Sexual Assault & Gynecologic Exams

No woman enjoys going to the gynecologist  to get a Pap smear. You are naked from the waist down, feet in the stirrups, butt scooted all the way to the end of the table, with a thin sheet draped over your knees to give the illusion of modesty. Meanwhile, your doctor has a lamp trained directly onto your vagina. Then comes the speculum to open up your vaginal vault so that your doctor can get a better look, and swap around with what are basically giant Q-Tips to take samples of your cervix and vaginal walls. Many women don't go for their well-woman visits when they should, just because the whole experience is so uncomfortable.

But what if you were a rape survivor?

Around 300,000 women in the US are sexually assaulted every year. This is only an approximation, because many women do not report assaults due to shame, feeling to blame, and denial. Many women are too ashamed to tell anyone at all, and therefore don't get the help that they need to deal with what has happened to them.

I am one of those women. I was raped by a stranger. I did not report it. I was drunk at the time, and felt like it was my fault for putting myself in a vulnerable situation.

Nearly a third of rape victims develop Post Traumatic Stress Disorder (PTSD). People with PTSD have flashbacks to the trauma - these can be triggered by sight, sound, smell. Dissociation, or the separating oneself from thoughts and feelings, happens to protect the victim psychologically. PTSD sufferers are also hyper-vigilant, always on the lookout for potential danger.

A Pap smear definitely acts as a trigger for a survivor of sexual assault. Regardless of whether you were raped brutally by a stranger or a person known to you, rape is an incredibly painful physical and emotional violation. When we are afraid, our vaginal muscles contract to try to block whatever is being inserted against our will. In the case of rape, unwanted penile penetration feels awful enough. But a metal speculum is even more painful, especially due to all the muscle clenching. It's a vicious cycle - the more your doctor encourages you to relax, the tenser your tend to become, making the exam even more painful and embarrassing, almost to the point of the original trauma itself.

Going to the gynecologist terrifies me, and it triggers memories of being raped. I sweat. I cannot relax. It hurts like hell. So for many years, I just didn't go. And I'm not the only one: many assault victims do not go for well-woman exams. This is dangerous for several reasons. Pap smears are performed to check for STIs (you may have to specifically request
 tests from your doctor), and to check for changes in the cervix that could either be pre-cancerous, or active cervical cancer.

So as a rape survivor, how do you handle going for regular Pap smears? In my experience, it's incredibly important to have a good "team." Ideally, this team should consist of someone you are close to, who you can trust to talk about your rape with; a therapist who deals specifically with trauma survivors; and a gynecologist who is understanding, and willing to go at your pace during the exam. There is a fantastic article on Jezebel on preparing for a pelvic exam after a sexual assault, written by a woman who was raped.

 Please remember that if you find yourself in this position, there is nothing to be ashamed of. You did not ask to be raped. But it is important to be current with your well-woman exams. They can and do save lives.