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Re: sexual abuse & doctors...Dr. Hill, one more question...PLEASE!!From: D. Ashley Hill, MD (anonymous@obgyn.net)Wed, 31 Jan 2001 19:26:20 -0600 (CST)
At Wed, 31 Jan 2001, embarassed wrote: > >First, I would like to say thank you so much for answering my previous >questions and helping me to feel a little more at ease. I'm wondering >what causes these exams to be so much more emotional for sexual abuse >survivors? There have been countless medical studies on sexual abuse/assault survivors. Some studies show that while many survivors are doing great, there is an increased incidence of psychologic and medical problems like depression, anxiety, substance abuse, relationship problems, suicidal thoughts or actions, stomach illnesses, pelvic pain, painful intercourse, and vulvar disorders in women (and, I suppose, men, although they have been less frequently studied) who are survivors of sexual abuse or assault. Of course, some women will have none of these, a few might have all, while others will have specific issues. I do not think anyone really knows why pelvic pain or pelvic exams are sometimes more painful in women abuse survivors, although we do know that anxiety heightens pain, and that painful stimuli as a child *might* increase pain later in life. There was a recent, somewhat controversial study that suggested boys who have been circumcised have a lower tolerance to pain than those boys who have not. Much of this research is hard to perform, as there are a lot of variables. The bottom line is that early psychologic trauma like abuse can lead to increased anxiety during sexual relations, even in a loving relationship, and during pelvic exams. Thankfully, health care providers have realized this for some time, and, hopefully, will work very hard with abuse survivors to advise counseling and perform gentle, patient-directed exams. The key is to find a health care provider who will take the time to listen to you, and to guide you through the exam. Best wishes, DAH
-- David Ashley Hill, MD Associate Director Department of Obstetrics and Gynecology Florida Hospital Family Practice Residency Orlando, Florida
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