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I want to avoid abuse triggers and flashbacks, but I really should go to see a GYN...

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trying_to_deal asks:

I have a history of sexual abuse which I have just started working on in therapy--including repressed memories. I have never willingly engaged in sexual experiences and I am 25 years old. A few years ago, during an ER visit for extreme pain (kidney stones) I was given an internal exam which felt out of my control. In fact, seemed forced and I left feeling very violated. Now, I have never seen a gyn even though I am much overdue. I feel like I should for health reasons but I am terrified I will have flashbacks again if the doctor touches my vagina. How do I deal with this? It has impacted this and my ability to seek relationships because of fear of being touched vaginally.

CJ replies:

For folks who have experienced any kind of sexual violation--including medical experiences that have felt violating--it makes some sense that you might have anxiety or fear about pursuing further care. I don't know that I have The Answer for you when it comes to how to best manage this, but I do have a few thoughts on strategies that you might be able to use to help manage some of the fear and discomfort you have around any kind of vaginal contact.

First and foremost, big huge kudos to you for being involved in therapy and taking the courageous step to start looking at your abuse as a part of that therapy. I know how difficult it can be to bring up those issues and to really allow yourself to go face to face with the range of emotions that accompany the experience of abuse. Hopefully the therapist that you're working with is well-trained in sexual trauma and will be able to be a resource for you as you explore you own experiences, feelings and emotions.

It's possible that right now, just as you're beginning your work around the abuse, that it's not the best time for you to try to head to the GYN and see how it goes. I hear that you want to be able to take this step to care for your overall health, but remember that your mental health is just as important as your physical health. It sounds like a trip to the GYN could be a good goal to work toward--and one that hopefully you can share with your therapist as you two work on your treatment goals and objectives--but please try not to pressure yourself into taking that step until you feel like you have the coping strategies to manage the feelings that could arise from that visit. We each have our own healing timelines, and while sometimes I think that we feel some kind of urgency to "be OK" or reach a certain milestone or goal in a set period of time, our bodies often just do not work that way. It can take some patience and compassion for ourselves to recognize that we need a bit more time and help before we jump right in to something that is a significant fear for us. And there's nothing wrong with that, in the least!

You also mentioned that your abuse history and negative medical experience has impacted your ability to seek relationships because you fear any kind of vaginal contact. It's important to remember that just because you enter a relationship with someone, that does not automatically equal ANY kind of sexual contact. Particularly if your history has included only non-consensual sexual contact, that's something that perhaps can be a challenge to keep in mind. Your body is still your own, your pleasure is your own, and you have the right to share it or not share it as it feels ok. If you are interested in being sexual, or interested in intimacy, there are many ways to give and receive both of those things that do not necessarily involve your vulva or vagina.

Have you done any kind of self-exploration of your own genitals, such as through masturbation? Often in the recovery process, that can be a daunting yet incredibly important step to take. Through self-exploration you are able to learn more about your body and appreciate it, not to mention get a better sense of what feels good for you and what you desire. Books such as Sex for One by Betty Dodson have sometimes been helpful for folks who are just starting to explore their own bodies and reclaiming pleasure for themselves. You have the right to pleasure in your life, and to feel autonomy within your own skin. I think that some compassionate self-exploration could be one way to help you feel more comfortable with things going on around your genitals, and certainly might allow you to feel more control before going into a situation where someone else (whether a partner or a medical provider) is doing that exploration or examination.

As for the medical issue itself, I know that there are many GYNs who have quite a bit of experience working with survivors of sexual abuse or assault. Unfortunately, abuse and assault are way too common in our society, so you are not the first person who is scared about this type of exam, and will unfortunately not be the last, either. If you feel that you can be so honest--and I know this can be a vulnerable position to put yourself in--when you call to make an appointment I would let the receptionist know that you have experienced abuse and are very concerned about the appointment. You can ask if there is a clinician they would recommend who may be able to block off a longer appointment schedule so that nothing feels rushed, and who has a lot of experience working with survivors. I have found that clinics such as Planned Parenthood and other local feminist health centers often have wonderful staff who are incredibly kind and compassionate when it comes to working with survivors.

If you are interested in moving toward getting GYN care, perhaps you could schedule an appointment with a recommended provider, but make it clear that you do not want to get an internal exam at that time. There are certainly tasks that can be accomplished (including some STI screens, discussions about safer sex and risk, gathering sexual history, etc) that can be done without any type of internal examination. Having that sort of appointment first might allow you to get a better sense of your comfort level with the clinician, as well as to see whether that in itself is triggering to you. In that first appointment, you should--if possible--talk openly with your clinician about your history and your worries, and the two of you can discuss what strategies could help you feel more in control during that exam. For some people, knowing what to expect from the exam, and seeing the type of instruments being used, can be helpful because then you don't feel so unprepared. I know that in emergency medical care situations, likely such as the one you had in the ER, there was probably not a lot of explaining about what was going on, unfortunately. That can be overwhelming and frightening for anyone.

A couple of other examples of what you could talk about at your first meeting with you GYN could be talking about how much information you want about what the clinician is doing and why. Some folks don't want to hear any of that, but others will feel a lot better if they know exactly what is going on. Some clinicians will let you insert the speculum yourself if that would be more comfortable for you. Some clinicians might allow you to bring some kind of music with you to listen to that would help you feel relaxed, and, depending on the clinician or office, some might allow you to have a support person in the room if that is going to be something that can be calming for you. These are just ideas, and may not be your personal idea of how to make the experience better, but I think that having that conversation with your provider can really help them get a better understanding of the kind of care and support that you need. You should not feel badly about bringing this up. It's your body and you are taking a brave step in the face of some very real negative experiences and emotions. If you don't feel like the provider you're seeing is receptive to adapting to your needs, you can ask if they have another referral they could make, or keep calling around. If you feel comfortable talking about this with your friends, you might ask them if they have a GYN they really like (even if you don't mention your abuse history, talking to friends might give you a sense of whether they have a provider with whom they feel they can communicate openly, without judgment).

If you decide to schedule an appointment with a GYN--even if for a consult--it might be an idea to try to coordinate that with your therapist so that you can go to therapy soon after, just in case the appointment does bring up any stuff for you. And certainly you and your therapist can talk about strategies for managing anxiety and fear that you could use in the moment. Sometimes deep breathing, and repeating to yourself in your head or out loud that you are safe can be little tricks that have a big impact on the way we feel in a given situation. The clinician that you go to should also be willing to stop the exam if you are feeling out of control, like flashbacks are coming on, or are just too uncomfortable. You can let the clinician know, even after a consultation, that this is not something you're sure you are ready for or will be able to tolerate, and that clinician should be able to work out a way for you to let him or her know that you need for the exam to stop if it feels too intense.

But, again, I think that you should make sure that the time is right for you to take this step. If you're just beginning to explore the abuse, it might not be the best time to go into a situation that could potentially trigger it. Your therapist can be a support for you and if you have not talked with that person about this situation, I would encourage you to do so. The two of you can work on strategizing for how you might be able explore your own healthy aspects of sexuality before taking the step of trying to have a GYN exam.

If you are interested in reading about the topic of abuse recovery, I really like two books by Staci Haines, The Survivor's Guide to Sex: How to Have an Empowered Sex Life After Child Sexual Abuse, and Healing Sex: A Mind-Body Approach to Healing Sexual Trauma. Both of these books can help you explore your own sexuality as you recover from your abuses. And I do believe that the healing has to happen from within, first. That's why masturbation or self-exploration can be such an important part of healing. If you personally do not feel in control of your sexuality and pleasure, it's all the more difficult to feel in control or non-violated when you're in situations such as going to the GYN or being with a partner, when someone else is doing the touching. It is ok--no, desirable!--for you to feel a certain level of comfort with yourself and your body before you share it with anyone else, whether romantically or for a medical exam.

I do want to say, though, that healing is possible. It may take longer than you'd like, and it may feel kinda messy along the way, but it is possible to recover from abuse and enjoy a full range of sexually healthy behaviors. But you do have time, and can work this through on your own timeline. I'm hoping you can talk about this more with your therapist, and perhaps start to do some research about possible GYNs and what happens during an exam. I hope that you'll be able to connect with a compassionate provider who can both hold and respect your story and experiences, and work with you to create a collaborative and safe experience of getting an exam.

In the mean time, here are some other articles that might be helpful for you to check out:

written 19 Feb 2009 . updated 21 Jan 2014

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