On dealing (or not) with gynaecological exams and PTSD
[Content notes: Gynaecological exams, sexual abuse triggers, mental health issues.]
[Note for new/non-readers: Just so you know where I'm coming from with this - between 2005-2006 I was sexually abused and raped, and as a result suffer from PTSD. I also suffer from depression and anxiety.]
I turned 25 about 6 months ago, which (in this part of the UK) means that I got a letter inviting me for cervical screening (previously known as a smear test). I couldn't go straight away, mainly because my ridiculously irregular period decided to turn up at the wrong time - an by "ridiculously irregular" I mean "medium to heavy bleeding for about a month, then around one week off before starting again". Of course, by the time it got to that one week, I'd forgotten about the letter, and I only ever saw the letter again when I was back on my period.
(By the way, I don't know why I have periods that can be measured in months. My old (now retired) doctor figured it was a reaction to the pill I was on when it started (Cerazette), and she must have been at least partly right, because my periods have been slowly getting shorter, but it's been over a year since I stopped taking it, and I was kinda hoping I'd be near to normal by now. But I digress.)
Anyway, after another letter and a phone call reminding me, I finally ended up going two weeks ago.
I went into this knowing pretty much what was going to happen - I had a smear test, general gynaecological exam and transvaginal ultrasound in 2006 (in an attempt to find out something about above-mentioned irregular bleeding) and I've also had various STI tests at a GUM clinic in 2009. Both times I ended up being triggered quite badly - with the 2006 tests I figured it was the penetrative aspect of it that was triggering, but with the 2009 tests I was triggered by having to explain my whole sexual history, so I as in a pretty big mess before the actual tests started. Because of this, I did my best to prepare myself for this cervical screening - penetration hasn't been a problem for a while (well, mostly) an I decided not to mention anything about my sexual history that wasn't strictly necessary.
That... wasn't really enough.
The thing about triggers is that they're sometimes hard to identify, because things very rarely happen one at a time. I mean, some triggers are obvious, but sometimes you can get triggered and as hard as you try to figure it out you can maybe narrow it down to a few things that happened in a small time-frame, but you won't know which one it was until it happens again in completely different circumstances.
And then there are triggers which happen at the same time as other triggers so often that you can't really tell the difference between them. As I said earlier I always figured that, when I had those tests in 2006, I was triggered by the penetration involved. And I was - penetration was something that it took a good few years to make my peace with, and those tests happened only months into my recovery. But there was also a second trigger that I didn't even consider, because the penetration trigger was an obvious problem, and everything else hat happened during those tests either never happened again or never triggered me in other circumstances.
So when it came to this exam, I was ready for the insertion of the speculum to be both uncomfortable and triggering. I went into the room focusing on how I would get through that. I got undressed behind the curtain, laid down on the table, covered myself with the paper covering I'd been given and called the nurse over, still focusing on getting through the whole penetration bit without incident.
The nurse came in an asked me to open my legs, and that's when it hit. Because there I was, vulnerable in front of someone I didn't know, and the last time I was that vulnerable in front of someone (who I did know), it didn't end well.
Even though I had something to hold onto (a small soft toy I always carry with me) and I was concentrating on breathing and staying relaxed, I was on the edge of tears just because of that extra trigger that I hadn't prepared myself for. And then I had to change position while the speculum was still inside me, which resulted in me dropping the toy (and burning my leg on the lamp that the nurse was using), and I just cried quietly for the rest of the procedure.
The nurse, bless her, told me that I could have just told her and not suffered through the procedure like that, but I've had enough bad experiences with medical personnel on this issue (i.e. the GUM clinic staff in 2009) and I really did not want to put myself through anything like that again (although, to this nurse's credit, she did add straight away that she understood that I might not have wanted to).
Anyway, having felt like hell for the last two weeks due to this, I would like to pass on the following tips which may be useful for getting through cervical screening and other gynaecological exams:
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[Note for new/non-readers: Just so you know where I'm coming from with this - between 2005-2006 I was sexually abused and raped, and as a result suffer from PTSD. I also suffer from depression and anxiety.]
I turned 25 about 6 months ago, which (in this part of the UK) means that I got a letter inviting me for cervical screening (previously known as a smear test). I couldn't go straight away, mainly because my ridiculously irregular period decided to turn up at the wrong time - an by "ridiculously irregular" I mean "medium to heavy bleeding for about a month, then around one week off before starting again". Of course, by the time it got to that one week, I'd forgotten about the letter, and I only ever saw the letter again when I was back on my period.
(By the way, I don't know why I have periods that can be measured in months. My old (now retired) doctor figured it was a reaction to the pill I was on when it started (Cerazette), and she must have been at least partly right, because my periods have been slowly getting shorter, but it's been over a year since I stopped taking it, and I was kinda hoping I'd be near to normal by now. But I digress.)
Anyway, after another letter and a phone call reminding me, I finally ended up going two weeks ago.
I went into this knowing pretty much what was going to happen - I had a smear test, general gynaecological exam and transvaginal ultrasound in 2006 (in an attempt to find out something about above-mentioned irregular bleeding) and I've also had various STI tests at a GUM clinic in 2009. Both times I ended up being triggered quite badly - with the 2006 tests I figured it was the penetrative aspect of it that was triggering, but with the 2009 tests I was triggered by having to explain my whole sexual history, so I as in a pretty big mess before the actual tests started. Because of this, I did my best to prepare myself for this cervical screening - penetration hasn't been a problem for a while (well, mostly) an I decided not to mention anything about my sexual history that wasn't strictly necessary.
That... wasn't really enough.
The thing about triggers is that they're sometimes hard to identify, because things very rarely happen one at a time. I mean, some triggers are obvious, but sometimes you can get triggered and as hard as you try to figure it out you can maybe narrow it down to a few things that happened in a small time-frame, but you won't know which one it was until it happens again in completely different circumstances.
And then there are triggers which happen at the same time as other triggers so often that you can't really tell the difference between them. As I said earlier I always figured that, when I had those tests in 2006, I was triggered by the penetration involved. And I was - penetration was something that it took a good few years to make my peace with, and those tests happened only months into my recovery. But there was also a second trigger that I didn't even consider, because the penetration trigger was an obvious problem, and everything else hat happened during those tests either never happened again or never triggered me in other circumstances.
So when it came to this exam, I was ready for the insertion of the speculum to be both uncomfortable and triggering. I went into the room focusing on how I would get through that. I got undressed behind the curtain, laid down on the table, covered myself with the paper covering I'd been given and called the nurse over, still focusing on getting through the whole penetration bit without incident.
The nurse came in an asked me to open my legs, and that's when it hit. Because there I was, vulnerable in front of someone I didn't know, and the last time I was that vulnerable in front of someone (who I did know), it didn't end well.
Even though I had something to hold onto (a small soft toy I always carry with me) and I was concentrating on breathing and staying relaxed, I was on the edge of tears just because of that extra trigger that I hadn't prepared myself for. And then I had to change position while the speculum was still inside me, which resulted in me dropping the toy (and burning my leg on the lamp that the nurse was using), and I just cried quietly for the rest of the procedure.
The nurse, bless her, told me that I could have just told her and not suffered through the procedure like that, but I've had enough bad experiences with medical personnel on this issue (i.e. the GUM clinic staff in 2009) and I really did not want to put myself through anything like that again (although, to this nurse's credit, she did add straight away that she understood that I might not have wanted to).
Anyway, having felt like hell for the last two weeks due to this, I would like to pass on the following tips which may be useful for getting through cervical screening and other gynaecological exams:
- When you make the appointment, ask if you can bring a friend with you (either to be in the room with you or wait outside) if you think that will help you.
- The only pieces of information the nurse/doctor need to know (apart from who you are) are if you're sexually active and if you have any relevant allergies. You do not have to disclose anything else unless you want to.
- Feel free to ask your nurse/doctor questions about the procedure and equipment before you start.
- If the doctor/nurse is going to use a metal speculum, ask them to warm it up slightly first - most good nurses/doctors will be happy (if it's possible) to do so. If they are going to use a plastic one, ask if they can use a small amount of water-based lube.
- You can ask the nurse/doctor to talk you through the procedure as they're doing it. Alternatively, you can ask them to talk to you about something other than the procedure, if you find that more helpful.
- Try to relax the muscles as much as possible.
- If you need to, use any grounding techniques that work for you - holding onto something, breathing exercises, anything.
- Take a pantiliner or sanitary towel with you, as many people bleed slightly after the sample is taken. I wouldn't really recommend tampons/mooncups/etc for this, as you may be slightly sore after the procedure.
- Be nice to yourself afterwards.
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