WOMENS-HEALTH Messages for January, 2001: Re: sexual abuse & doctors

Re: sexual abuse & doctors

From: D. Ashley Hill, MD (anonymous@obgyn.net)
Tue, 30 Jan 2001 21:15:49 -0600 (CST)

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Reply: embarassed: "sexual abuse & doctors...Dr. Hill, one more question...PLEASE!!"

At Tue, 30 Jan 2001, embarrassed wrote:

Let me address these important questions one by one:

>
>My therapist has told me that I might as well tell my doctor that I have
>been abused, because they can tell from a pelvic exam (if she is tense
>or the exam causes pain) if a woman has been abused.

This is not at all true. However, once in a great while a patient will be very emotional during an exam. In those cases I will stop and gently ask if she has ever been sexually abused/assaulted. In many cases the answer is yes. See below for a description of what happens then.

>It seems if the doctor knows the woman has been abused (it's been my
>experience anyway) then they always want to blame the pain on that. Is
>there a way to get a physician to treat the endometriosis and not use
>sexual abuse as the reason for pain?

I am not familiar with this. Although a number of valid research studies have shown that women who are abuse survivors have a higher incidence of pelvic pain, it is possible that those women respond to painful stimuli differently than nonabused women. Regardless of the science, endometriosis can cause pain. The gynecologists I work with would not hesitate to first assume that the pain is from the endometriosis, although they would very likely suggest counseling as a way to deal with any issues that might also arise from an abuse history.

Also, the exams are ALWAYS painful >for me and I know that I do tense up...I think, because I know they are
>going to be painful and because I don't like being touched at all!! Is
>there a way to make these less painful?

Absolutely. It is very important to have a frank discussion with your doctor and his or her nurse. Doctors do not like to cause pain. If you are honest about your apprehension, your doctor will be able to talk you through the exam. Further, you should always feel comfortable saying "stop" when you are in pain. Over 4 years of residency and almost 7 years of practice, I have never had a patient demand that I stop the exam. Rather, I have found it makes patients with an abuse history more relaxed. Finally, there are breathing and focus exercises that your therapist can help you with as a mechanism to decrease anxiety. Routine pelvic exams should almost never hurt. >

I also read once that doctors will sometimes >become sexually aroused when performing an exam...is this true?

I sincerely doubt this is true. Medical exams, even pelvic exams, are nonsexual situations. Sure, pelvic exams focus for the most part on a "sexual" area of the body, but it's not a sexual situation. Half of the population have vaginas. It's no big deal for doctors, because we do these exams all the time. After examining literally thousands of women, I assure you there is no sexual stimulation from performing a pelvic exam.

These were excellent questions. I hope you ask your friends and coworkers who they use as a doctor, and perhaps "interview" a prospective doctor to see if you feel comfortable with him or her. It's important for every woman, regardless of any history of abuse, to find a competent, compassionate doctor to help them stay healthy. Best wishes to you,

DAH

-- D. Ashley Hill, MD Associate Director Department of Obstetrics and Gynecology Florida Hospital Family Practice Residency Orlando, Florida

The above is general medical information, and should not be construed as specific treatment advice. Due to time constraints, I am unable to answer individual emails. Thank you.

Next message: William McIntosh, MD: "Re: right to see obgyn?(dr m)"
Previous message: Connie: "Re: CT and ultrasound tomorrow Having left side pain badly.. help"
In reply to: embarrassed: "sexual abuse & doctors"
Next in thread: embarassed: "sexual abuse & doctors...Dr. Hill, one more question...PLEASE!!"
Reply: embarassed: "sexual abuse & doctors...Dr. Hill, one more question...PLEASE!!"

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