Sexual abuse & retraumatization at Pap tests
The issue of traumatization or re-traumatization during gynaecological visits and internal exams has not been given much attention in the scientific literature, until recently.
The epidemic of sexual abuse for women in the world is undeniable and it is therefore important that gynaecologists and therapists be extra careful about how to approach women at such sensitive examinations. Very few women disclose their previous abuses, especially if they are not asked and encouraged to do so in a non-judgemental and safe place, so there is a high chance that you may at some stage deal with a woman with vaginismus (or any other gynaecological patient showing any kind of distress) who may have been abused in the past and they deserve a particularly compassionate and gentle approach.
Also, even if the girl hasn't been sexually abused, internal exams can be extremely upsetting and even traumatizing for a girl, if the doctor isn't careful with his/her comments or is a bit rough. I and other women who shared their stories in our forum or in support groups for vaginismus, felt suicidal or very upset after leaving a gynacologist's room..
We are reporting hereafter two very helpful links to guidelines which may help you as a practitioner deal with such cases.
The first one is an extract from a report written by a Centre Against Sexual Assault in Melbourne, Australia, about the barriers to cervical screening as experienced by survivors of sexual assault. The second one is a link to the Guidelines for medico-legal care for victims of sexual violence, written by the World Health Organization.
Finally, we already gave a list of ideas of what could make a gynaecological exam better for women with vaginismus (see our Guidelines for smooth gynecological visits for women here) but we will add here the following suggestions which were made by sexually abused women participating in the study mentioned above, when asked how their experience could have been improved.
Basically they all just ask for more humanity...
“It is a personal thing, this woman doctor was a caring person who cared for women’s health, she did not put herself above me, and she talked me through it all. She made me feel comfortable and respected, this is the main element it is an undignified test. I like to be respected and have my body respected.” From
1. Barriers to Cervical Screening Experienced by Victim/survivors of Sexual Assault - Pilot Study -
The whole study can be found on the CASA website at www.rwh.org.au/casa/projects.cfm?doc_id=4105#pap_test_project
Jill Astbury, Karen Carlson - CASA HOUSE - (2002) Key Centre for Women's Health in Society, University of Melbourne
2. World Health Organization: Guidelines for medico-legal care for victims of sexual violence
For the whole text, please go to:
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