One in four women will experience some type of sexual assault in their lifetime. So, why does no one talk about how difficult a gynecological exam can be for those who have suffered abuse?

Nobody enjoys disrobing, scooting down the table (just a little farther… ) and then having their lady business probed with a metal object. On the fun scale, I rank my annual gynecological exam somewhere between cleaning the toilet with a toothbrush and watching C-SPAN for 24 hours.

Yet, for women who’ve been sexually assaulted or abused, a routine exam can take on a whole new level of fear and pain. Being sexually assaulted and going in for your annual gyno exam are two very different things and, yet, to your body both can feel like a violation. But, health care is so important and taking care of yourself physically can even help you on your road to emotional healing.

Don’t be afraid to ask for what you need

“When I had my first exam after my rape, I thought it would be fine and I went in with no fear,” Tyler D., 32, says. “However, once I was sitting back there in the room, paper gown around me, I felt very vulnerable. The idea of being naked in front of someone was making me nauseous, so when the doctor came in and placed a simple hand on my leg, I lost it.” She was so upset she wasn’t able to go through with the exam at that time. Her doctor listened and didn’t push her into finishing the exam, but instead advised her to get counseling.

Unfortunately, not all medical professionals are that understanding. When Tyler later decided to see a fertility specialist, she was shocked when he ripped her paper gown off because he thought it was getting in the way of his equipment. Seeing her tears, he told her to buck up or get out, that he had other patients to see and didn’t have time for her to break down. “That moment made me realize just how critical it was to find doctors who have experience with treating people with sexual assault trauma and are able to offer compassion instead of re-victimizing the patient all over again,” she says.

But, if trying to have kids made her realize the importance of finding the best doc, having kids made her realize the importance of finding a way to take care of their mother — herself. Now, when it comes time to schedule her exam, she tries to keep it all in perspective. “I remind myself it is important to have these exams done so that I can stay healthy for my children,” she says. “I think about all of the amazing things in my life that I am living for, and I try to remember that is just a brief period of discomfort.”

Her advice to other women who’ve been raped is to not hide how you’re feeling from your doctor. “If you need music in the room, or you need time to recover after a breakdown or if you need Valium to help you get through it, all of those things and any others are completely acceptable,” she says. “Your doctor is there to serve you and if you aren’t feeling heard or respected, move on. Find a doctor who has worked with patients in your situation and is willing to do what it takes to help you have a positive and safe exam experience.”

You are in control of what happens to your body now

After being molested as a child, Emma L., 36, avoided any medical care that might bring up her past, but when she got engaged, she decided she needed to have an exam before getting married. Unfortunately, just sitting in the waiting room, unsure of what would happen and scared of the unknown, triggered a panic attack. Yet, when she asked to speak to the doctor privately before the exam about her past abuse, he simply told her to grow up and that “it wasn’t that big of a deal.”

As if that wasn’t bad enough, he added that she needed to have her hymen cut or she could “bleed to death on her wedding night.” Emma fled his office, convinced that sex would never be a safe option for her — physically or emotionally. “I did not end up marrying my fiancé at the time, because I was so scared of sex, and my doctor, and my issues,” she explains.

Years later, Emma got up the courage to try again after meeting her grandmother’s doctor and observing how patient and caring he was with her grandma. Her aunt had recently died from stage IV cervical cancer, leaving behind four children, and knowing that it ran in her family made her realize it was time. This time, her doctor listened when she asked to speak with him before she took off any clothes. “We came up with a plan together, one that we were both comfortable with. He assured me that I could tell him if anything made me uncomfortable, and he would stop,” Emma says. She adds that a female nurse was always present during any physical exam, which made her feel a lot safer.

Having control over the exam made her much more comfortable and she was able to tolerate a brief exam. Her doctor advised her to come back for a full exam when she was ready — it took her about six months — and even prescribed her a low dose of Xanax to take before the appointment.

Her advice to other women who were abused as children is to find a doctor who will let you be in control of the whole process. “They ask if what they are doing is OK, if I am OK, and they tell me before they do anything, so there are no surprises. I get a play by play and a lot of information,” she says, adding that it’s taken years to develop a relationship of trust. But, she emphasizes that it’s worth it — her doc delivered her baby and it couldn’t have been a more positive experience.

Know that if you are one of the one in four women in America who has experienced some type of sexual abuse that you too can take care of your physical health by having your yearly exam without compromising your mental health. (To make it a little easier Kelli Dunham, a nurse practitioner who is super passionate about making sure women get Pap’d, has a great list of accommodations you can ask for before your next appointment.) You can even look at it as one more way you can stand up to your abuser; don’t let him/her take your health from you! But, most of all know this: You are in good company (even if we’re all wearing fugly paper gowns). You are not alone.

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