Arousal during medical exam

[Quaily]

I went through several very bad medical experiences when I was younger, involving the genital area. They gave me PTSD.

I heard that it can happen to people who've been traumatized in this way that they can become involuntarily aroused during pelvic exams. Is this true? Because it's happened to me, and I felt so ashamed, thinking I was some kind of pervert.

I now have to go see a pelvic floor therapist for pelvic/bladder pain. Besides being incredibly anxious about the exam, due to my ptsd, I'm also worried about arousal, and I'd be so mortified. Especially if she could somehow tell. I desperately need the help for pain, but I'm so scared.

[Jacob]

Welcome to Scarleteen Quaily!

This is totally true, people usually use the term "arousal non-concordance" for what you're describing. Being physically aroused isn't usually a choice, and arousal happens on a completely separate track to desire, sometimes they run parallel, sometimes they don't. Just because our bodies do a thing, it doesn't mean we want that thing - sometime it's even a survival mechanism. So I don't think you have anything to be embarrassed about.

Depending on your level of trust with the therapist I think PTSD from past experiences is absolutely something you could bring up as a factor which makes you nervous ahead of the exam.

If it felt safe to do so you could also say that as a result of that PTSD your body sometimes reacts in an involuntary way, "as if" you were aroused, and that you would find this embarrassing and unwanted if it happened.

The level of detail you gave would be completely up to you, after all the main purpose of bringing it up is to make you feel more comfortable having already clarified ahead of time anything that'd be more upsetting if it occurred unexpected.

You do have a right to privacy especially with medical professionals, and even moreso with those who work with this part of the body (and have likely seen much more surprising things than you are describing).

Do you think that pre-examination conversation could be helpful?

[Quaily]

"arousal non-concordance"
Oh wow, I never heard of that, thank you! You'd think that, at the age of 65, I'd know these things.

Here's another thing I don't know: can she see or tell if I'm aroused (I'm female)? That's what would mortify me.

It's hard enough for me just to go there and have it done. I don't think I could talk about it. I'm already worried I'll get flashbacks and start crying or dissociate while she's up there. But I'm in pain, and I really need the help. Rock and a hard place, eh?

[Latha]

Hi there, Quaily!

Oh wow, I never heard of that, thank you! You'd think that, at the age of 65, I'd know these things.

Isn’t it such a useful term? I think I heard it was coined pretty recently, by Emily Nagoski in her book ‘Come As You Are’. Lots of people don’t know about it yet, which is a shame, because it could help so many.

can she see or tell if I'm aroused (I'm female)?

It’s quite possible that the therapist won’t notice anything at all, even if you feel aroused. But if she does notice something, like lubrication, it wouldn’t imply anything negative about you. Many people, including those with no history of trauma, experience physical arousal in situations like this. It can be as simple as a reaction to nervousness, or to a change in temperature. No clinician worth their degree would judge you for such a common and normal reaction - they likely wouldn’t think anything of it.

I understand how this might be hard to believe, given the negative experiences you’ve had. But it is possible to find therapists and doctors who will act with compassion and care for you. If you become distressed during this exam, you don’t have to bear it. You can stop what is happening at any time, and ask for any adjustments that would help you. It would be okay to do this as many times as is necessary. I think it would also be fair to expect this therapist to check in with you through the exam, and stop if it seems like you are not okay. You don’t have to be ashamed of this - being sensitive to the fact that their work might be stressful to patients is almost an implicit requirement of the job for pelvic floor therapists.

I hear that finding the cause of your pain is an immediate need. But if it’s difficult to have a pre-examination conversation, what would you think of scheduling an appointment just to get to know the therapist and talk to them about your symptoms, without the pressure of immediately doing a pelvic exam? You could ask them about what they would do during the exam, and see if you if you feel comfortable bringing up your concerns. You might also ask them (or another doctor) about short term pain relief while you’re working on this.

I want to share three resources here:

Pelvic Exams: A Modern Guide (In case you would like to go over what you can expect.)

I've been abused, but I have to have a pap smear.: This advice column responds to someone in a similar situation to you. The letter does contain explicit descriptions of medical abuse - if you want, you can skip it and go straight to the advice.

Aftershocks: The Physical Effects of Sexual Trauma: Though this series focuses on sexual trauma, the information of managing physical pain might still be useful.

[Quaily]

Thank you for making me feel like less of a freak!
I went to my first appointment today. My heart was going like a triphammer.

It went really well. The pt was so sweet and kind. We spent a lot of time talking, and I gave her a short version of what I had been thru and why I had ptsd. I told her I brought a weighted blanket and my stuffed emotional support quail, and she loved it. She said she wished all her patients were so well prepared! She was surprised that I was already doing some yoga poses to relax, and asked me how I knew about those. I told her I learned them at UTubeU.

One thing that surprised me was that I barely felt anything, and I certainly didn't get aroused, thank Goddess! I was expecting it to be, not painful, but more robust. But a lot of it barely registered. She did find a few sore spots.
Also, I was expecting more "homework ", but she told me to just keep doing the yoga poses, one each for one minute, twice a day. And she showed me a better way to breathe while doing them.

I'm SUPER proud of myself for going, and getting thru it all. I'm even looking forward to next week's appt!

[Latha]

Hi Quaily!

I’m glad the appointment went well, and that you felt comfortable with this PT! You should be proud of yourself - good luck for your next appointments!

[Jacob]

Just catching up on this thread, and so happy it went well Quaily!

[Quaily]

Thank you both. I have another appointment this Friday. I'm a little anxious, but not like last time. I've also scheduled an online appointment with a psychotherapist for next month. I feel that this ptsd needs to be put to rest after 30 years, so wish me luck with this lady. I hope I like her and she can help me.

[Jacob]

Amazing. I hope that therapy goes well!

[Quaily]

The appointment with the psychotherapist fell thru. Can't find anyone who'll take my insurance.

I went for my second appointment on Friday. At first, it was like last time: no real feeling. Then, all of a sudden, it was like I woke up. I could feel her finger sort of brushing the internal muscles. It was very intense for me.

Today was a bit rough. I had this weird episode when I went to poop. All of a sudden, a rush of intense burning rose from my navel to my throat, like whole body heartburn. My head felt full of pressure.

It was so strange. I are something and drank water, and fell asleep. Felt a lot better when I woke up.

But when I took a bath, I started crying. My chest felt tight.

This whole thing has been such a roller coaster.

[Latha]

Hi there, Quaily!

I was reading your post and thinking to myself, ‘Oof, those ups and downs are a roller coaster’ — and then you said it yourself! I’m sorry to hear that you’ve been having such a tough time, and that the appointment with the psychotherapist fell through. Dealing with the healthcare system can be exhausting — the system we live in makes getting support far too complicated. If you’d like, we can recommend books/workbooks about PTSD that you could look though on your own. And if you feel up to telling us a bit about what you’ve tried, someone on the team might be able to suggest other ways to deal with the insurance problem.

When you had the intense experience with the PT, were you able to communicate that to her?

[Quaily]

Hi Latha,
No, I didn't tell her at the time, but I think I will next time.

I'm in California, in the bay area. Because of disability, I'm on Medicare/Medicaid. A LOT of therapists don't take Medicaid. I've been looking thru various services that are supposed to match you up with a suitable therapist, but twice now, even tho it said they accept my insurance, they email me and say they don't, and cancel.

I'm kind of hoping that this weekly PFT will act as a sort of exposure therapy, and help me get over this. But the stuff that's coming up, memories from 60 YEARS ago, is really a lot to deal with. I'm a little autistic, and emotional stuff is hard for me.

Yes, I would be grateful for any help with finding a therapist who is familiar with PTSD, and also any books/workbooks you could recommend.

Thanks!

[Jacob]

Hey Quaily,

I just want to start by joining you in bemoaning how grinding and long these processes of seeking and accessing care can be! It's not cool that it has to be like this, but unfortunately it can take a while - and we can only recommend persistence in trying to find something.

I don't think we can directly find you a therapist, but we can offer a couple of places to start looking:

We did some research and found this resource which may be helpful, do you want to start here (if you haven't already): Free and Low-Cost Psychiatry Referrals?

This is one of the more promising services on that list but I'd recommend working through each of them and keeping note of everyone's recommendations of what to do next if you are turned away: Pathways to Wellness.

More often than not, this is the kind of situation where you are following all the "pathways" and retracing your steps each time to eventually find something that isn't a dead end. Usually the key is just to keep going rather than anybody being able to say which route will be a "sure thing".

I hope this gets you on your way!

(Also, I don't know if it's an option, but for private therapists - though some may offer sliding scales - Psychology Today has the most-often updated directory of therapists by location.)

[Jacob]

Ooh and in terms of books, Heather recommended Judith Herman’s "Trauma and Recovery" if you'd like to look that up and see if it's something you'd find helpful!

[Quaily]

Ooh and in terms of books, Heather recommended Judith Herman’s "Trauma and Recovery" if you'd like to look that up and see if it's something you'd find helpful!

Thanks! I will look up that book. I think I may have found a therapist. I applied, anyway, so we'll see if she tells me she doesn't take my insurance.

[Heather]

Fingers crossed! I know this exhausting dance all too well.