As a medical professional you have taken an oath to do no harm, but there are ways in which you can hurt your patients without even recognizing you are doing so. What seems to you as a simple exam may cause injury to those who have been victimized by someone’s touch. This is a subject that we, survivors of sexual violence, have been meaning to discuss with you for some time now, but your authority can be more intimidating than you may know. I am also unsure if you are aware just how much power you, as a physician, hold and to the extent that you affect the lives of all of your patients. Your interactions with us travel much deeper than the physical core.
The relationship between patient and doctor is also mental, built on trust, understanding, and the security of knowing that your doctor has your well-being at heart. We, as your patients, entrust in you the most intimate parts of our bodies and our lives. But this trust has to be earned, and it is much harder for us patients who have been so severely violated. The intent of this letter is not to in any way criticize your work as a physician, but to better inform you of the needs of this specific group of patients.
Survivors of sexual abuse suffer in ways that only others who have been victimized can truly relate to. Once the assault is over in the eyes of those around them, it still continues for the victims. Like many soldiers who come home from war, those who have been sexually assaulted are prone to develop PTSD. This disorder causes frequent and unpredictable flashbacks and body memories. Those of us living with PTSD have no control over its occurrence or its impact on us. Anything can trigger it: touch, an image, a word, even a smell. Flashbacks are not like basic memories; when they happen we relive the attack as vividly as if it were truly reoccurring. Everything our bodies felt, they feel again and we respond to it involuntarily. Our fight, flight, or freeze reactions are activated and we may lash out, hastily leave, or close ourselves off all together. It is both emotionally and physically disabling for us to endure.
As a doctor of physical, and not mental health, you may be wondering how this information concerns you. You play a large role in our healing as well. By being forced into sexual acts, touch has been turned into something painful and hands have become a weapon. For many of us, the feel of touch is no different than a hot iron being pressed into our skin. The notion of being touched in itself is threatening, which makes a visit to your office feel like we are intentionally harming ourselves. We are essentially throwing ourselves into the snake pit. We know that we will be re-traumatized to some extent and we come to you already anxious and afraid, but how you act toward us is the determining factor of how we will react to you. If we choose to confide in you it isn’t us seeking to be coddled, but seeking your understanding and empathy. For us to allow you into our bodies you need to first be let into this tragic part of our lives. You need to understand what we went through if you are to be able to respect our boundaries and limitations.
When we walk into the examination room, our hearts start to race and breathing feels difficult. More than anything all we want to do is turn around and run. When you tell us, “Remove your clothing,” we start to shiver and we cling to the fabric, our only protection from wondering eyes and fingers. Our nakedness brings about the feelings of shame and vulnerability.
Cognitively we know you are not our attacker, but when you reach to touch us your hands become theirs. You become them. We may pull away or make you stop as our personal assault begins to play out within our mind. Our brain sends signals to every nerve ending in our body, relaying that the sexual assault is happening again. Gynecological exams are especially prone to this. A speculum being inserted into the vagina when a survivor is in the throes of a PTSD episode is equivalent to the penis of her rapist penetrating her.
It is important to remember that survivors come from all races, religions, and age groups. The sad reality is that no statistic can accurately portray the number of individuals who are sexually assaulted each year. The number of reported incidents is staggering, but the number of unreported is even higher. So, no matter where or who you treat, you are likely to come into contact with a number of survivors during the course of your career.
While most of the focus when it comes to sex assault is on adult women, we mustn’t forget the much younger victims of both sexes. It is estimated that, for children under eighteen, one in four girls and one in six boys are sexually assaulted or abused. For this reason I feel it is a necessity for doctors, especially pediatricians, to know the signs that a child has been or is being sexually abused. Doctors can often pick up on physical signs of abuse such as bruises and broken bones, but may miss the physical signs of sexual abuse if they are not specifically being looked for.
This makes behavioral and developmental markers invaluable. Some of these signs include appearing overly compliant or aggressive, anxiety, fear or avoidance of touch, and speech or learning disorders, just to name a few. Having the ability to pick up on the signals a child victim gives off could save their life and countless others from going through the same ordeal. It can be as simple as keeping pamphlets on hand in your office and having yourself and staff read over them periodically. If you suspect abuse, do not be afraid to ask questions or report it. Children cannot remove themselves from dangerous situations and it is the responsibility of all those who interact with a child to be that child’s voice.
I can’t even begin to count the number of times I personally have had my needs as both a child victim and an adult survivor neglected by a medical professional. Some actions were made out of pure cruelty, but most out of a lack of knowledge regarding what traumatic events inflict upon their victims beneath the physical wounds. To be honest with you about what has happened to us is profoundly re-traumatizing, but we take this risk and the hurt numerous times in hopes that if we explain our situations to you, that you will be patient and gentle with us.
It is a devastating blow to go through our victimization again just to be shrugged off or to have our doctors act like our disabilities are inconveniencing them. The treatment we receive from others after our sexual assaults, including our doctors, can be just as traumatizing for us as the assault itself was. The attack left us in our lowest low. Many of us have no confidence or self worth. We require the support and reassurance of others to help us overcome what has been done to us. Without someone in our corner fighting with us, it is extremely difficult, if not near impossible for us to recover.
Doctors are a necessity in the lives of everyone, but you are even more valuable to us survivors. You may be the first person we allow to touch our bodies after they have been desecrated by another’s hands. It is terrifying, shameful, and a very painful experience. In those moments, some of our most vulnerable, we need your patience. We need kind and honest words in a gentle tone, and we need a slow and understanding touch that is safe for us to say no to.
You have the ability to give us power back that was taken from us and that little bit of power can make a world of difference while we tread this road. When you take the time to listen to us and learn what we need from you as our physician a mutual respect between patient and doctor grows. You taking the time to listen to us tells us that you truly care about us and the treatment that we receive from you. These simple yet meaningful acts allow us to build trust in you when trust can be difficult to manage. When we are able to build trust in you and trust in your touch, that opens the door for us to allow others in as well and it all starts with you.