So the gyne visit went about as well as it could possibly go, and better than I could have envisioned.
The nurse-practitioner I saw was very experienced and nice and drew the correct line between warm sympathy and matter of factness. She said we could take as long as we needed, and she did the history taking and blood pressure stuff first. She explained everything really fully and was very relaxed, egalitarian and friendly.
She was matter of fact, thorough and respectful about asking my history – saying it woudl be helpful to know whatever I told her. I did a good job too, matter of fact and calm. She said she’d mail me copies of everything she put in my chart and all my test results too, so I’d have it as well.
I’d typed up all my questions, so I wouldn’t forget anything and just handed them to her, which worked well.
I did ask about the scar tissue.
She tilted up the exam table so I was sitting up and gave me a mirror to hold and I could see everything she did, which was great. She showed me the parts of my vulva that she thought showed old injuries. Turns out I have some vascular damage where the veins/arteries are really big and close to the surface and the whole area is hot, which she thought spoke to me having been injured and the veins being damaged when I was a kid. She also showed me some tags of flesh (like little lumps sticking out around the opening) around my vagina that to her looked like I’d torn and had healed without being sewn up. At this point I took a minute to hold my wife’s hand and breathe, since I got a bit emotional, but I didn’t really cry or anything till we left the office and were in the elevator. I haven’t really cried much yet, but I expect I will.
She knows some folks at a gyne clinic where care is given to children who have been raped, and she said she’d talk to them about what signs the vulva/vagina of an adult survivor might show as well. She said she’d never had a survivor patient before (that she knew of, I add silently) and that the mirror and tilted table worked so well she’ll probably make that standard. She said when she was trained to do pap tests (I guess they practiced on each other) they did it with the ‘patient’ (another student) sitting up with a mirror, so that’s interesting, maybe a lot of female doctors or nurse practitioners were trained that way and might be familiar with it.
I’m pretty happy about finally having proof to back up what I remember, and also that she was able to give me some ideas to help reduce the irritation and sometimes pain all this causes me, that nobody’s been able to help me with so far. She’s suggested cold packs to reduce the swelling, which I think could actually work. We might also get an appointment with a gynecologist to see if they can remove the tags of scar tissue flesh, since they get sore.
I’m also really sad and angry for that little girl with the torn vagina and no-one giving medical attention I needed. I’m pissed at my mother, who obviously should have noticed a little girl with a ripped, bleeding vulva.
And finally, I gave her a copy of the ‘survivor safety form’ I made, and a copy of the article about survivors and pap test avoiding. I suggested that if the health region wanted to put on a clinic for survivors, there were a lot out there that weren’t getting pap tests. She seemed interested and said she was networking with a group of other women practitioners and they were looking for groups to offer care to (or something like that), I offered to be a ‘community informant’ if that would be helpful (in health region they like to have ‘advisory groups’). She asked me to email her a copy of the form, which I’ll do. So that’s hopeful as well.
All in all I feel blessed and hopeful. Yay!
If any health care providers (or survivors who want to talk to them) are reading this, here are some links I recommend:
*** My survivor safety sheet: http://sworddancewarrior.files.wordpress.com/2009/04/information-sheet-for-primary-health-care-providers.pdf
***[REALLY GOOD RESOURCE] Schachter, C.L., Stalker, C.A., Teram, E., Lasiuk, G.C., Danilkewich, A. (2008). Handbook on sensitive practice for health care practitioner: Lessons from adult survivors of childhood sexual abuse. Ottawa: Public Health Agency of Canada. http://www.phac-aspc.gc.ca/ncfv-cnivf/pdfs/nfntsx-handbook_e.pdf
Helping survivors of childhood abuse through labour: http://www.gentlebirth.org/archives/abuselbr.html
Prevalence of sexual assault history among women with common gynecologic symptoms. http://www.ncbi.nlm.nih.gov/pubmed/9790390?dopt=Abstract
Health risk behaviors and medical sequelae of childhood sexual abuse. http://www.ncbi.nlm.nih.gov/pubmed/1434879?dopt=Abstract
Effect of Childhood Sexual Abuse on Gynecologic Care as an Adult http://psy.psychiatryonline.org/cgi/content/full/48/5/385