As a fellow survivor, I understand your pain and frustration. I've found nurse practitioners to be the most gentle practitioners and gyns *only* (ie - no OB care) for me. I don't know why, but I saw a high-risk OB with my 2nd pregnancy, and he, while an excellent doctor in terms of my baby's care, was very rough.

I also have seen a couple of midwives, and I find them hit or miss. Most of my friends have had homebirths, and I tried the midwife they use, thinking she would be gentle and understanding. I found, though, that she was not considerate of my feeling at all, probably because she deals with women who deliver babies with no medical interventions.

One thing I generally caution against is sharing the abuse openly. I know common sense would seem to dictate sharing, but I've found that everything I say then becomes some pathology relating to the abuse. I would simply say that I have some concerns about gyn care and would like additional reassurance of gentleness rather than delving into the abuse (unless it's necessary to handle other issues you're having, of course).

Second everything Prof. Foxy said, and:

I am not an abuse survivor, but I have vaginismus, so I also require a very gentle, calming gynecologist.
My experience is that younger women practitioners have been the best, for me. Also, I ask questions with my pants on, like "can I insert and remove the speculum myself, at my own pace?" ask for the tiniest speculum, etc.
And honestly, when you see the doctor before taking off your clothes (which you should, or leave immediately) gauge how calming and understanding they seem and get up and leave if they don't meet your standards. I've had quite a few traumatic pap smears, and now, I'd rather be rude and leave.
Also, could you ask your former doctor for a referral?

It's all about the nurse practitioner, absolutely!!

Hi Vain.

I am also a sexual abuse survivor, although not childhood. My boyfriend when I was 17 repeatedly abused me sexually.

While I refuse to have annual pap smears, I have been to the gynecologist for health problems a handful of times. I can tell you what made me more comfortable the few times that I went.

All except a few times I have seen the same nurse practitioner. She was very open about discussing what happened to me and stopped any part of the exam that was painful. She also didn't force any part of the exams. The best part, however, was tht she allowed me to feel every instrument (the q-tips, little brush thingies, etc) that would be used to take cells from my vagina or cervix. And she set the exam table up so I was practically sitting up and could see everything that was happening.

Other than this one amazing NP, I have generally had bad experiences with female medical providers. I prefer to see a male gyn if I have to because they just seem more gentle--it almost seems like some women gynos know too well how much stretching and whatnot the vagina can physically handle and they forget that it can still hurt. One told me once that the speculum couldn't possibly hurt because it was smaller than a penis.

Like Aimee, I have had a few very painful exams. I agree--you should ask for the smallest speculum. I would also recommend a plastic one rather than metal. The metal always felt very sharp to me.

Don't ever let a doctor do something to you that you don't want her/him to do! You have the right to have your wishes respected in the utmost, especially with such a sensitive exam.

Grrr. This makes me mad.

Not at the questioner, or the commenters, and certainly not at Professor Foxy, but at my colleagues who can't seem to treat their patients as people first and body parts second.

Clinicians should never ask a new patient to get undressed before they meet. NEVER. I do sometimes have established patients change for Paps before I come in the room but my assistant offers them the option; if they have something they want to discuss, they can remain in their street clothes for the first part of the visit.

It also makes me profoundly sad to hear that there are still clinicians who haven't heard of vaginismus, and that it's not safe to disclose a history of assault. Just - sad. It shouldn't be like that.

I have nothing profound to add to Professor Foxy's wise advice, but felt compelled to speak up if only to say that some of us (even us MDs) are listening, and we're trying.

Do you live anywhere near Bowling Green, Kentucky? If so, I know the most amazing doctor there who does the most comfortable, considerate pelvic exams.

I would also suggest that you might even ask the office if the practictioner has any experience was abuse survivors.

(Only semi-related: While I can bear about any pain, I'm told I have a tilted uterus and a cervix that is unusually high. All docs except the one mentioned above have felt like they were plunging to my navel. OH GAWD.)

I have heard wonderful things about using midwives or nurse midwives for well-woman care and pelvic exams. Do an internet search for midwives in your area and see if there are any nearby. Not all midwives do well-woman care, but if you can find a good one, you're in luck. Even if their websites don't specify well-woman care, it can't hurt to call, explain your situation, and ask. Midwives tend to spend much more time with their patients, and some will even travel to your home to give you an exam on your own turf (if this interests you, look specifically for "home birth" midwives). Good luck in your search. I hope you can find a provider that you like!

I use a group of nurse-midwives who do both pregnancy and well-woman care, and they are FABULOUS! I love them--so caring, take so much time with me, always listen to my concerns. I can't say enough good things about them!

It would be a good idea to call a local crisis center for survivors of sexual assault and abuse. Not only could they probably connect you with a good doctor, as professor Foxy pointed out, but they might be able to send an advocate with you to the first appointment.

I'm a trained advocate, and usually we work with people who are dealing with something more recent, but I don't see why an advocate couldn't go with you for this.

You might check Vagina Pagina's gyn directory to see if there is anyone near you: http://community.livejournal.com/vaginapagina/4372021.html

It is also totally okay to call an office before you go to ask if the provider has experience with survivors of assault or abuse, and to let the know that you'd like a longer appointment time, to meet the doctor before hand, not to be touched a certain way... anything that is going to make you make you more comfortable and feel more in control.

Great advice professor F!

I would like to add the following:

I don't have issues with pelvic exams, but I have other past experiences that have left triggers for other medical procedures, so I have gone through the process of searching for the right medical provider.

First, you can go to your friends and ask them for recommendations, but you don't have to discuss past abuse if you don't want to. Just say you have a "phobia" about pelvic exams that is very strong, and you need someone who is more than just "gentle". While this is not exactly true, it does state the severity of the problem, while respecting your privacy.

For example, I have a very strong phobia about blood. While I'm not trying to compare my phobia to your abuse, I also need someone who can communicate with me, be patient, and who will totally respect my boundaries. More than just
"Being gentle". I'd recommend my doctor to you and maybe that way you would find someone appropriate even if we never discussed your history.

I also think that you will know if a doctor/nurse/midwife etc is the person you need by how that care provider acts during an non-traumatic procedure. Try the doctor out on a regular check up first. Do they take all the time you need to answer questions, or are they in a total rush? Do they stop to explain everything? Honestly, pretend you have a fear of needles and go get your flu shot. How does the doctor handle it?

I completely agree that even women without any fear or trauma often get treated terribly by doctors in gyno procedures. Women who need and deserve care and respect because of past experiences shouldn't have to put up with this disrespectful treatment.

Hope that helps. Best of luck and keep looking until you find the doctor who truly provides care and compassion. You are worth it.

I have been reading this site for around a year and I enjoy the comments discussion. I find it contains thoughtful and provocative insights. I prefer lurking and never imagined that I would participate as a "member of its community" or whatever.

HOWEVER. I'm just a little disturbed that it seemed that not a single person has responded to Mina's seemingly serious suggestion that kicking your doctor is an appropriate response to discomfort during a pelvic exam. Yeah, violence towards health care professionals is totally awesome!

If someone did that to me I'd put them in restraints so they wouldn't do it again...but that would be traumatic or something.

Also, does anyone find the concept of assaulting someone because they are "being too stupid to [sic] even look out for his or her safety" more than a little ironic coming from the perspective of an ABUSE SURVIVOR? I mean, it's one thing to have a reflexive response, but it's quite another to intentionally go ahead and whack someone because the HCP can't immediatafuckingly about-face elbow-deep in a spasming bear-trap vaegstrom.

Anyone who thinks that's OK deserves sub-standard health care.

I agree, inkredulus that in the course of a pelvic exam intentional violence against health care providers is unacceptable.

If I have understood the discussion thus far, the underlying sentiment behind Mina's comment was that patients should not feel helpless during pelvic exams. Honest communication and respect are important for both the doctor and patients in handling such sensitive visits. This particular woman obviously feels very vulnerable, and so I agree with Mina that the doctor must recognize such feelings and be accommodating(to the extent that is possible). If the patient feels uncomfortable with a particular physician, the patient should be entitled to terminate the examination.

Furthermore, you condemn Mina for suggesting violence, yet in your own comment, you dare suggest that people who are not fully cooperative with doctors be denied health care. The comment seems hypocritical and perhaps I would agree with you more if you didn't so obviously champion the health care professionals at the cost of patient autonomy and emotional well being.

my mother is a Nurse Practicion specilizing in OB/Gyn. so, i thought i would send on this question to her.

she basicly said what Foxy said, except she really strenously recommends NPs (no surprise). she strenously recommends PPs, or getting a referal from Planned Parenthood.

she also said that what she did, when she was looking for a Gyn for me when i first needed to see one, is she called around anonymously asking the people who worked for the various OB/Gyn people what the policies of the providers were towards those who had been sexually assulted/molested, and she also asked the people who worked with the provider how well the policies worked for the patients. she says that a lot of people call and ask questions of a provider without giiving names, and that there is no reason why you can't do this, and since you are being all Anon there is no reason not to tell them about the general situtation (assult survivor) and list your needs and concerns and get info. then call back later to make the appointment if you think that this specific provider will work, that way they don't connect you to the person who called wanting to know how they worked with those who have been assulted.

i wish you GoodLuck and a warm, non-painful speculum!

Hey, ummmm, let me qualify this. I was the person who sent in the question, and some more detail might help.

After the doctor was rubbing my external genetalia in a sexual way (which she claimed would ease the entry of the speculum when I said I was afraid of pain), then proceeded to wiggle the speculum up and down when I explained my bladder problems ("but this shouldn't hurt, right?" *prods speculum into enflamed bladder*), and continued the exam as though nothing was wrong after I screamed "STOP!", clasped my palms to my face, and started sobbing, I'm wondering why violence in the face of violence is so extreme.

I withdrew my consent, and she just continued. She had been belittling me all session, so this was par for the course, I suppose. After I got over the shock and horror (a few days later), yes, I wondered why I didn't punch her in the face and run from the room screaming about a doctor who had just sexually and physically mistreated me.

If somebody is continuing to touch you against your will, yes, I guess it's "traumatic or something". Somehow, I'm not convinced anything short of violence would have stopped this God-complex ridden practitioner from touching me inappropriately.

But, ya know, since I didn't fight back hard enough, I was "really asking for it" and "wanted it", right? And since I considered violence (long after I left the office) as a response to violence, I deserved it. Gotcha.

If I do say anything, it's my word against hers. Who is everyone going to believe? The prestigious doctor who was "just trying to help" or the "hysterical" abuse survivor? I think it's obvious.

For anyone who is experiencing rude, violent or otherwise incompetent healthcare, I highly recommend taking a friend with you. It's not just emotional support for the patient, it makes the healthcare providers much more likely to behave themselves, explain procedures and generally treat the patient like a human if there's a witness and potential patient advocate. If your friends are nervous about being the advocate, I can say that it's unlikely that they'll ever have to say a word - just my presence has been enough to ensure appropriate behaviour, more than once.

I will share my horrible experience with a nurse practitioner. I had gone in for STD treatment for an STD I caught from a sexual assault. I had not even met or spoken with the NP before she came into the room. I had only told the medical assistant briefly that I had been sexually assaulted and given an STD from it. As the nurse came walking in, she said "Oh I don't think you got this from that that! You probably got it before." She knew absolutely nothing about my sexual history. I had only had one sexual partner before the assault. I KNOW I didn't get it from my ex-boyfriend.

Anyways, I have since gotten an new NP and she has been extremely kind.

I also had a horrible experience calling a rape crisis counselor. The counselor actually asked me (again, without knowing anything about my sexual history, if I was sure that I hadn't gotten the STD before the assault.

Blithely,

I just read your comments. I am so sorry for the abuse that you suffered from that dr.! I had shared my story about how I a nurse practitioner was beyond rude to me, insinuating that I had gotten my STD before being sexual assaulted. Anyways, during the meeting I was just in complete shock that she said that, so I didn't even think of anything to say. I actually allowed her to go on and do the entire exam. I was just so incredibly shy and nervous about having the exam in the first place. Now it has been over a year, and I still think about it a lot. I wish I would have stood up for myself. I wish I would have gotten dressed and walked out of there.

Blithely, no you didn't want it!! You were just in a state of complete shock at what she was doing. Plus you were nervous for being so vulnerable as having your genitals exposed to the dr. That's how I felt. I was just in so much shock and so nervous that I just laid there and allowed her to do the whole exam.

I've also had trouble finding a healthcare provider for pap smears and other gynecology-related stuff. Far and away the best care I've gotten in this area has been from providers who work at clinics or doctors offices that are LGBT-friendly. They were the most willing to listen, far more sensitive to my concerns and didn't act like it was bizarre for me to be sexually active and still really uncomfortable during pelvic exams. I'm bisexual, so going to LGBT-friendly providers is important to me for other reasons as well, but it might be a good place to start looking for anyone who is searching for sensitive gynecological care. A lot of cities publish listings of LGBT-friendly healthcare providers - I would recommend checking those out as a starting point.

Ugh...this stuff makes me cringe. I just started my first year of med school (I'm leaning towards ob/gyn) and its appalling that there are doctors out there that act like this!

At the same time, I'm not a fan of some of this gyn bashing. They're not all bad people or forget that a patient is a human being. I will say that there are some procedures that cannot be safely stopped mid-procedure (e.g. a lumbar puncture). Granted, an insertion of a speculum is NOT one of those.

Please keep searching until you find the kind of OB/GYN you are looking for - they are definitely out there. Mine is an absolute saint. A few years ago I had a life-threatening health problem, and she was the only doctor (out of five) to correctly diagnose it. Because of that experience, I get very anxious when I feel any pain in my lower abdomen; she is extremely understanding and kind. A couple of times, I've called to make an appointment with one of her nurses, who always tell me that she is booked for months, but will speak to the doctor. When she has learned from her nurse that I am experiencing pain and I am very anxious about it, she made an appointment for me, that day, after all of her other appointments, and has stayed after the time she usually goes home in order to see me.

She is both an amazing doctor and an incredible person - an unfortunately rare combination, in my experience.

Wow, thank you to EVERYONE who has commented on this thread.

I am really anxious in medical situations, and have had only extremely unpleasant experiences getting gyn exams / pap smears. Reading your comments helped me realize how much power I can have in this situation to get info about my doc, express my needs, say "no" when something is too painful or not right, etc. It seems like common sense, but I guess I am just so used to the idea that doctors are authorities and that whatever they say, goes. So thanks everyone for making me feel a little more empowered about my body, and dreading my next checkup a tiny bit less!

Excellent advice except for one clause:
"Many people prefer one gender over the other...."
Come ON, Professor Foxy. What you mean is "many people prefer to get their pelvic exams from a woman." The only genders realistically available when one is searching for a doctor are male and female. Does any gyn patient prefer a male doctor? Someone upthread said that in her experience men were more gentle, but I've never heard anyone say she preferred to be examined by a man.

I myself am willing to accept a male gynecologist because men are less popular with patients and thus offer me a shorter waiting time. That's as close as anyone has ever come, I think, to preferring a man for a pelvic exam.

Small nit to pick: I wouldn't protest except that the rest of the answer is so honest and up front.

I suggest looking for a woman-run clinic. I've never had a bad gyno myself, but I've encountered a couple of really wonderful ones. The best was at a clinic in my hometown that employed only female doctors, and as far as I can tell, feminist doctors. My doctor was very gentle and considerate, let me know what she needed to do before doing it, and made what could have been an awkward experience actually pleasant. Instead of feeling weird about some stranger looking at my genitals, I felt good about taking care of my health and good about having a doctor who obviously considered women's health so important. I talked to her about getting on hormonal birth control and she listened to all of my concerns, gave me a ton of information, and actually recommended that I get an IUD after a few years (I was 19 at the time, and I'm told most doctors won't even discuss that with very young women.) She wrote a note to tell my insurance providers that my HBC was for treating dysmenorrhea (true, but not the only reason) to help avoid any difficulty getting it covered, because some insurance companies are stupid about that. She was simultaneously very professional and pro-woman.

The doctor I see at my university's clinic is also good, but occasionally I run into an uncomfortable spot. Yes, I think it's neat to be handed the mirror and allowed to see what she's looking at. No, I don't need commentary about what a lovely pink color my cervix is. "Everything looks healthy" is good enough for me. She also tends to look at me with concern if I refer to having multiple sexual partners, no matter how clear I am about using safer sex measures and getting tested regularly.

I am so glad that so many people are discussing this topic. I work as a medical assistant at Planned Parenthood and it's remarkable the amount of patients who tell me about their horror stories of OB/Gyn providers they have had in the past. I would highly recommend calling your local PP. Most of us use Nurse Practitioners, most of whom are female and we already have experience with a more diverse range of situations since we treat many uninsured women.

I am concerned about the amount of commenters who seem to be recommending that the woman who wrote in with the original question just stop getting routine pap smears altogether. Practitioners are well aware of the fact that BC doesn't have anything to do with a pap, but it is bad medical practice to continuously prescribe medication to a patient without routine checkups. First of all, it can take multiple years after contact with HPV before anything shows up in a pap, so being in a relationship doesn't necessarily mean that a pap is not important. Also, there are usually no signs of cell changes in the cervix before it progresses to cancer. Cervical cancer should be an entirely preventable disease, yet it kills many young women every year. If people personally don't want to get pap smears, that's fine. However, it bothers me that women would be recommending against it to a woman who is clearly interested in pursuing routine Gyn care.

Until recently I've only had painful exams - a couple of which the doctor couldn't even complete. For my last exam, however, I went to a nurse practitioner who was extrememly patient. It was just a quirk of my anatomy that made the exams difficult in the past. I think the difference was that she spends most of her day doing pelvic exams while the doctors and nurses I went to in the past did them only occasionally. When it comes to recognizing and overcoming potential challenges with a patient, experience matters a lot. I would never recommend that people go to their general practitioner for a pelvic exam, especially not the first one. After my exam, the nurse explained why they had probably been difficult in the past and what to tell anyone who does my future exams so they can bypass all the uncomfortable trial and error. That was very empowering.

While I don't have specific memories (I hardly remember any of my childhood), I have many of the symptoms that go along with past sexual abuse, and a family situation that would make it very likely. Whatever the reason, pelvic exams are revolting to me and very triggering. I've only had two so far, but I wanted to say a bit about them.

I was finally forced to get a pap smear after negotiating with doctors for two years to keep prescribing me BC. The experience was terrible. The (female) doctor dismissed my concerns entirely. I had to undress before I actually met the doctor (I thought it was standard procedure, so I didn't protest), which made me feel vulnerable and unable to be forceful about my treatment. I had to sit in a chair that was raised to standing eye-level, which made me feel like a specimen. The doctor wouldn't perform the exam by herself, and a nurse stood by and stared at my crotch the entire time. Then, the doctor proceeded to use two fingers to perform the pelvic exam (all the while commenting on how it looks/feels). The whole process between my legs took about ten minutes. During the breast exam, she sort of chuckled and said, "you really don't like this, do you?" I wanted to say something to her, but I was too busy trying to keep myself from sobbing.

Flash forward to today, nearly two years after that. I'd been dreading the exam for weeks, but was again required to go to refill my prescription. I decided to make my needs very clear to the doctor this time, and to leave if anything didn't feel right. The most important thing I did this time was bring my boyfriend of four years with me. He's a sweetheart and, knowing a bit about my history, offered to go with me. He told me that before I got undressed for the exam, he would ask me if I was comfortable, and that I should answer him honestly so that the doctor could hear. I also told him beforehand what things I needed to have done to make me feel okay with the exam, so that he wouldn't let me forget to mention them and wouldn't allow the exam to proceed without the doctor agreeing to them. He made a great advocate, and it made me feel safe knowing he was there.

So, once at the appointment, the nurse did the typical questionnaire and then told me to get undressed. I refused and said that I wanted to speak to the nurse practitioner before the exam began. She was extremely understanding. She understood very quickly that something was "off" a bit, and treated me very gently. She told me right away to remember that I was in control, and that if I needed her to stop, she would. She didn't protest when I told her that I wanted to leave my upper half in my street clothes, instead of the paper gown. She did the breast exam right underneath my shirt, and it made me feel much less vulnerable to be allowed to stay partially clothed.

Another thing I loved about this appointment was that she didn't require someone else in the room. The other woman refused to do it by herself, and this one was just fine with it. It felt so much better to have only one person looking at me. To make me comfortable, she told me before she touched me anywhere. She also touched the speculum to my thigh first, so I would be comfortable with it. When the pap was over and it was time for the pelvic exam, she only used one finger, and it took only around 30 seconds. The entire exam couldn't have lasted more than three minutes.

I really can't believe how much better this appointment was than the last one. I cried for three days after seeing the previous doctor. I remember feeling probed and violated, but this time there were no negative feelings afterward.

I know this is a long, fairly disorganized post, but I don't have the time to correct it. I just wanted to share a few things that made my experience better.

Make sure you rate and review the good docs and not-so-good docs on Tinkn.com

I've never had a particularly bad gyn experience, but I did go to a midwife for my most recent appointment and it was so much better. It just seemed so much less medical, and she went out of her way to talk to me, explain everything, and make sure I was comfortable. She also said that I was part of a "low-risk" group for cervical cancer (previous normal pap smears, no family history, less than 5 sexual partners), so I only need them every 3 years. Obviously not every midwife will be the same, but they do seem to take a more holistic approach and take more time with each appointment.