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

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 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 suggestionsbased 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.
    
    

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