in Nursing Science, April.
Schachter, C., Stalker, C. & Teram, E., (1999).
Toward sensitive practice: Issues for physical therapists working with survivors of childhood sexual abuse. Physical Therapy, 79(3), 248-261.
Schwandt, T. (1997).
Qualitative Inquiry: A Dictionary of Terms. Thousand Oaks, CA: Sage.
Seng, J. & Hassinger, J., (1998).
Improving maternity care with survivors of childhood sexual abuse. Journal of Nurse-Midwifery, 43(4), 287-295.
Seng, J. & Petersen, B., (1995).
Incorporating routine screening for history of childhood sexual abuse into well-woman and maternity care. Journal of Nurse-Midwifery, 40(1), 26-30.
Simkin, P., (1992).
Overcoming the legacy of childhood sexual abuse: The role of caregivers and childbirth educators. Birth, 19(4), 224-225.
Stalker, C., Schachter, C. & Teram, E., (1999).
Facilitating effective relationships between survivors of childhood sexual abuse and health care professionals. Affilia: Journal of Women and Social Work, 14(2), 176-199.
Strauss, A. & Corbin, J. (1990).
Basics of qualitative research: Grounded theory procedures and techniques. London: Sage.
Teram, E., Schachter, C. & Stalker, C., (1999).
Opening the doors to disclosure: Childhood sexual abuse survivors reflect on telling physical therapists about their trauma. Physiotherapy, 85(2), 88-97.
Varallo, S., Ray, E. & Ellis, B., (1998).
Speaking of Incest: The research interview as social justice. Journal of Applied Communication Research, May, 254-271.
Ward, D., (1995).
Women and health care. In C.I. Fogel and N.F. Woods (Eds.), Women's health care: A comprehensive handbook (pp. 111-124). London: Sage.
Wilshaw, G., (1999).
Perspectives on surviving childhood sexual abuse. Journal of Advanced Nursing, 30(2), 303-309.
Source URL: https://cwhn.ca/en/yourhealth/faqs/GettingThroughMedicalExaminations

Links:
[1] http://cwhn.ca/en/node/faq2.html#one
[2] http://cwhn.ca/en/node/41869
[3] http://cwhn.ca/en/node/41870
[4] http://cwhn.ca/en/node/41871
[5] http://cwhn.ca/en/node/41872
[6] http://cwhn.ca/en/node/41873
[7] http://cwhn.ca/en/node/41874
[8] http://cwhn.ca/en/node/41875
[9] http://cwhn.ca/en/node/41876
[10] http://cwhn.ca/en/node/41877
[11] http://www.gentlebirth.org/archives/burden.html
[12] http://www.gentlebirth.org/archives/abuse.html
[13] http://www.gentlebirth.org/archives/abusebib.html
[14] http://www.lalecheleague.org/llleaderweb/LV/LVAprMay97p27.html
[15] http://www.irvingstudios.com/child_abuse_survivor_monument/index.html
[16] http://www.gentlebirth.org/archives/abusepaper.html
[17] http://www.vansondesign.com/RecoveryCanada/SexualAbuse/Library/choosingadoctor.html
[18] http://www.gentlebirth.org/archives/abusehnd.html
[19] http://www.gentlebirth.org/archives/skrape.html
[20] http://www.sidran.org/sub.cfm?contentID=51&sectionid=4
[21] http://www.authorsden.com/visit/viewarticle.asp?id=3667
[22] http://www.authorsden.com/visit/author.asp?AuthorID=6402
[23] http://www.phac-aspc.gc.ca/ncfv-cnivf/pdfs/nfntsx-handbook_e.pdf
[24] http://www.apa.org/pubs/books/4317023.aspx
[25] http://www.gentlebirth.org/archives/abuselbr.html
[26] http://thethinkingmother.blogspot.ca/2006/03/impact-of-past-childhood-sexual-abuse.html
[27] http://www.pennysimkin.com/
[28] http://www.youtube.com/watch?v=YhEVY2k9DWw
[29] http://www.gentlebirth.org/archives/pennynot.html
[30] http://www.gentlebirth.org/archives/abuseps.html
[31] https://www.wisconsinmedicalsociety.org/_WMS/publications/wmj/pdf/103/6/73.pdf
[32] http://www.dvrcv.org.au/help-advice/sexual-abuse-in-childhood/pregnancy-to-parenting/
[33] http://www.dentalfear.com/santos.asp
[34] http://www.dentalfearcentral.org/sexual_abuse_dental_fear.html
[35] http://www.smh.com.au/articles/2003/11/15/1068674436780.html?from=storyrhs&oneclick=true
[36] http://www.pwhce.ca/pdf/abuse.pdf
[37] http://forums.about.com/ab-womenshealth/messages?1gnF=y&msg=1385.42
[38] http://forums.about.com/ab-womenshealth/messages?1gnF=y&msg=1669.1
[39] http://forums.about.com/ab-womenshealth/messages?1gnF=y&msg=2064.14