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How do I deal with the results of a medical trauma or abuse?

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malia asks:

Hi, I'm sixteen and about four months ago I was treated at the hospital for severe anemia due to over excessive menstruation. While I was there, I had to have a pelvic exam done, and I'm already really shy, and I've never been touched like that or even have had a boyfriend. So the doctor (who was a man) was about to do it, but I was so scared he had to physically spread my legs apart. Then he put the speculum in and did whatever, but he had to push through the hymen, and it hurt pretty badly. It seemed like he didn't care at all how I was doing, or anything. Now I cringe when people mention sex or anything like it because it reminds me of him and the pain and embarrassment. How am I ever going to trust a man enough again to let him get close, and how can I block this event out of my head?

Heather Corinna replies:

When we have any kind of trauma, we don't tend to heal by blocking it out. Of course, we generally cannot simply "block out" memories by sheer force of will in the first place. But it's certainly common to wish we could.

By all means, you had extremely poor care at the hospital -- I hate even calling it care. Our instincts tend to be really accurate, so I'd trust your sense that this doctor did not seem to care about you, especially given that how he treated you is in alignment with carelessness and possibly with outright abuse.

No healthcare provider should ever be using physical force, save when we're talking about saving someone's life. Even in an emergency, your doctor or other support workers for the doctor should be talking with you about what they are doing and why, asking you questions, and offering you comfort and support throughout, especially with a young and scared patient in this kind of situation.

Since you were in the hospital for anemia, even though you were having vaginal bleeding, we can probably assume that you having a speculum exam (rather than a bimanual exam, which involves gloved fingers, but not a speculum) was not likely a life-or-death issue for you: if anything, it's the severe anemia that was. Unless I'm misunderstanding what was going on with you, my impression is that the anemia would have been the thing to tend to first, and emergency treatment for that generally involves blood transfusions and/or an injection of iron.

A speculum exam is usually to look at your cervix -- to seek out any cervical cell changes, mostly due to factors that would not be an issue for you, not having had any sexual contact -- not your uterus, which would be the site of interest for excessive menstrual bleeding. In fact, I'm not even sure why it was essential you had a speculum exam that day at all, since you have not had any previous sexual experience which would cause a pap smear to be needed. The lone possibilities that come to my mind are that the doctors may have been concerned the bleeding was due to a sexual assault you were not being honest about (as that's common in abuse survivors), and wanted a better look at your vagina or cervix. However, if that was the case, no WAY would being so forceful with you have been the proper protocol: that kind of treatment is horrible enough for someone who has not come in having been assaulted, it would be outer limits with someone who had. Or, they may have been doing a hysteroscopy or sonohysterogram: looking at your uterus via your cervical opening. But, since the bleeding was probably uterine, rather than vaginal, and you had never had a pelvic exam before, they also probably could have started with an abdominal ultrasound before doing any kind of bimanual or speculum exam.

One additional possibility is if they were to have done something called an endometrial ablation or D&C to treat or identify your bleeding, which is is the removal of the lining of the uterus. However, this would be something that would be a last recourse, especially for someone your age and/or who was presenting these symptoms for the first time. And those would also be -- if they did that -- terms which should sound familiar to you now, as they should have discussed either with you in advance of doing it.

Please be aware that without seeing your chart and consulting with a doctor or two myself, or knowing anything about you beyond what you have told me here, it is possible my educated guesses on what treatment would have been most appropriate may not be apt. Since you don't know what it was the doctor was doing per the speculum exam, all I can do is guess (though you shouldn't have had to, as they should have been communicating what they were doing with you throughout).

However, even if I'm mistaken, and you were given this exam with an interest towards saving your life and your health, the way that exam was given was totally unacceptable, and not within sound standards of general or gynecological care.

My suggestion to you would be to file a formal complaint, though you also have the option of reporting this abuse through the police if you'd prefer. If you do not want to do that with the police, or they suggest you start with a medical board complaint, here is what to do:

Your profile lists you as being in the United States, so first, click here to find your state medical board: http://www.fsmb.org/directory_smb.html.

Each state has a different protocol for filing complaints, so when you find your state board in that list, click through to their site to find out how to file a complaint in your state. The site for your state board may list the steps online or have a number to call to begin the process. But generally, you will write out in detail, much like you did here, everything that happened to you. (And doing that more than once is something that can help you start to recover emotionally.) Even if you don't recall the doctor's name, all the staff who were involved in your visit will be noted in your medical chart, so the hospital will have the information on who it was that did this.

Make this a very formal letter (you might want to enlist the help of a trusted adult in this if you feel open to that), print it out, and send a copy to the hospital and a copy to your state medical board. I would send both letters certified mail so you can have proof they were received, but just be sure to follow the exact instructions you're given by the board on filing your complaint. The page which told you how to file a complaint should also tell you what the whole process is like from start to finish with a complaint so you'll know what to expect in terms of a response and resolution.

I suggest doing that for a few reasons. More than anything else, seeking out justice when we've experienced an injustice tends to often be healing and can help us to feel like our injury has been acknowledged and recognized. This is also a way for you to find out exactly what was done and WHY it was done. While I don't see any rationale for physical force in any of this, and doubt they will have one, either (this is largely where the abuse here lies), you should at least have information on why they felt a speculum exam was so essential, especially knowing your age, state of mind, and your lack of sexual history or previous experience with any kind of pelvic exam.

You also have the power to potentially protect someone else from this doctor's behavior, which is no small deal, and can help you to feel better yourself: sometimes helping others is a way to also help ourselves. Depending on what is determined with your case, it may result in the doctor having to be supervised for a while or do some additional training, being suspended from practicing, or even in having his license revoked and/or criminal charges being filed. Additionally, you may be able to press legal charges through which you could be awarded compensation you may want or need for any therapy or other support services during your healing process. To do that, you'll need all of this documentation and to start this process with the complaint.

I'd strongly suggest getting some counseling. A good counselor, specifically one who works with survivors of abuses, can be of a lot of help. They can help you deal with how you're feeling now, including helping you develop tools and skills to manage post-traumatic triggers, to rebuild trust around men, doctors, or people as a whole, and can also help you to work out the embarrassment and any shame you might be feeling, even though you have nothing to be embarrassed about: after all, you didn't do anyone any harm here or do anything to be ashamed of. They can also help you with communication tools for any doctors from here on out, as well as any you may need in your current or future close relationships around these issues.

If you don't feel able or ready to file complaints, I would at least start with that counseling. If you need help finding a counselor for this issue in your area -- especially if you can't pay for counseling yourself or haven't yet informed your parents or guardians about this and are not ready to do that -- you can get a referral through the toll-free RAINN hotline at:(800)656-HOPE.

In the case all of that sounds too daunting right now, another way to get started on your healing is just to tell someone about this. You told me here, and that's an excellent start. Perhaps next you might tell a parent or guardian, a teacher you trust, a close friend: anyone you feel close to, who you know loves you or cares for you, and who you feel will be able to listen and be a good support for you. Who you tell can also be someone to help you through things like filing a complaint or finding good counseling services.

It's the silence that often goes with any abuse or assault that can often do the most harm, sometimes even more than the abuse or assault itself. While, absolutely, any of us would prefer to never remember or block out what happened to us, not only is that not usually possible, it's usually something that harms instead of helps, especially in the long-term.

I want to say a few more things that I hope will help you.

What happened here wasn't sex, nor does it even remotely resemble sex. Sex -- real, consensual sex between people who care for one another -- is something people do that is about something wanted, that is about mutually-felt desire and pleasure, about closeness, about compassion, about respect, about love (even if that love isn't always romantic love). In consensual sex, no one is physically forced to do anything, nor should any kind of sex usually be painful. Even if if and when there is pain, a caring sexual partner -- the only kind anyone should choose to have -- stops what they are doing to care for a partner in any pain or discomfort, physically and emotionally.

For most of us, our genitals are a place so linked with our sexuality that of course you may have some sexual associations with this for a while, even though this wasn't about sex. As well, because you did experience trauma and pain genitally, it may well be that it does take you some time in your life not to associate your genitals or sex with pain (and your counselor can also help with that, as can a caring OB/GYN, not someone like this doctor at the hospital). I know that's probably not the best news you've ever heard, and that may not be so comforting to hear right now, but I think having some awareness and preparedness around that is better than not having it. This kind of trauma usually takes some time to recover from, and can have some impact on your sexuality. But with some good support, help and time, you're certainly not going to feel the way you do right now as time passes, and you absolutely can heal and have a healthy and happy sexual, interpersonal and emotional life.

I want to also add that this isn't about what men -- as a whole -- do. In other words, I hear and understand your concerns about trusting men in the future, but this was one man, not all men. Some men are abusive, not all men, and we can even safely say most men are not abusive. Certainly it's understandable, especially with this being so recent, that men may trigger feelings of fear for you right now, but you can probably think of more men who have NOT treated you this way than of men who have. With trauma caused by something or someone, any of us may find we feel uncomfortable for a while around settings or people which have characteristics of the thing or person who caused that trauma. Many people who have been in car accidents feel scared by cars for a while, people bitten by dogs nervous around dogs for a bit; those mugged on a certain corner may feel fear when on that corner again, someone abused by an aunt or uncle may feel wary around all aunts or uncles.

I was sexually assaulted more than once in my life, but because an older Greek man assaulted me does not mean old men or Greek men are dangerous as a whole: just that that one was. I was later assaulted by a group of younger African-American men: that does not mean African-Americans as a group are all going to assault me or anyone else, just that that particular group of young men, who happened to be male, who happened to be African-American, did. We're going to be hard-pressed to find any large group or classification of people who do not have any members of that group who have done someone harm: women have abused or harmed people, children have abused or harmed people, white people have abused or harmed people, crossing guards have abused or harmed people. People who wear t-shirts have abused or harmed people, but that doesn't mean that because you and I are wearing t-shirts now that we can't be trusted. If we all didn't trust people based on any one member of a group doing someone harm, none of us could trust anyone, including ourselves.

Mind, it really is common, especially when an abuse was recent, to make those kinds of correlations for a while -- even if we don't want to -- or to be triggered by something characteristic of an abuser or an abuse, be that gender, race, size, age, a smell, a sound, what have you. And when you're vulnerable and in someone else's professional care, you should be able to trust them, so your trust was betrayed here. That you do feel this way right now isn't something you should feel guilty or bad about: you just want to be mindful of over-generalizing so that you can heal and not lock yourself into fears about a given group of people, which can have ill effects on your psyche and your life as a whole.

I'm going to leave you with a few more links to give you some more information, in conjunction with my very best wishes and hopes. You're more than welcome to come back if you want to talk about this more, or have any extra questions, and may find that our message boards are a good, safe space for that.

written 04 May 2009 . updated 21 Jan 2014

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