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Wednesday, April 11, 2012

When Rape and Medicine Collide: A Survivor’s Story

[Ed. note] A few weeks ago, there was a blog post written about the proposed law in VA requiring a transvaginal ultrasound for any woman seeking an abortion.  Before signing the law, they removed that specification.  However, that is typically the only ultrasound option for many women who are electing to have an abortion early on during their pregnancy.  So for all intents and purposes, this forced transvaginal ultrasound is still very real for the women in VA and in several other states across the nation.  This legislation motivated the following blog piece by a writer who wishes  to remain annonymous.

Trigger warning: Contains language around gynecological exams and personal experiences of childhood sexual assault.  Please practice appropriate self-care as you read and if you need any support contact our hotline (800-841-8371).

I have been working on this piece for about a month, afraid to send it in. But today, I woke up and decided to finish it, because today, I have to get a pap smear.

The reason why this is significant is because I am survivor of sexual trauma. I was not able to admit that fact to anyone until 15 years after the fact (I am still closeted to most of my friends and family, which is why this has been written anonymously). For years, I had squirmed through gynecological exams, frantically biting my lip to hold back tears, thinking it was normal, that every woman feels this way about having her vagina examined. I was 23 when I finally admitted the truth to myself, 24 when I first admitted it to somebody else: my doctor. I was scheduled for an IUD insertion and had, as usual, squirmed through the preliminary pap smear and pelvic exam. When my doctor - a man in his mid-thirties who always wore bowties - sat me down to schedule the procedure, I blurted out: "I don't think I can do this. I was assaulted when I was a kid. I can barely make it through a pelvic exam."

He must have been trained by BARCC, because his reaction to it was perfect. He thanked me for telling him, and emphasized that what I was feeling was normal. He talked me through the procedure and gave me a prescription for Ativan (an anti-anxiety medication) to take before undergoing it. And most importantly, he emphasized that if at any point I changed my mind, even if he was midway through the procedure, he would stop. On the day of the procedure, he spoke gently with me, describing each step of the process before he did it and asking me if it was okay to proceed. A nurse was in the room the whole time, holding my hand. At the end of the procedure, I burst into tears, and the nurse hugged me, shook her head when I apologized for crying, told me I was normal and went to get me tissues.

About six months later, my doctor scheduled me for a ultrasound to test for endometriosis. The procedure was held in a different office, and my doctor was not present. The technician, no doubt assuming I knew what an ultrasound was, did not prepare me or talk me through the procedure. I had only seen ultrasounds done in the movies and on my pregnant sisters, so I was in no way prepared for it when she inserted a speculum and then a large, plastic wand into my vagina. Here's what I can tell you about ultrasounds - they're not gentle. It's called a "probe" for a reason. They have to push, prod, and otherwise put a lot of pressure on the organs they're surveying. I laid back in the hospital bed and tried to hold back tears and the welling sense of panic in my chest. I closed my eyes, like Tom Coburn said, but it didn't make anything better. After it was over, I didn't tell anyone what happened. But later that week, I tried to have sex with my boyfriend, and when we were finished I started sobbing. I ran to the bathroom and vomited, my chest still heaving with sobs. My boyfriend did not know about my childhood experience. I kept saying "something bad happened to me" over and over again. Luckily, he had the foresight to call one of my best friends, who is himself also a survivor of child sexual assault. He didn't ask me what happened, because he didn't need to. He told me later that he already knew, the same way I had known he was gay before he had ever told me. He just talked me out of the crisis.

It's been two years since all of this happened. And though the support of my boyfriend and best friend have been invaluable, I can say without a doubt that without the care, kindness and professionalism of my doctor and nurses, I would not have ever had the courage to tell them, and would as such not be anywhere near where I am today - healing, and able to talk about what happened to me without doubting myself, or reliving the experience.

Which brings us to the point of this article: more and more states have been attempting, and succeeding, to pass legislation that mandate the use of ultrasounds for women seeking abortion. Since ultrasounds in the first trimester (when most women seek abortions) are all done transvaginally, there has been an outcry of "state mandated rape" from women who don't understand why they should be subjected to a physically and emotionally taxing procedure without medical necessity, because their legislators want them to. Proponents of these bills roll their eyes at what they view as a hysterical overreaction, but what is rape if not exerting power over someone by penetrating someone without their consent?

This public debate has added meaning for me, because I have a medical condition that makes it inadvisable for me to undertake a pregnancy. The prospect of abortion is scary enough. For me, it would be an agonizing decision, and I can't imagine the procedure itself would be anything but physically and emotionally torturous. But knowing that were I to ever get pregnant and make the incredibly difficult choice to terminate it, I would be rewarded with an unnecessary and unconsensual invasive procedure? It is hard enough for me to get a completely consensual and necessary pap smear. It is neither right nor fair to shame me for getting an abortion by forcing me to undergo an unnecessary transvaginal ultrasound in addition. Nor is it right or fair to my doctor, doctor who shepherded me through one of the scariest experiences I have ever had - disclosing my sexual assault for the first time. Just as the state does not have the right to mandate my unconsensual penetration (i.e. the definition of rape in almost every state law), it also does not have the right to make my doctor a rapist. It does not have the right to remove the trust he has established with me. I encourage you all to read this post by a doctor who feels the same way.

"When the community has failed a patient by voting an ideologue into office...When the ideologue has failed the patient by writing legislation in his own interest instead of in the patient's...When the legislative system has failed the patient by allowing the legislation to be considered...When the government has failed the patient by allowing something like this to be signed into law...We as physicians cannot and must not fail our patients by ducking our heads and meekly doing what we're told. Because we are their last line of defense."

There's a reason these laws are being called state-sanctioned rape. It's because that's what they are. But it's not enough for me to say so. Doctors have to say so too. Part of standing up against rape in the community is standing against it in all forms. I'm asking you to stand with me, and other patients like me, and doctors who don't want to be put in the position of having to violate their own patients. Because we are all the last line of defense against rape, whether state-mandated or otherwise, and we must not fail each other.

Written by: Annonymous

Posted by stacey on 04/11 at 05:35 PM

Comments

Thank you for sharing this. I wrote about my own experience and thoughts on this matter in emails to several legislative representatives, but with no reply.

Doctors -- and the AMA in particular -- have the political power to push back against this. Unfortunately, the legislators who passed this seem far less concerned with what survivors think about it.

I've never talked to other survivors about the anxiety and occasional dissociative symptoms I get before/during/after any kind of reproductive exams...I've had many pelvic exams over the years and the transvaginal ultrasound twice. The two times that I started crying were closely related to insensitive behavior on the part of the care providers. (No one warned me that the ultrasound wasn't going to be an external procedure on my stomach, by the way. It's a real shock to be suddenly carted from the emergency room with stomach pains and told to remove your underwear and spread your legs -- for anyone, and particularly for survivors. And just in case anyone is wondering, I was not and have never been pregnant.)

Doctors and nurses who take care and truly practice informed consent can make a huge difference, and the ones who advocate have all my respect. Unfortunately, those who don't can cause a lot of harm.

Posted by anon  on  04/11  at  10:16 PM
Thank you for your powerful words and your incredible bravery in speaking out and sharing your experiences. I think what you shared will help a lot of healthcare professionals out there have much greater empathy and understanding for the ways in which policies and procedures like these can impact survivors, and concrete ways they can stand in solidarity.
Posted by LM  on  04/11  at  10:45 PM
Thank you for being so very brave.
Posted by N  on  04/16  at  05:59 PM

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