Distress and Pain During Pelvic Examinations Effect of Sexual Violence

Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, United States
Obstetrics and Gynecology (Impact Factor: 5.18). 01/2009; 112(6):1343-50. DOI: 10.1097/AOG.0b013e31818e4678
Source: PubMed


To estimate the range and severity of distress and pain during pelvic examinations among female veterans with and without histories of sexual violence, and to examine whether posttraumatic stress disorder explains additional variance in examination-related distress and pain above that accounted for by exposure to sexual violence.
We employed a cross-sectional cohort design in which 67 selected female veterans completed self-administered questionnaires to assess history of sexual violence and experiences of distress and pain associated with the pelvic examination. A subsample of 49 completed an assessment for posttraumatic stress disorder approximately 2 weeks later.
Distress associated with the pelvic examination was highest for women with prior sexual violence and posttraumatic stress disorder (median 5.49), next highest for women with sexual violence only (median 2.44), and lowest for women with neither (median 0), P=.015. Higher ratings of pain were also found among women with sexual violence (median 2.5) compared with those without (median 0), P=.04. However, posttraumatic stress disorder was not linked with increased pain from speculum insertion beyond that accounted for by sexual violence; limited power may have precluded detection of this effect.
Distress and pain during pelvic examinations may indicate a history of previous sexual violence, particularly in those with posttraumatic stress disorder. Extra sensitivity to the special needs of this population is warranted and may contribute positively to the quality of patients' experiences.

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    • "Indeed, a substantial majority of women returning from Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) are younger than 45 years of age, and are in their reproductive years. Some research has examined women's experiences with reproductive health, including contraception care (Borrero et al., 2012), gynecological care (Weitlauf et al., 2008; Frayne et al., 1999), and pregnancy outcomes (Mattocks et al., 2010; Chireau, Salz, Brown, & Bastian, 2006; Kang et al., 2000), but VHA maternity and delivery care has largely been unexplored (Bean-Mayberry et al., 2011). "
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    • "It is possible that previous unpleasant and painful experience of events could continue to haunt their psychological wellbeing and as such could provoke a negative response and attitude towards TVU, as demonstrated in this study. This observation is in tandem with other studies that have established an association between women’s resentment to pelvic examination in relation to their previous sexual violence.16,17 The perception of ultrasound as a painful procedure sounds interesting as the women’s conclusions from mere visualization of TVU in this study speak volumes of clients’ notions and perspectives towards medical investigations and treatment. "
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