Scarleteen

Hi, this is my first time posting here. Possible cw for sexual trauma -ish stuff and mental health issues, I guess?

I'm 24 but have only started having regular gyn exams recently (first exam + pap smear a year ago, and had this year's annual appt earlier today). I had a really bad time with last year's exam. The doctor was nice, and asked me multiple times throughout if I was ok/if there was any pain. And it wasn't physically painful, so I said I was fine. But the internal exam felt like a violation. I don't know exactly how to put this into words clearly, but it felt like "this is something I've just got to deal with, I want to get preventative care to catch any potential issues, so even though I strongly do not want anyone to stick their fingers inside of me, I just have to suck it up and get this over with". Emotionally, it felt awful, I cried a little during the exam and then went home and cried for a few more hours. And it brought up a lot of feelings about past sexual encounters I've had, which were not sexual assault or anything, I was verbally consenting and thought that I wanted it at the time, but with a similar line of thought of "I like this person, and I like being close to them, and want them to like me, and they really want to have sex with me and I don't really have any objective reason for why I don't feel comfortable having sex, so I will just have to put aside the fact that I'm really pretty uncomfortable with this and just deal with it." (I know there's a lot of messed up stuff in that line of thought, but it's how I felt at the time)

I'm not sure if the similarity between these situations is clear outside of my own head, and I don't want it to sound like I'm downplaying the seriousness of sexual assault or of situations where doctors actually do procedures without patients' consent. But both the sexual experiences that I mentioned and the gyn exam have left me shaken and upset for a long time afterward. I have had panic attacks when I remember those times. I flash back to those moments on a pretty regular basis, and it's always deeply upsetting to remember. Both of those experiences made me feel like I had no real options or agency, and I think that's what makes them feel so traumatic. (I hesitate to use the word trauma because I'm not sure it's an accurate way of describing my experiences, but the symptoms I'm experiencing seem pretty similar to how other people describe trauma/post-traumatic stress, so idk.)

Today I had this year's gyn exam, and it was much less upsetting (my doctor said that since I haven't been sexually active since my last exam I could skip the pap smear and just have an external exam this year). But I still was pretty stressed out about it from last time, and as a result I panicked and said I didn't have any questions or concerns just to get the appointment to end sooner, even though I had intended to ask about my very painful menstrual cramps and if there's anything else I could try to reduce the pain. (I did talk to her about my cramps last year, but I guess she probably forgot, and now because I got too scared to mention it this time, she's put in my medical notes that I have no issues with cramps).

I think I'm going to try to find a different ob/gyn for next year's checkup, since maybe I would feel more comfortable with a different doctor? But at some point I'm going to have to have another pap smear done, and I don't know how to deal with it. Does everyone feel violated when you get an invasive exam like this that you really don't want but that is necessary for keeping you healthy? Are there different strategies that could help me deal with this better? Off the top of my head I can't think of anything the doctor could do differently on her end to make the exam less stressful, but are there possible things that could help that I'm not thinking of?

I should maybe note, I have tried going to therapy before, with various different therapists (though not to talk about this specific thing), and it consistently made me feel more emotionally volatile and less able to deal with my mental health issues in my day to day life, so I don't do therapy anymore. I've found it more helpful for myself personally to read books and other resources about mental health on my own, where I can process information at my own speed and don't have the stress of trying to communicate my issues clearly to another person in verbal language. I of course don't say this to discourage anyone from doing therapy since I know it's hugely beneficial to a lot of people, I just mention it because it's not really an option that I'm open to at the moment, but if anyone knows of any books/websites/etc that have information or tips about how to manage trauma reactions as they relate to medical stuff and especially gynecological stuff, I would be very grateful for that!

Welcome. I'm so glad you found us.

Your experiences and you describing them doesn't diminish or discount anyone else's experiences. I want to make sure that you know that right from the start. Sometimes when I say that to people feeling that way it helps them to know that I'm a survivor of more than one sexual assault, one of them very violent, and I still feel that way. We can all have our different traumas -- and it does sound like this was traumatic for you -- without any of them minimizing or erasing another.

I'm so sorry that this was your experience. I'm sorry to say that this also isn't an uncommon experience: bimanual exams and paps do feel like violations to some folks, or to some folks in a particular exam, and that includes when healthcare providers aren't doing anything wrong. Having someone go inside your body is a big deal. (I've even felt this way sometimes with eye exams where someone else is touching my eye.) This isn't how it feels to everyone, or always feels, but clearly it's how it felt for you, and again, it has felt this way for others.

In terms of the last exam you had and not feeling able to ask what you wanted to, I would suggest you just use your online chart platform, if you have one, to ask what you wanted to ask. Had you asked about menstrual pain in the office, there really isn't anything else the doctor would have likely done that they already did, so you should still be able to get information that's just as good/sound as it would have been had you asked when you were there, okay?

The current best practice guidelines for pap smears are once every three years, so you actually have some time before you need another unless something came up that necessitated it. Do you still want to talk about what you (and a healthcare provider) could do to make all of this a better experience, even though it's a ways in the future? I'm happy to do that with you, if so. I'm also glad to talk more about how you are feeling right now and brainstorm ways to care for yourself around all of this if you like.

Thank you so much for the kind response. I would definitely appreciate any ideas on how to make this type of exam less upsetting in the future. I think part of what's stressing me out so much is that I'm not sure what I can do to make it a less unpleasant experience next time, so it feels like this terrifying unavoidable thing that's just looming in the future, even if it's a few years away. I think it would be reassuring to be able to plan for what I can do next time to help myself get through it better.

Glad to be of help.

I understand that feeling of the looming yuck. Let's see what I can do to help with that. I have a few suggestions.

One thing you can do that's become fairly common practice in a few fields of medicine (dentistry and gynecology amoung them) is offering anxious patients medications to help calm those feelings, usually a benzodiazepene of some kind. When that's done, that will just be a one-time medication you can take the night before and/or day of an appointment. I'm not an anxious GYN patient, but I am very much so with the dentist, and I find that very helpful.

I'd also suggest that you do what you can to choose a GYN who you just generally like and feel comfortable with. Obviously, if we have mixed or negative feelings about someone -- or they feel like a total stranger -- it's much more likely that the kind of experience you had is going to happen. On the other hand, if we have a more established relationship with someone, if they feel like a real partner in our care of ourselves, and if we can have conversations about our feelings with them ahead of time, it makes a more positive experience a lot more likely. In that search, I'd suggest you ask clinics or receptionists what the particular doctor tends to do to help anxious patients and let them know you are one. I get that might not feel like the best word for how you are feeling, but it's the umbrella term often used in healthcare, so they'll know what you're talking about. If you feel comfortable doing it, you can also say that you have experienced some medical trauma in a previous exam and ask what they do for patients in that spot.

Once you feel like you may have found someone, you can ask for a consultation appointment that does NOT involve any kind of physical exam, it's just you talking with the provider and asking them the questions you want to. Since you just had a bimanual exam, you could even ask for this for someone to talk with about your menstrual stuff. They might want to do some bloodwork at that kind of appointment, but they could refer to the records of your last exams for any information they needed as a result of that.

I also want to point you to this article -- https://www.scarleteen.com/article/bodi ... dern_guide -- by Caitlyn Tivy, an awesome PT who writes for us. It includes some variations for exams, but also talks some about how a bimanual exam is something a lot of folks don't even need anymore, and may well be something you can usually opt out of entirely.

Lastly, we can talk some more here about all of this to help you process your feelings some more, and that includes your previous sexual experiences you mentioned. By all means, with a history of feeling like that kind of engagement with your body -- sexually, medically -- has not been what you actually wanted or like something you felt able to say no to, it's not at all surprising it really messes with your head. Working through some more of that and maybe talking about how, moving forward in every arena, you can start only having people be engaged with your body on your terms, might help, too.

How does all of that sound?

Thank you for all the information, that's really helpful. I tend to have a mindset of "the doctor is in charge, you have to do what they tell you without any pushback or questions or discussion of other options," which I'm trying to unlearn, but it's very difficult. It's reassuring to have some specific things I can ask about that might help.

Working through some more of that and maybe talking about how, moving forward in every arena, you can start only having people be engaged with your body on your terms, might help, too.

Maybe that would be helpful. I have a really hard time articulating my feelings about this stuff, though. That's kind of part of the problem I have in situations like this; if someone asks me a question like "is this OK?" whether that's in a medical context or a sexual context, I have a really hard time even knowing how I actually feel in the moment, and so my default answer is usually along the lines of "yes, it's fine" even though I'm not sure if I actually am fine. I don't really know what my terms are for how I want other people to engage with my body.

I think part of the issue with the sexual experiences I've had in the past was that my baseline, everyday levels of anxiety were super high at the time. I was used to feeling really scared anytime I was interacting with other people, even in the most basic situations, so even though I was pretty anxious and uncomfortable about sex, that was kind of my default emotional state, so it didn't really occur to me that there was any other way things could be. These days I'm more emotionally stable most of the time and have a better understanding of what it feels like to be calm and relaxed and happy. But I still kind of go back into that anxiety mode sometimes, especially in situations like doctor's appointments (and probably sex as well, though I haven't been in that kind of situation for a few years), and it makes it really difficult to set boundaries about my body because I end up thinking "I'm going to feel kind of upset and anxious no matter what, so I might as well let this person do whatever they want to do".

Hi user24601,

I hear you on the frustrating dynamic of how having had/still dealing with anxiety can make it hard to differentiate between "this is anxiety I need to pay attention to" and "this is the anxiety that makes up the background noise of my life and I need to just tune it out right now." I know for me at least, time (and some kind of management of my anxiety) is a big part of learning how to tell the difference, so you may notice that the longer you feel emotionally stable, the easier it becomes to tell when you anxiety is actually alerting you to something important.

It seems like there might be two way to approach what you're describing around all this. One would be switching your default answer when you freeze up or feel unsure from "yes, it's fine" to something that indicates you need a second to check-in with yourself. Does that feel like something you'd be up for learning and practicing for the future?

I also hear you saying you don;t know what your terms are for other people engaging with your body. Do you think that comes from that same issue of "everything makes me anxious so I don't know what ACTUALLY makes me anxious?" Or does it feel like there are other things going on that make it hard to tap into what you do and don't want in terms of touch?

I definitely agree that time is really important for dealing with these kinds of issues. I've worked really hard to learn better strategies for dealing with my mental health over the last few years and it's really made a difference in my ability to have normal, day to day interactions with people without feeling panicky and miserable all the time. I think a big part of that improvement is that, as I learn and practice better coping strategies, I have more positive experiences that bolster my confidence and make me feel like it is actually possible to have pleasant and calm interactions, and I think that kind of confidence really only builds up over time.

I think I definitely do need to work on changing my default response. I think maybe when I next have a gyn appointment, I will ask the doctor before the exam begins if it's ok if I need to take a pause to calm down during the exam. I think establishing ahead of time that I might need to stop the exam for a moment will make it more comfortable for me to actually speak up and say that in the moment, and might give me more of a sense of control over the experience.

I think it's hard to know how I want people to engage with my body because most of my past experiences have been with this mindset of feeling anxious about everything, so I couldn't really parse out what I do or don't want. I get overwhelmed really easily and in the past I've never had the confidence to ask for a moment so I can calm down and process things. I think probably being able to pause for a moment is the most useful thing I can do to start with, especially in the medical context. Sex is more complicated because of all the social dynamics involved, but I've been taking a break from pursuing sexual relationships anyway, for both mental health reasons and pandemic reasons, so maybe in the meantime if I can get more practice at speaking up and asking for what I need when I'm uncomfortable in a medical setting, that skill might make it easier to do the same in sexual situations later in the future.

Thank you both so much for being so patient in talking with me about this, and for your kind and insightful responses. I feel a lot better than I did a few days ago. I think just talking about it and articulating what I was feeling has helped a lot, and now I have some practical things I can try to make my next gyn appt less upsetting. Working out all my issues around this stuff is going to be a long process I think, but I feel like I have some good next steps to get me started. Thank you!

Hey user24601,

I hope it's okay that I'm jumping in here. Thank you for opening up about your experiences and being so vulnerable. I'm so sorry that your experiences with OB/GYN exams have been difficult. I really think that your idea of establishing boundaries early and achieving a sense of control in that sense is something that I would do in your situation. It seems like it'll help you feel less powerless when someone is interacting with such sensitive areas. I know that my OB/GYN often starts a casual conversation during my exam (asking about school, work, family, friends, etc.) and it helps to distract me from any discomfort that I might face. This may not necessarily work for you but it's an idea!

I think that advocating for your body is a great way to engage with it. Your choices are entirely valid and we are here to support you in any way. I'm glad that we helped you reach some sort of resolution and please let us know if you need any further assistance, we're always here!