Coping with Medical Procedures

Survivors of child abuse and sexual assault frequently report difficulty with medical procedures.

As many survivors are so painfully aware, losing control of our bodies through illness and medical treatment can cause anxiety and stir up other feelings related to our initial victimization.
Preparing for Medical Treatment by Diane Norman

Gynecological and dental procedures are most commonly reported as problematic due to the vulnerable body position but also the necessary touching involved in these procedures that may be very similar to events that the survivor experienced during the abuse. As explained in Pregnancy & Giving Birth - One Survivor's Pre-Maternal Odyssey by Kate Mayer and Helping Survivors of Sexual Abuse Through Labor by Jennifer Burian giving birth can be particularly traumatic for a survivor.

A survivor's reluctance to go to the dentist may stem from several causes.  For one thing, many survivors of sexual abuse develop eating disorders, and both bulimia and anorexia can cause severe damage to the teeth. According to Turkus, shame about the abuse is often compounded by shame about being bulimic.  As the survivor lets years slip by without a dental exam or professional cleaning, the delay itself becomes an added source of shame...Another reason survivors may put off routine dental care is low self-esteem.  Individuals who don't believe they're worth taking care of are less likely to make regular visits to the dentist or the physician.  In those instances, as self-esteem grows, the ability to take care of such basic needs grows.
Taking Care of Dental Health by Suzanne Scott and Lynne M. Constantine

However, all medical procedures are potentially distressing. Being alone with the doctor (often male) can be very difficult for someone who was abused by a male. Coping with the doctor as an authority figure is also a challenge for survivors who were abused by an authority figure such as a parent or step-parent. When the medical procedure involves a vulnerable body position and/or touching, the potential for distress is high. Reports of flashbacks, dissociative episodes, panic attacks, headaches, stomach aches, etc. are common.

Another issue survivors face when seeking medical care is whether and when to disclose the history of abuse. As suggested in Somatic Symptoms and Medical Conditions Frequently Found in Adult Survivors of Childhood Sexual Abuse by Christine Hennig and Common Names and Symptoms of Some Abuse Related Illnesses by Jason Black, survivors commonly suffer from a number of medical problems. The history of abuse or sexual assault can be a significant factor in the doctor's ability to properly diagnose and treat the survivor.

However, most survivors hesitate to reveal their history. Not only is the rush of a busy medical practice unlikely to produce an emotionally safe environment for such disclosure, many survivors have reported feeling that the doctor treated them differently after disclosure. In some cases, every medical problem is reduced to "stress" related to the abuse history. In other cases, the survivor perceives he or she is taken less seriously by the doctor who has received the disclosure.

Survivors are not the only ones struggling.

Physicians themselves often struggle with the enormity of the problem. Some patients repeatedly appear in physicians' offices with symptoms that defy diagnosis, and others respond to physical examinations in ways that prompt physicians to suspect that some trauma, possibly sexual child abuse, may be the source of the problem. "That's a very common occurrence in our practice," says Dr. James Calvert, chairman of the Department of Family Practice at Georgetown University Medical Center. "We see it all the time."
Medical Community Takes Notice of Survivors' Health Concerns by Mary Anne Reilly

Armed with the knowledge that it is "normal" to feel distress about medical care, what is a survivor or a caring health care professional to do?