I've been abused, but I have to have a pap smear.

Hello Rose,

You’ve come to the right place for advice. You deserve love and care in your life, and I’m sorry someone broke your trust and abused you as a child. I hope that as an adult, you have lots of strong friends and supporters around you, not just in the context of going to the doctor, but for life in general.

I also want to say that I am so sorry that your last exam was so horrible. Treating a patient the way that doctor did is not standard practice, normal or okay. What you have described also sounds like an abuse⁠ (abuse: Purposeful harm or mistreatment of another person, which can be verbal, emotional, physical or sexual. An ongoing pattern or cycle of such mistreatment or harm can characterize an abusive relationship.) , medical abuse, in particular. If you are able and open to it, you may want to consider filing a report with the patient advocate at that facility, or with the board that oversees medical licensing in your area — yes, even though it’s been a couple of years. If you want help sorting out⁠ (out: Short for ‘out of the closet’. When someone’s LGBTQ+ identity is known to other people.) where and how to do that, we’d be happy to help you via any of our direct services. You might also consider talking to a lawyer. But if that isn’t something you want right now, or you don’t feel up to that, that’s okay, too.

I’m glad you recognize you need gynecological care to address health issues, especially if you think you have a yeast infection⁠ (yeast infection: An infection of the vagina caused by an overgrowth of the yeast Candida albicans, which naturally lives on the body. (candidiasis)) , which needs to be treated ASAP. (By the way, you don’t need an internal exam for a yeast infection, and you can see your regular primary care provider for it!)

As for your other very important concerns, let’s start here: Sometimes people use the terms “pap smear⁠ (pap smear: A medical test (sometimes called a pap test) done by swabbing the cervix which checks for changes/abnormalities of the cervical cells. It can be used to identify changes to those cells due to HPV or cancer or which could lead to cancer.) ” and “pelvic exam” interchangeably, or don’t realize the smear is not necessarily a required part of a pelvic exam. And a gynecology appointment doesn’t always require the internal component of the pelvic exam. Heather’s detailed breakdown of what should happen at a gynecological appointment and pelvic PT Caitlyn Tivy’s guide to pelvic exams have more information on this topic.

If you’re stressed out about the potential for a pap smear, you probably did not need a pap smear and may not need one now, either. This test involves a swab of your cervix⁠ (cervix: The opening to the uterus, the bottom of which is at the back end of the vagina.) to see if there are abnormal cells indicating that you have human papilloma virus (HPV⁠ (HPV: Human papillomavirus, a very common sexually transmitted infection with more than 40 HPV types.) ) or cervical cancer, and would usually only be recommended if you’d had vaginal sex⁠ (sex: Different things people choose to do to actively express or enact sexuality and sexual feelings; often this involves genitals, but not always. ) or abuse that included your vulva⁠ (vulva: The name for the external genitals of people assigned female at birth. The vulva includes the mons, external clitoris, inner and outer labia, fourchette and perineum.) . The pap smear wouldn’t help screen for ovarian cysts or cancer, or help a provider learn more about your period⁠ (period: The fluid – or flow – which contains blood, from the shedding of the uterine lining usually at the end of each menstrual cycle. Sometimes periods may be less fluid and more globby; this is the state that is often mistaken for blood clotting.) . If your provider recommends one, you can ask for clarification or decline it.

Talk it out: Therapy is part of your healthcare too!

If you are not in therapy for help with your childhood sexual⁠ (sexual: About or relating in some way to sex or sexuality.) abuse and medical trauma⁠ (trauma: A serious or critical physical and/or emotional injury or physically and/or emotionally painful experience.) , I think your number one step should be doing just that. A therapist can help you process and work with you to help you learn how to manage your feelings and fears, with things such as talking, breathing exercises, meditation, and visualization. Therapy can help you lead your best life and can be incredibly useful for preparing for your exam; if you can’t talk or think about this without cry, a pro can also help you figure out how to have these conversations.

You’ll want to look for a trauma-informed care provider who’s familiar with supporting patients like you. Your local rape⁠ (rape: When one person does a sexual act to, on, or inside another person who does not want to participate; who refuses to participate and/or who does not or is unable to fully and freely consent to take part in that activity.) crisis center may have recommendations. You can also try searching for “trauma-informed therapist” in your area or consult an organization such as the International Association for Resilience and Trauma Counselingexternal link, opens in a new tab. A therapist may not always use the term “trauma-informed,” but may specify that they specialize in trauma, childhood sexual abuse, post-traumatic stress disorder (PTSD), sexual assault⁠ (sexual assault: When someone is attacked, or attacks someone else, in a sexual way.) , or related topics. Checking out bios on their websites can provide a lot of great clues into whether someone is really a good fit, including whatever gut feelings you have just reading those bios. Your instincts are so valuable in choosing the right therapist for you. Sometimes simple word of mouth to find a provider is best, especially if you belong to a support group or online community, such as our message boards, for people who share your life experience (something I also recommend!).

Therapists can use a wide variety of modalities, such as eye movement desensitization and reprocessing (EMDR), cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), and good old-fashioned, talk therapy. Read up on your options to see if one in particular appeals to you. The American Psychological Association is a great place to startexternal link, opens in a new tab. Therapists usually start with an initial intake appointment where you just talk with the them about your goals and how they approach therapy to see if they’re a good fit before you really dig in to talking more deeply. It’s always okay to say “thanks, but no thanks” and search for another provider if and when someone doesn’t feel right. It’s also okay to terminate a relationship⁠ (relationship: An ongoing interaction or association with another person, place or thing.) with a therapist at any time if you don’t like how things are going.

Before your appointment

We’ve come a long way when it comes to caring for people who have experienced childhood sexual abuse, not just when it comes to gynecological exams, but in terms of whole health care. Providers are starting to get education about this in school and can pursue additional training and certifications on their own. There are people out there who are prepared to give you the time and respect you deserve.

Dealing with healthcare providers can be intimidating — we have a whole guide on doing just that with self-advocacy tips and other information you can use. You definitely want to see someone who specializes in gynecological care who can address your clinical concerns. If you have a primary care provider, that person may have recommendations, and you can also use the resources on trauma-informed care above. Consider calling offices directly to ask how they care for patients who have experienced child sexual abuse or medical abuse, specifically with gynecological exams. If you know you want a friend or advocate in the room with you, ask about that as well, since not all practices allow it.

When you make an appointment, you can stress that as someone who has experienced child sexual abuse, has medical trauma, and also has several medical issues to discuss, you will probably need more time in your appointment than the average patient. If you prefer a specific provider, say so. If you’re okay with working with any provider in the practice, but want someone of a particular gender⁠ (gender: Characteristics that are seen or presented as distinguishing between male and female in a society. Gender may or may not include assigned or chosen: social roles, feelings, behaviors and/or presentation or appearance.) or other group, you can ask for that as well. Consider asking for an end-of-day appointment, when your provider may be able to better accommodate running a little over, if necessary, and the practice will be quieter.

What to expect at your appointment

You can start again by mentioning your history before you go over the reasons you are in the office and your goals for the appointment. You can mention that you have never had vaginal intercourse⁠ (vaginal intercourse: When a penis or sex toy is inserted into and held by the vagina while partners move their bodies as feels good to them for the purpose of either sexual stimulation and/or reproduction.) or used any toys in your vagina⁠ (vagina: The internal passage leading from the opening of the vulva to the cervix of the uterus.) . Definitely tell the provider that your last examination was painful, nonconsensual, and traumatic. A lot of the pain you experienced during that last exam may have been associated with your emotional trauma and stress, which can make it hard to relax for an already uncomfortable examination and is a good reminder for the provider to take it slow (they also can often offer you medications in advance for fear and anxiety if you like), but it could also be a sign of another medical issue that the provider needs to consider, such as vaginismus.

You can decline something, request an alternative, ask to pause at any time, or stop altogether. This is your body! If a provider or their staff pressures you in any way, that’s not a safe or good practice to be in, even though they may explain, and rightly, that declining certain care or procedures could interfere with the ability to correctly diagnose you or determine the best treatment option. In that case, that conversation could include a negotiation to discuss alternatives (including a different provider), accommodations, or other ways for moving forward with the recommended or needed care.

If you’re bringing an advocate, talk with that person ahead of time about your concerns and tell them about the support you need, because they can and should stop the exam if you’re feeling unsafe, and their support should help you feel more comfortable and confident. You might want to consider a counselor or friend who is willing to be more assertive⁠ (assertive: To be self-assured, self-confident. To stand up for oneself in a positive, nonviolent way.) . They can just be there, talk to distract you, hold your hand, do deep breathing with you, or help you advocate with your provider, especially if you’re starting to feel shut down, disoriented, or upset. They should back you up if you say, “Can you explain?” “Can we slow down?” “Is there an alternative to this?” or simply “stop” or “no.” If they need to, your helper can push the doctor away or call for help.

If your doctor recommends follow-up appointments and testing, a lot of this advice will be useful there too. Whether you are getting an ultrasound to check on ovarian cysts or seeing a pelvic floor therapist to address pelvic pain, all of these providers should also go slow, listen to you, respect your past, and stop at any time if you need a break. Remember: you always have the right to ask for an escort, another provider, or a different approach to the procedure, exam, or test.

You did it!

I’m proud of you for making it through this very long advice, and for taking control of your gynecological health: Getting this immediate care, and ongoing wellness care, will help you lead a healthier, happier, longer life.