Many survivors of child(hood) sexual abuse find intimate examinations or procedures difficult. This can include visits to the dentist, opticians or for smears or similar examinations.
Whilst such visits might be considered optional and therefore avoidable, the reality is that avoidance can also be seen, on some occasions, as also self-harming if there are ongoing health implications.
Consider, as best you can, how you might reduce the level of stress if you need to attend for an examination. You might find it easier to explain why, but if that is not possible then it might be enough to say something like “I find such examinations very difficult and I do not want to explain why. Please can we work together to find a way to do this without it being too stressful.” This can often work (based on feedback to us) by empowering both the survivor and the professional caregiver.
The results revealed in a study undertaken by the National Association for People Abused in Childhood (NAPAC) highlighted that only 49 percent of women who were abused as children underwent cervical screening compared to 79 percent of the general population.
NAPAC researchers sought survivors to complete a survey on their website. The survey included closed questions on demographic characteristics and cervical screening attendance. Open ended questions included discussed barriers to screening. A content analysis was used to decipher the responses.
"One way of coping with the trauma of sexual abuse is to control or avoid the triggers of trauma responses," researchers wrote. "Intimate gynecological examinations can be particularly stressful for women who have been abused because of the parallels with the abuse situation, for example, perceived loss of control, the power disparity and the physical sensation of the examination."
Though the fear of reliving the feelings of shame, guilt, self-blame and feeling unclean, contaminated or dirty may inhibit victims of sexual abuse from undergoing cervical cancer screenings, it is imperative they do. Women who have been sexually abused are more likely to develop cervical lesions in addition to participating in risky behavior such as drug or alcohol abuse.
NAPAC advice provided to survivors included:
- The survivor having time and space to talk about their fears and anxieties of having the test.
- A friend or supporter being present during the test.
- The smear taker having an understanding and insight into the issues of childhood abuse and the legacy of issues that adult survivors can face.
- A discussion of words/responses which would trigger anxiety or flashbacks for a survivor and finding alternative 'safe' words to replace these. For example, many smear takers would tell the woman to try to relax during the test. The word 'relax' is often used by abusers and can be very frightening for survivors. An alternative is to agree a word in advance to use in discussions with the patient.
- A private and comfortable environment for undressing and for the smear test to be taken.
- A clear signal agreed beforehand for the woman to be able to halt the test if she needs to at any stage.