Sexual Violence, Posttraumatic Stress Disorder, and the Pelvic Examination: How Do Beliefs About the Safety, Necessity, and Utility of the Examination Influence Patient Experiences?

Center for Health Care Evaluation, Veterans Affairs Palo Alto Health Care System, Palo Alto, California 94025, USA.
Journal of Women's Health (Impact Factor: 2.05). 07/2010; 19(7):1271-80. DOI: 10.1089/jwh.2009.1673
Source: PubMed


Sexual violence and posttraumatic stress disorder (PTSD) have been linked to increased reports of distress and pain during the pelvic examination. Efforts to more fully characterize these reactions and identify core factors (i.e., beliefs about the examination) that may influence these reactions are warranted.
This descriptive, cross-sectional study examines the relationship between sexual violence, PTSD, and women's negative reactions to the pelvic examination. Additional analyses highlight how maladaptive beliefs about the safety, necessity, and utility of the pelvic examination may contribute to these reactions. Materials and
A total of 165 eligible women veterans were identified via medical record review and mailed a survey that assessed: (1) background information; (2) history of sexual violence; (3) current symptoms of posttraumatic stress disorder; (4) fear, embarrassment, distress, and pain during the pelvic examination; and (5) core beliefs about the examination. Ninety women (55% response rate) completed the survey.
Women with both sexual violence and PTSD reported the highest levels of examination related fear: chi(2) = 18.8, p < .001; embarrassment: chi(2) = 21.2, p < .001; and distress: chi(2) = 18.2, p < .001. Beliefs that the examination was unnecessary or unsafe or not useful were more commonly reported in this group and were associated with higher levels of examination-related fear and embarrassment.
Women with sexual violence and PTSD find the pelvic examination distressing, embarrassing, and frightening. Efforts to develop interventions to help reduce distress during the examination are warranted.

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    • "Additionally, many VHA providers have not been routinely caring for women during their VHA careers and lack the ability to provide gender-specific services (i.e., care that is dictated by gender, such as pelvic examinations and pap smears). Moreover, the prevalence of comorbid interpersonal trauma among women Veteran patients also creates challenges for delivery of comprehensive care as routine gender-specific examinations and procedures, such as pelvic exams, are often more difficult for these patients (Weitlauf et al. 2010). As a result, VHA has launched large-scale training programs to expand the capacity of providers to deliver comprehensive gender-specific care to women Veterans. "
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