Sexual assault unfortunately remains a big problem in America, with an estimated one in five U.S. women likely to be raped sometime in their lives.
The aftereffects these women suffer are many, but their tendency to avoid pelvic exams is one that doesn’t get enough attention. Such exams are vital to screen for cancer and sexually transmitted diseases, as well as to evaluate pain, bleeding and vaginal discharge.
How do gynecologists help women who’ve been sexually assaulted feel comfortable with routine pelvic exams?
Donna G. Baick, MD, a gynecologist with UCI Health Gynecology Services, says victims of sexual assault aren’t alone in shying away from these exams.
Addressing the patient’s concerns
“It’s an important exam, but many women are apprehensive when they come in for an appointment,” says Baick, who is also an associate professor in the UCI School of Medicine’s Department of Obstetrics and Gynecology. “I try to treat every woman who comes to me the same, making sure I address her concerns before we start the exam.”
On the questionnaire she gives new patients, she asks whether they have been assaulted or raped.
“Some will check no, some will leave it blank and some will check yes and give explanations,” Baick says. “Sometimes I have an inkling that women are going to be uncomfortable, so I ask them straight out, and I also ask if they want to talk about it.”
Talking about sexual assault doesn’t come up regularly with patients, but Baick says more women are mentioning their experience as they’ve become more empowered by the #MeToo movement.
Put the patient in control
Baick knows an exam may trigger flashbacks or create emotional upset. In those cases, she’ll talk with the patient, and maybe recommend a breathing exercise or other relaxation technique to help the woman feel more comfortable. If necessary, she’ll reschedule the exam for a future visit.
The important thing is for the woman to feel empowered and in control during her exam. Baick allows the patient to decide when to go forward and when to stop.
Baick acknowledges that women sometimes feel more comfortable with another woman as their health provider — someone who knows what it feels like to have menstrual cramps, have a speculum inserted or to have her feet up in the air. She also knows many excellent male gynecologists who are sensitive to the fears and concerns women have.
But any woman who feels that her physical exam, and her pelvic exam in particular, was inappropriate, should report her concern to the Medical Board of California.
Find a comfortable approach
Sometimes Baick may suggest other positions to perform a pelvic exam if a woman prefers not to have her feet up in metal stirrups. The exam can be done while a woman lies on the bed holding her own knees up or with her hips placed on a bedpan or pillow.
The most important thing is to engage with the patient, she says. “When you talk to them and make them feel comfortable, most women don’t have that much of a problem.”
Tips for apprehensive patients
For women who are especially nervous about having a pelvic exam, Baick suggests:
- Making an appointment near the end of the day when your provider will likely have more time to talk
- Writing your concerns down beforehand to give your provider if you feel you cannot talk about it
- Bringing a friend or relative into the examining room for support
- Asking for a medical assistant to stay in the room to help you feel more comfortable
Regular checkups are important to maintain a healthy body. A pelvic exam can help your physician find problems early that can lead to timely treatment. But many sexual assault survivors have lost trust in others as well as a sense of control over their bodies.
“Hopefully, if a woman can find the right provider,” Baick says, “she can feel empowered and begin to heal, both inside and out.”