After years of disassociation, our writer is figuring out her boundaries.
I recently went to my annual visit with my gynecologist—like I have been for years. I am 49, and this should have felt like an ordinary and uneventful appointment. But it was different this time. I have recently confronted the truth about the sexual abuse I endured as a child and that acceptance has brought a new sensitivity to my own feelings. In short, after a lifetime of numbing disassociation, I am present.
So, this time, I felt slightly uncomfortable when the medical assistant told me to take everything off and put on the gown with the opening in the front. I joked that I planned to keep my socks on as she closed the door behind her. I thought to myself, I wish I didn’t have to do this.
Moments later I was lying on the metal table with my feet in the stirrups. I heard my doctor utter the familiar phrase, “scoot down,” and slid closer to her. We made small talk but there was no eye contact. Just me going on about the weather, scanning their faces, watching their eyes focus between my legs.
When I got home in the early evening, I felt oddly exhausted. Embracing my identity as a trauma survivor has meant allowing myself more rest, so I went to bed hours before my usual lights-out. I woke up feeling restored, and my mind was activated with questions, primarily: Why do I have to have a third person in the room watching the doctor examine me?
As someone who historically follows rules and obeys authority figures (yes, that’s a typical trauma response called fawning), I had long ago accepted that this was standard practice. I assumed that the medical professionals involved were prioritizing my comfort and care. According to the official AMA guidelines, “from the standpoint of ethics and prudence, the protocol of having chaperons available on a consistent basis for patient examinations is recommended.”
In fact, most institutions mandate that chaperons be present for rectal, pelvic, and breast exams. And when I looked online, I was confirmed in my suspicion that this third person’s presence is often mandatory: “At Yale-New Haven Hospital and affiliated clinics there is a rule that a chaperone must be present for any examination of so-called ‘sensitive’ areas, including breasts, genitalia, and perianal area,” stated Med Page Today.
Deeper dives also revealed that there is almost no data to support that this practice is necessary. I am not going to speculate about who benefits from the presence of a third party in an exam room, but I can say wholeheartedly it wasn’t this patient.
My gaze had been transfixed on the medical assistant’s eyes. When I was sexually abused there were witnesses, people taking pleasure from my assault. This is one of the worst memories I carry with me and undermines my trust in other people. As a result, I generally don’t like being looked at, but I particularly don’t want to watch a stranger watching my vagina be penetrated.
In retrospect, I would have liked to have been asked if I wanted an observer in that room.
One of the side effects of my traumatic injuries is that I can often experience a delay in perceiving threats. If I sense something menacing, it feels natural to consent, and then when I have landed somewhere safe the sensations of panic arrive. I see myself as a strong person, but a closer look at my life has helped me recognize that I have trouble advocating for my own wellbeing once feelings of fear arise. My voice is one of the first things to go, so it was nearly impossible to articulate my discomfort in the moment of that exam. I hadn’t felt safe enough to feel my feelings.
After hours in my own bed, I had restored my equilibrium and could declare, “I didn’t like that.”
Here’s how I wish it would have gone: When the medical assistant passed me the gown, she would have added, “as you are changing, please take a moment to consider if you would prefer a third person in the room for your pelvic exam. Their presence is not mandatory, and your wellbeing is.”
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