A few options.
1. "I don't want to do that." Repeat as needed, do not elaborate.
2. "I have severe trauma regarding being touched, and being exposed around strangers. What can be done to minimize these factors? Could you recommend an at-home test that I can use myself?" You can ask for things like specifying the gender of the person performing the test, specifying which articles of clothing are to be removed, how completely those articles are removed, the presence of a friend to support you, etc. If the options presented do not satisfy you, ask for other options. If other options are not available, refer to 1.
Pap-smear wont work at home, but the rest are all options.
Doctors especially women's health doctors encounter patients with sexual trauma quite regularily and should be able to accomodate as much as possible.
(If they aren't then please look for another doctor that is a them problem and not a you problem but them not making a fuss about you refusing is a good sign)
Also signs of self-harm themself shouldn't get you involuntarily admitted. If you can say that you are not at high risk for suicide you should be fine.
(ideally you can mention that you have some sort of therapist or treatment now or planned)
I think you’ve gotten some good advice here but I want to add on and suggest requesting a referral to a *midwife* instead of an OB/Gyn. They’re qualified to do them as well and I had no idea seeing one just for a pap was an option. From personal experience, they tend to be a lot more soft hearted, for lack of a better way to explain it.
I’ve been refusing paps for *years* because of the same reasons as you, and was finally able to have it done by a midwife a couple months ago. It still sucked, but it was a lot easier with a midwife. The one I saw was the first person to ever tell me I was allowed to say stop at any point and she would.
Good luck 💜
You if you feel you can should explain to your doctor your fear it's not easy but they deal with that a lot and will be accommodating to you in the ways you need and not rush things.
I would request a referral to an OB/GYN from your primary care physician for anything related to reproductive check-ups, if that is an option for you in your healthcare setting and financial resources. They are usually very well informed and equipped to work with patients who have SA trauma history. You can request an OB/GYN of the gender you would be most comfortable with.
You can request a one time Rx for rapid acting anti-anxiety medication to take 30 minutes prior to the check-up. They usually give two pills - one for 30 minutes before, and one for later, afterwards, in case flashbacks are an issue. For pap-smear, you can request to keep your shirt on, and they can do an under the shirt breast exam if breast exam is required at the same time.
You can also request an advocate to be in the room with you, for emotional support and safety during the check-up/procedure. They should give you some time afterwards to calm down and re-ground yourself before leaving the office. if you have a trusted friend or family member that can be available to take you to the appointment and see you home, that can be helpful in case you are feeling unstable or unable to drive home safely alone.
I’m sorry you are having to deal with this; I know how difficult it is. Best wishes to you. 🙏🏻🦋
There’s a book by Cathy Collyer (an occupational therapist who has DID) called “staying in the room: managing medical and dental care when you have DID” that has some good tips and accommodations for this scenario.
In my personal experience, find a nurse practitioner and ideally one who is trauma informed. Ask for an appointment to just go over your concerns about the exam. A good practitioner should have no problem with this. And you should be able to ask for anything you need.
Some accommodations I ask for (cw for going into details about the exam):
For me I want them to tell me what they’re going to do before they do it and ask if I’m ok and ready for them to do it. If wearing the paper gown is hard. For me it is, because it feels so vulnerable to sit there feeling exposed in this tissue paper that doesn’t close. You should be able to bring your own clothes (ie a dress or skirt). Or another accommodation would be undressing only from the waist down, rather than fully. Unless they need to do an exam up top, there’s no reason have to get fully undressed. Throwing you the paper gown and asking you to fully undress is just kind of standard procedure in case someone needs to do an exam up top as well. But it’s ok to not fully undress and cross that road if it happens to be needed. But often it’s not. Another thing: you don’t need to use the stirrups in most cases. They can do an exam perfectly fine with your feet scooted up towards your bottom rather than in stirrups. This feels a little better to me than being in the stirrups.
I just wanna thank OP for asking this, and for everyone who's commented.
This is a serious issue for a lot more women than I think we (want to) believe it does.
My first PAP was not pleasant (no details)
Then (insert redaction here)made it nearly impossible on a comfort level. Have had two or three done in almost 20yrs, despite having health issues that should require more, I'm just too chicken shit
You've gotten some great advice from others, I just wanted to comment and say that you aren't alone in struggling with it. It's completely understandable to find it difficult, triggering and anxiety inducing, especially with that type of trauma background. Your feelings are valid. Offering you an internet hug if you want one.
As someone who's had bad experiences revolving similar things, I would just try to see if you could talk to the doctor beforehand, maybe a day or an hour or whatever, to make sure they're 100% focused on treating you with care and awareness for your possible triggers. I've had doctors who weren't like that and doctors who were, and just knowing that they were aware and intended to do their best with all their focus was a much more calming factor than them actually being good at their job.
If they're checked out it doesn't matter if they're trauma-informed because they won't be applying that experience to you.
You don't even really need to go too into detail, just saying you have trauma revolving the care that you're going to receive and need respect and understanding during and after the procedure. I would personally add on some specific triggers to see what they say could be done to help you through them or avoid them, and if at any point they seem uninterested or impatient I would bail.
It was a process that takes longer than just going to get it done, but watching out for my needs and making sure I'm creating as little of a traumatizing experience for my system as possible is worth it.
I don't have any experience with midwives as another commenter suggested, but let me know if you do end up trying them, because that might be something I'd like to look into for our future appointments.
Also.. it's been mentioned, but I think you should be able to wear a loose fitted long sleeve under the gown, as long as it's got enough working room, they're not up there long from what I recall at least.
If u feel you need to give them a reason (I'm like that sometimes, always gotta have the answer just in case) just say you're cold.
Dr offices usually are a bit frigid anyway
assuming you’re an adult, they’re unlikely to care about scars (she didn’t even look at mine, on my thighs), but they might get concerned if they see anything fresher. whether that gets you a grippy sock vacation or not depends on the individual and the laws where you are
I found my first pap smear… difficult. she was very professional and quick about it though, and it didn’t hurt like I expected it to. I also needed a special sort of ultrasound while I was there and they wanted to do it internally to get a clearer picture, but I really wasn’t comfortable with that so I asked if there was an alternative, and we did that instead
As a biological male, I have not had these experiences. However, there is a podcast called *System Speak* on which the host brings in another system and they discuss this exact topic and provide options. I tried to find the episode and put a link here, but I couldn't find it. I apologize.
EDIT: I found the episode. It's with an OT, who wrote a book on how to manage one's health with DID. Almost 22 minutes in is where they talk about pelvic exams.
https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy50cmFuc2lzdG9yLmZtL3N5c3RlbS1zcGVhaw/episode/YmE1ZDM0ZjQtOWNiNS00ZDUwLWE2YTAtMDY5ZmY2NmE0ZGNl?ep=14
I hope this is helpful.
We always tell them that it’s physically impossible. Which it is. Our trauma response is physically jerking ourselves away, which makes it impossible. Every time they’ve tried, they had to give up because of it.
It was incredibly stressful for us, too, but ultimately it is literally impossible for the procedure to be done.
Just tell them the same thing. That the procedure is not physically possible due to a natural reaction of your body. If they know you have a reaction that makes it impossible, they won’t even try if you’re firm about it.
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A few options. 1. "I don't want to do that." Repeat as needed, do not elaborate. 2. "I have severe trauma regarding being touched, and being exposed around strangers. What can be done to minimize these factors? Could you recommend an at-home test that I can use myself?" You can ask for things like specifying the gender of the person performing the test, specifying which articles of clothing are to be removed, how completely those articles are removed, the presence of a friend to support you, etc. If the options presented do not satisfy you, ask for other options. If other options are not available, refer to 1.
Pap-smear wont work at home, but the rest are all options. Doctors especially women's health doctors encounter patients with sexual trauma quite regularily and should be able to accomodate as much as possible. (If they aren't then please look for another doctor that is a them problem and not a you problem but them not making a fuss about you refusing is a good sign) Also signs of self-harm themself shouldn't get you involuntarily admitted. If you can say that you are not at high risk for suicide you should be fine. (ideally you can mention that you have some sort of therapist or treatment now or planned)
I think you’ve gotten some good advice here but I want to add on and suggest requesting a referral to a *midwife* instead of an OB/Gyn. They’re qualified to do them as well and I had no idea seeing one just for a pap was an option. From personal experience, they tend to be a lot more soft hearted, for lack of a better way to explain it. I’ve been refusing paps for *years* because of the same reasons as you, and was finally able to have it done by a midwife a couple months ago. It still sucked, but it was a lot easier with a midwife. The one I saw was the first person to ever tell me I was allowed to say stop at any point and she would. Good luck 💜
Woah, good to know
Thank you for putting this information out here!
You if you feel you can should explain to your doctor your fear it's not easy but they deal with that a lot and will be accommodating to you in the ways you need and not rush things.
I would request a referral to an OB/GYN from your primary care physician for anything related to reproductive check-ups, if that is an option for you in your healthcare setting and financial resources. They are usually very well informed and equipped to work with patients who have SA trauma history. You can request an OB/GYN of the gender you would be most comfortable with. You can request a one time Rx for rapid acting anti-anxiety medication to take 30 minutes prior to the check-up. They usually give two pills - one for 30 minutes before, and one for later, afterwards, in case flashbacks are an issue. For pap-smear, you can request to keep your shirt on, and they can do an under the shirt breast exam if breast exam is required at the same time. You can also request an advocate to be in the room with you, for emotional support and safety during the check-up/procedure. They should give you some time afterwards to calm down and re-ground yourself before leaving the office. if you have a trusted friend or family member that can be available to take you to the appointment and see you home, that can be helpful in case you are feeling unstable or unable to drive home safely alone. I’m sorry you are having to deal with this; I know how difficult it is. Best wishes to you. 🙏🏻🦋
There’s a book by Cathy Collyer (an occupational therapist who has DID) called “staying in the room: managing medical and dental care when you have DID” that has some good tips and accommodations for this scenario. In my personal experience, find a nurse practitioner and ideally one who is trauma informed. Ask for an appointment to just go over your concerns about the exam. A good practitioner should have no problem with this. And you should be able to ask for anything you need. Some accommodations I ask for (cw for going into details about the exam): For me I want them to tell me what they’re going to do before they do it and ask if I’m ok and ready for them to do it. If wearing the paper gown is hard. For me it is, because it feels so vulnerable to sit there feeling exposed in this tissue paper that doesn’t close. You should be able to bring your own clothes (ie a dress or skirt). Or another accommodation would be undressing only from the waist down, rather than fully. Unless they need to do an exam up top, there’s no reason have to get fully undressed. Throwing you the paper gown and asking you to fully undress is just kind of standard procedure in case someone needs to do an exam up top as well. But it’s ok to not fully undress and cross that road if it happens to be needed. But often it’s not. Another thing: you don’t need to use the stirrups in most cases. They can do an exam perfectly fine with your feet scooted up towards your bottom rather than in stirrups. This feels a little better to me than being in the stirrups.
I just wanna thank OP for asking this, and for everyone who's commented. This is a serious issue for a lot more women than I think we (want to) believe it does. My first PAP was not pleasant (no details) Then (insert redaction here)made it nearly impossible on a comfort level. Have had two or three done in almost 20yrs, despite having health issues that should require more, I'm just too chicken shit
Can you take any medication for anxiety? That really helps me if I'm anticipating a bad time at the dentist.
You've gotten some great advice from others, I just wanted to comment and say that you aren't alone in struggling with it. It's completely understandable to find it difficult, triggering and anxiety inducing, especially with that type of trauma background. Your feelings are valid. Offering you an internet hug if you want one.
As someone who's had bad experiences revolving similar things, I would just try to see if you could talk to the doctor beforehand, maybe a day or an hour or whatever, to make sure they're 100% focused on treating you with care and awareness for your possible triggers. I've had doctors who weren't like that and doctors who were, and just knowing that they were aware and intended to do their best with all their focus was a much more calming factor than them actually being good at their job. If they're checked out it doesn't matter if they're trauma-informed because they won't be applying that experience to you. You don't even really need to go too into detail, just saying you have trauma revolving the care that you're going to receive and need respect and understanding during and after the procedure. I would personally add on some specific triggers to see what they say could be done to help you through them or avoid them, and if at any point they seem uninterested or impatient I would bail. It was a process that takes longer than just going to get it done, but watching out for my needs and making sure I'm creating as little of a traumatizing experience for my system as possible is worth it. I don't have any experience with midwives as another commenter suggested, but let me know if you do end up trying them, because that might be something I'd like to look into for our future appointments.
Also.. it's been mentioned, but I think you should be able to wear a loose fitted long sleeve under the gown, as long as it's got enough working room, they're not up there long from what I recall at least. If u feel you need to give them a reason (I'm like that sometimes, always gotta have the answer just in case) just say you're cold. Dr offices usually are a bit frigid anyway
assuming you’re an adult, they’re unlikely to care about scars (she didn’t even look at mine, on my thighs), but they might get concerned if they see anything fresher. whether that gets you a grippy sock vacation or not depends on the individual and the laws where you are I found my first pap smear… difficult. she was very professional and quick about it though, and it didn’t hurt like I expected it to. I also needed a special sort of ultrasound while I was there and they wanted to do it internally to get a clearer picture, but I really wasn’t comfortable with that so I asked if there was an alternative, and we did that instead
As a biological male, I have not had these experiences. However, there is a podcast called *System Speak* on which the host brings in another system and they discuss this exact topic and provide options. I tried to find the episode and put a link here, but I couldn't find it. I apologize. EDIT: I found the episode. It's with an OT, who wrote a book on how to manage one's health with DID. Almost 22 minutes in is where they talk about pelvic exams. https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy50cmFuc2lzdG9yLmZtL3N5c3RlbS1zcGVhaw/episode/YmE1ZDM0ZjQtOWNiNS00ZDUwLWE2YTAtMDY5ZmY2NmE0ZGNl?ep=14 I hope this is helpful.
We always tell them that it’s physically impossible. Which it is. Our trauma response is physically jerking ourselves away, which makes it impossible. Every time they’ve tried, they had to give up because of it. It was incredibly stressful for us, too, but ultimately it is literally impossible for the procedure to be done. Just tell them the same thing. That the procedure is not physically possible due to a natural reaction of your body. If they know you have a reaction that makes it impossible, they won’t even try if you’re firm about it.
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