Better, stronger, faster than before.

First off, the specialist did not help me assess the damage from the assault. I was disappointed. However, she did have a very credible theory for what could be causing my pain and took a biopsy to confirm. The biopsy was freaking painful and caused a lot of bleeding (they cut off a small piece of flesh to look at under the microscope) but can be used to confirm the diagnosis.

The diagnosis she’s testing with the biopsy is vulvar lichen planus. It’s an inflammatory condition of the skin, that women sometimes get on the vulva. I have most of the symptoms and the doctor thought there was a good chance that’s what it is. Basically it makes your vulva and vagina look and feel like you’ve had a bad sunburn. I looked up some pictures to add to this post, but I don’t want to inflict them on you. They’re not pretty.

If so, it’s only indirectly caused by the assaults. According to the American Skin Association “Sometimes this disease affects the areas of skin where you had a trauma, such as a superficial scratch, cut, or burn.” So the reason I have it on my vulva is likely to be because my vulva was injured.

It is not caused by an infection, aging or menopause, diet, hygiene practices or sexual activity.” and it is not sexually transmitted.

The gyne wasn’t keen to remove the flesh tag from my vagina, she thought it might cause more scarring. I’m willing to wait to assess that till the lichen planus (if that’s what it is) gets under control. If there are any other women out there who have kept or removed flesh tags from the vaginal opening and want to weigh in on whether it was a good thing, I’d love to hear your comments.

Lichen planus is thought to be an autoimmune disease, but they’re not positive about that. It does run in families a bit too.

One source said that because it’s autoimmune, avoiding allergy triggers or taking antihistamines could help. However, primarily it’s treated with steroid creams, or if that doesn’t work, oral steroids.

She couldn’t prescribe the cream now, because the hole from the biopsy has to heal first, which will take about a week. I can’t get another appointment to see her for a month, so that’s how long it will take.

In the meanwhile I’m going to (sigh!) try and eliminate dairy and gluten, both of whom I have mild allergic responses to, in the hopes that will help calm my immune system down. There are lots of things that are helpful for calming down autoimmune issues too, so I’ll look into those and try them out.

All in all, it’s hopeful. I may be able to have sex without pain and itching afterward. That’d be pretty awesome.

Here’s a video a woman made with art and commentary about a similar condition, called Lichen Schlerosis. The art and sentiments are pretty much the same though. Her drawing of a sore vulva inside an eye is the featured image for this post.

How to get care for an vulva injured in childhood.

Photocredit/art credit: http://kateordie.tumblr.com
Photocredit/art credit: http://kateordie.tumblr.com

I am going to blow my own horn here. I did good.

First, some background. I had sex for the first time with a new lover recently and my vulva was really not happy afterward, directly related to my injuries. First off, my lover did not respond well to being told I had scars/injuries on my vulva (she ignored the comment. really?) and then was much rougher with me than my sensitive peach can handle. Yes, I probably shouldn’t have continued having sex with her, but you know, sometimes you make a call at the time. I changed the activity, but by then the damage was done. Now I know. Next time I’ll be more firm about what can and cannot happen up front.

The flesh tag at the mouth of my vagina got rubbed raw and my poor peach hurt for days. It was what most women would consider ordinary sexual activities, none of which would have been unusually rough treatment for an uninjured vagina/vulva.

So I put my foot down, and decided by golly I was going to find a doctor and get this sorted. I tried at first to find a family doctor with some street cred about sexual assault. This was a disaster, as the doctor I found at first was, and then was not accepting patients. The sexual assault centre didn’t have anyone to recommend, and I ended the day in tears.

I  waited a week or two to cool down and then a couple of days ago I decided to just go into the walk-in clinic and ask for a referral to a specialist there. Here’s what I did right:

  1. I asked my wife to come with me. She made me eat first so I wouldn’t be low blood sugar, kept me company in the waiting room, and also wrote down what the doctor said.
  2. I asked for support. I messaged four of my friends who know about the injuries and told them what I was doing and asked for energetic support. I said I wanted to avoid crying and find an effective referral. They sent me supportive messages back that I read in the waiting room.
  3. I dressed up. I wore business-casual clothing, did my hair, applied light makeup. Office armor.
  4. I introduced myself and my wife to the doctor with our first names, to make us real people.
  5. I brought a printout of a photo I’d taken of my vulva that clearly shows the scars. This turned out to be a brilliant idea, as I could show the doctor the scars without having to undress.
  6. Some good phrases I used: “I’m looking for a referral to a specialist to address some injuries from a sexual assault.” “I didn’t receive medical attention, but that doesn’t mean I didn’t need medical attention.”  “It healed badly and affects my sex life now.” “I have a picture of the injury.”
  7. I pulled out my printout of the photo my wife took for me. (If you take a photo of your own injury I recommend using a flash, as it shows the scars more clearly) and pointed out the two long lines of scars. Having the photo also allowed me to point out where the flesh tag is and where the vascular damage is.

The doctor said he would try and track down a suitable specialist for me and gave me a timeline for how long he thought it would take. A couple of weeks for him to find someone suitable (he gave me some internet search terms to look under if I wanted to try and find someone myself) and then 3-9 months to get in. He consulted with me about whether I should see an Ob/Gyn (who might have experience with similar injuries from birthing tears) or a reconstructive gynecologist. All in all he was very nice and I was happy about what happened. He said that removing the flesh tag would be straightforward but that there might be scarring which might be problematic. I told him I just wanted to see what I was dealing with and what could be done, surgically and non-surgically, to mitigate it. (I probably used the word mitigate. I’m like that.) Yay.

Bravery and Vulnerability

I’ve been reading Brene Brown’s recent book “Daring Greatly“. Most of the information is stuff I already know, but it’s good to review and there were some new bits. I recommend it for anyone wanting to learn about vulnerability and how to manage shame. She also has a number of TED videos which are excellent.

About a month ago, I went to the STI clinic to get tested. As a lesbian with not a lot of sexual partners, I’m very low risk, but I wanted to be able to truthfully say to any new partners that I’d been tested and was negative for everything, which I am.

The nurse was curious about why I’d come to this particular clinic rather than my doctor, and I said I felt more comfortable with a drop in clinic and that I’d heard this clinic was good with sexual assault survivors (which I had). We talked a bit about how doctors often got weird when the topic of my vaginal injuries was brought up, and how I have some ongoing conditions as a result I need help with but have been unable to get help for. She was sympathetic and gave me the number of a medical practice with two women doctors in it who were on the sexual assault team, and thus unlikely to be freaked out by sexual assault stuff.

So I finally got up the nerve to call the number this morning, and, as Brene Brown would say, dared greatly by winning while being vulnerable.

The reception nurse answered and then when I asked if the two doctors were accepting new patients she said no they weren’t. Then she asked me who I was friends with, and I said I was calling for myself. I eventually figured out she was asking who had referred me and I told her that the nurse at the STI clinic had and that I was a sexual assault survivor and she said these doctors would be suitable.

The nurse said “good for you” when I told her I was a sexual assault survivor, which I took to mean she was approving of me disclosing and asking for help. She said that one of the doctors could see me and gave me a date to call back and make an appointment, and to say I’d been told I could.

I’m in.

I’m really tired of having a constantly itchy vulva that is sometimes quite sore. I have tried all the self care, done everything they say prevents it, and still it persists. I have holes in my underwear in the place that itches most, from unconsciously scratching. I want to talk to someone about my scars, the vascular damage and the tag of flesh and whether I should remove it. I want to know whether the itching is from the blood flow issue or something that can be cured with antibiotics or antifungals.

I’ve had this itching and pain, chronically, for at least 20 years.

I have some hope now I can get it resolved.

Massage

I had an interesting experience having a massage today. I had a sore hip due to what my chiropractor says is a tight ‘IT band’. The massage therapist was doing various things to loosen this and I was asking her what might have caused it to get so tight.

Between the two of us we figured it is probably due to my sleeping position, which not coincidentally, is as different as possible from the one I was raped in. She asked if I was uncomfortable sleeping on my back and rather than lying I said calmly. “Yes, but not physically. Trauma. Emotional. But it’s a lot better now.” Typical stock survivor response, acknowledge the facts as calmly as possible, combined with reassuring the listener I’m not going to fall apart on them. However, I meant it. I *am* fine. She said that was good, and continued on.

Now some massage therapists get uncomfortable when you say things like this, but this one didn’t. A woman would know exactly what traumatic event would happen when a woman is on her back. There was not much more to be said.

Earlier in the session she’d been working on the back of my neck and I said, “oh, one thing I forgot. If you work on the front of my neck, please let me know first please.” She’d also accepted this well.

When it came time for her to work on the front of my neck she warned me and was gentle, asking what types of touch to avoid. She got it.

I asked her how my neck was. I’m curious. I have no idea how being strangled has affected my neck. She said something like it was very siezed up and tense. I said, well it makes sense, the soul and body are connected, and she agreed.

At the end of the session we agreed that my IT band and leg needed more work and so did my neck. I said, if we work on the neck it will need a session just for that, and I’ll probably cry. I’ll need to have my car nearby so I can go to it to calm down afterward. I told her I look after myself just fine, but that there is likely to be emotion connected to the tension. She was great. She told me that it happens all the time, that people often have feelings come up during or after sessions and she considers it an honour to help people clear. Her energy felt grounded and sincere.

On the way home in the car I sang my scar song about the abuse to clear some of the built up emotion from having my neck worked on. I had an inner child reaction which led to me going to bed curled up in a quilt for a few hours, after which I felt more clear.

I have booked a session for next weekend. I’m not sure if we’ll work on the neck or the leg.  I’m proud of how matter of fact I was, and how well the interaction went. Unexpected. I’m used to being more guarded with health care folks, so they don’t treat me funny.

I’m looking forward to having body work done in a context that allows me to release the feeling. Not looking forward to cleaning up the reaction afterward, but hopefully if I can release fairly fully it’ll be more relief than triggering. One can hope.

The picture I chose to go with this post is of baby birds, who were rescued after their nest was blown out of a tree by the photographer. At first I rejected the picture, as it is not the strength and confidence I felt today. However, the vulnerability of the birds and their long necks resonates with the vulnerability I feel in my own neck and this situation. There are some very intense, fragile and wounded sensations locked away in my neck tissue and this picture owns that. Telling the truth, being as vulnerable and strong as I actually am is a far stronger and more courageous place to be in. [the photographer took down the photo I had linked to.]

Eureka – take that, vulvadynia!

Okay, I seem to have it figured out.

The yoga is great, but I found something even better. Just becoming aware of how often I clench the muscles of my sore, rape-injured body was a big first step. Now I’m learning to train my body not to do it.

It helps that it doesn’t hurt much any more. The clenching was a reaction to the pain. My guess is my smart child self figured out that clenching restricted blood flow, which dampened pain. It does do that, but now, years later when the wounds have mostly healed, the restricted blood flow causes damage and pain of it’s own.

Heating pads.

The yoga increased blood flow thing worked so well at bringing the pain down, I’ve moved on to prevention. I’ve been sitting on a gentle heating pad, set on low, while watching TV with my honey. The constant gentle heat keeps reminding me to relax, and with that relaxation, I feel so much more grounded and safe, less on guard, which should be a paradox, but isn’t. The heat and a conscious decision to relax have allowed me to get familiar with the sensation of not-clenching, and helping me make it the dominant way my body is. I still clench, but not as much, and my vulva is a lot better.

It reminds me of training myself not to clench my jaw (TMJ) a few years ago. I’d do big yawns to loosen my jaw before bed and put heat on my jaw joint, consciously loosen the muscles and put them in a position where they weren’t as easy to clench, jaw hanging loosely. Over time, it gradually lessened, and although I don’t know if I never clench my jaw when I sleep,  I no longer wake up with a sore jaw, and the dentist doesn’t mention it when I go.

I’m thinking this is advanced-survivor stuff. Perhaps ten years ago, unclenching my muscles would have brought flashbacks that would have seemed too daunting to embrace. Perhaps they are still working themselves to the surface, although perhaps not since I’ve remembered the injury I’m recovering from. Perhaps I couldn’t have done it before I saw the scars stretching across my vulva from the rapes. Knowing is always better than not knowing, no matter how hard it is.

A good friend of mine from my teens got in touch recently. I hadn’t seen her since the first year of university, or perhaps before. She asked me how my parents were. I realized she must not have heard, that I didn’t tell her back then, at the beginning of my healing.  I wrote back that my parents had split up, and that I don’t see them, and asked how her parents were. There are many ways to tell, and which I use depends on my sense of balance between a strong certainty that I won’t lie about this any more against the need not to drive people away with awkwardness.

Complete and specific honesty is reserved for therapists, close friends and other survivors, who usually can take it without saying something stupid or hurtful or shrinking away from me, which is worse. This would be “My father is a sociopath and raped me starting when I was a preschooler. We lost touch after I reported him to the police. I recently found out my mother was actively complicit, so I don’t see her any more either.” Telling it this way is the best. It is a truth that prevents ever having to dance around the topic again. It allows my inside and my outside to be congruent and gives accurate context for things that may come up.

The other versions, for trusted non-survivors, are a lot less specific, such as “My parents were abusive and I don’t see them.” If the person accepts this, and leaves the topic alone, or says, ‘mine weren’t great iether’, we have a stronger friendship. If they say some rubbish about forgiveness or parents doing the best they can, I write them off.

If the person or situation isn’t important enough to get into it, I tell the truth, but not much of it.  I will tell strangers and acquaintances partial truths such as  “I don’t see my parents much” or “My mom is in X and my dad is in Y, they split up a few years ago.” A bland partial truth is usually enough to satisfy the question, and change the topic without lying.

I thought about telling my old friend more, but I decided to be more gentle. She knew my mother and father after all. This tragedy happened to people and in places that she is familiar with, that don’t have the distance they might otherwise have. She can read between the lines, and if she wants to know, she’ll ask. If she doesn’t, I have no need to tell her. Another thing that has loosened.

What I learned about health care and sexual abuse survivors

I’d like to summarize what resources and history I’ve gathered (or created) that might be helpful to other survivors.

I went from someone who had an 8 year gap in both pap tests and dental work to someone who has had a pap test and a dental cleaning within the past year.  I also successfully asked a health clinician doing my pap test to examine me for scar tissue from the rapes (I have evidence of tearing that no-one had mentioned to me previously.)

Here are my posts about that journey

  1. Warrior Schedules PAP Test– Okay, so I think I found a safe (to me) place to get a gyne exam.
  2. The day before the pap_Yesterday I saw my therapist and we talked about the pap test appointment tomorrow. What’s different about this appointment is: 1) the medical professional will know I’m a survivor. 2) I’m planning to ask if I have scar tissue. 3) …
  3. Warrior Victorious in Pap Test – 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 …
  4. In the wake of proof – Knowing I have scar tissue has changed my life I think. It’s like an incontrovertible validation of what I’ve been saying all along. No longer can I doubt or go into denial about the accuracy of my memory. I know …
  5. Icing my vulva – I’ve had pain and itching in my vulva for most of my life.  I’ve worn out holes in the fronts of underwear from scratching. This, I’ve found through some recent reading, is actually pretty common with vaginal injuries like mine.
  6. Hidden Disabilities and Dentists A childhood sexual abuse survivor goes to the dentist, and triumphs over fluoride treatments. Continue reading →
  7. I get an appointment with a gyne surgical specialist and finally get a diagnosis for my sore, itchy vulva, that pretty much always feels like it has a sunburn. I get a biopsy in the first appointment (painful!) and a diagnosis of chronic inflamatory condition in the follow up appointment. After treating with a strong steroid cream for several weeks, I switch to a herbal anti-inflammatory (turmeric taken both internally and as a topical ointment) which has completely controlled the symptoms.  Yay! Autoimmune and inflammatory conditions are apparently common in survivors.

Here are some great information resources I found:

Handbook on Sensitive Practice for Health Care Practitioners: Lessons from Adult Survivors of Childhood Sexual Abuse (applies to doctors, nurses, massage therapists, physiotherapists, dentists etc…) This report is a good read for both survivors and practitioners and is linked below. The one thing I would add is a one page disclosure and accommodation request form, so I created it. This document was written by university professors in the departments of  social work, physical therapy, nursing and medicine of several major Canadian universities. (I love Canada a lot. ) So it’s got the ‘clout’ to be influential with your doctor or dentist.

Here are some links to some other good resources:

And last but not least here’s a resource I created:

I’m really proud of this one. Wouldn’t you like to just hand your doctor a form with checkboxes for the accommodations you need to be able to tolerate a pap test? No working up to disclosing abuse just before getting into the stirrups, no worrying your voice will break or you’ll lose your nerve. All you have to do is hand over a piece of official looking paper. Look no more, here’s my survivor-designed and field-tested version, made using some of the recommendations from the sensitive practice guide linked above: SwordDanceWarrior’s Information Sheet for Gynecological Care Providers Providing Care to Childhood Sexual Assault Survivors I’ve used it. It works beautifully. I ended up in my own clothes rather than a gown, sitting up with a mirror so I could see what she was doing, with everything explained as she went along, and with my partner present. It was way less stressful than a regular pap test. If you use it, I’d love to know how it went.

Icing my vulva

I’ve had pain and itching in my vulva for most of my life.  I’ve worn out holes in the fronts of underwear from scratching. This, I’ve found through some recent reading, is actually pretty common with vaginal injuries like mine.

This summer, when I found out about the two tear scars and vascular damage, it all began to make sense. The medical professional that saw me suggested I ice my vulva when I was feeling pain or discomfort. Well she said something cool, and I’m using a well wrapped ice pack.

It works. It actually works and I don’t have to dissociate from that part of my body any more.

The pain happens without warning, and I’ve gotten accustomed to ignoring it. But now I have something to do about it, something that works.

So tonight I’m sitting on an ice pack, watching TV.

May you rot in hell, Dad.

This, as my friend Butterfly would say, is why you shouldn’t fuck kids.

In the wake of proof

Photocredit: Yann!s
Photocredit: Yann!s

Knowing I have scar tissue has changed my life I think. It’s like an incontrovertable validation of what I’ve been saying all along. No longer can I doubt or go into denial about the accuracy of my memory. I know what happened and I was accurate all along. It is an immense relief.

The other thing about it is I am more in touch with my own vagina, which is not so good on the one hand because I’m in mild discomfort most of the time. but is good because it allows me to be aware and take care of my body instead of just numbing that part of my body out. I think in the long run this is an incredibly good thing. It’s what I wanted, to have my body be my own, and to have no part of me belong to him any more out of my own fear to be in touch with horrors.

I have written a separate letter to my mother to let her know about the scar tissue and ask that she write me and let me know what she remembers. I don’t know if I will send it. I should not be surprized she hasn’t written me yet: when given the opportunity my mother will always bail, will always avoid doing anything that makes her uncomfortable and this surely must overwhelm and horrify her.

I want to tell my family “see, I have proof, you need to believe and support me now”, however, really, I doubt it will change anything with them for me. Denial is a powerful force. It is the societal denial that interests me most now. We have to start believing children and making it safe for them to tell.

I have a therapy appointment on Monday and am looking forward to talking this over with my therapist. This changes everything for me, and I don’t know what to do next.

I realize at some levels I have been depressed for awhile, a low level depression, really not sadness as much as a lack of happiness. I’ve been taking some vitamins, meditating and trying to get more sleep and it seems to be helping. Today I had two moments of happiness. I got a book from the library on singing – Anne Peckham’s Vocal Exercises for the Contemporary Singer. It has a guided warmup and then some more advanced exercises for sopranos. I’ve been doing the warmup exercises a few times a week and today was the first time I did the advanced exercises. It was exhilarating to sing in my high clear voice and to find the places where the voice rings and resonates. I had some advanced voice training about a decade ago, and had thought I’d lost that ability. Apparently not. Apparently all I needed was to warm up and work out my voice and it came back. I was singing for the joy of it and full of the joy of it like I haven’t in a long time.

The second flash came as I was walking back from some errands, and passed by a park I like which has some tall beautiful trees. I looked over at one I particularly like and felt a flash of joy in the rich greens of the leaves against a clear blue sky and the peaceful park.

Photocredit: Greekadman
Photocredit: Greekadman

I am emerging, like coming up from under a pool of cool water into a clear day.

Warrior Victorious in Pap Test

Thank the Goddess for Good Medical Care at Last! Photocredit: Great Beyond
Thank the Goddess for Good Medical Care at Last! Photocredit: Great Beyond

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

The day before the pap

Yesterday I saw my therapist and we talked about the pap test appointment tomorrow. What’s different about this appointment is:

1) the medical professional will know I’m a survivor.
2) I’m planning to ask if I have scar tissue.
3) I’m planning to ask about all the wierd things I have going on with my vagina.

It feels incredibly vulnerable to do this this way, consciously, asking for the compassionate care I want, especially when I didn’t have any care that I remember for my vagina when I was assaulted as a child.

I have duly printed out my ‘survivor safety lecture’ pap test sheet and marked the appropriate boxes. I also have typed up all my questions, and the rationale behind them on a single sheet of paper so that if I can’t deal with asking verbally, I can just get her to read it.

At my therapists suggestion, I’m going to reserve the right not to go through with the exam if I don’t like the nurse or her responses, so the questions have a dual purpose. I get to see how she handles them. My therapist also offered me an emergency session on Thursday or Friday if I need one, an offer which brings tears to my eyes even now.

It was good to talk it over with my therapist, and more importantly cry it over, cry over the body of the 5 year old girl with the injured vagina, cry over the lifetime lack of anyone to ask questions about my injuries or to care about them. Cry about the shame and fear of judgement / condescension / freak out of a nurse or doctor knowing my history examining me.

So, I’m going to watch some nice, anethesizing tv or read my new book.

On the up side, I’m still meditating 8 minutes per day and still practising either singing or guitar daily. I also started a tai chi class with my wife yesterday. So in general, things are good.

Wish me luck.

Pap test, anyone?

Sheila na gig - these are Goddess images honouring the sacredness of the doors of life. This one was found at Kilpeck Church in Herefordshire. Photocredit: Ben Grader
Sheila na gig - these are Goddess images honouring the sacredness of the doors of life. This one was found at Kilpeck Church in Herefordshire. Photocredit: Ben Grader

Okay, so I went bravely forth today on my quest to find a doctor to do a pap test. Like many survivors, I haven’t had a gyne exam in several years, in my case, about 8.  I haven’t had (or thankfully, needed) any other medical care during that time. I have recurrent yeast infections (or something that behaves like it) that I’ve learned to manage with home remedies.

As a childhood rape survivor and taxpayer, I believe (silly me!) that I have a right to medical care that respects my needs. I would like to have an appointment with a doctor who looks me in the eye when she talks to me, treats me as an equal, tells me what she’s going to do before she does it, answers all related questions fully and allows me to sit up while doing the internal exam. I would further like the impossibility of a doctor that can do all of the following in a warm, friendly, matter of fact manner that doesn’t make me feel like I’m crazy for needing any of the above.

I called my local incest counselling agency to ask for suggestions. The intake clinician called back to say that they don’t have a list of doctors and I should try my provincial medical association. I dutifully went to the website of the provincial medical association. As is typical, they are actually a doctors advocacy group, so they don’t have any info for patients looking for specialized medical care.

Then I began having fantasies about becoming a health care advocate for survivors – doing the calling around to find a doctor with a clue, accompanying survivors to medical appointments. What I really need is for someone to do that for me.

I did a bunch of internet searching on the issue. Yes, survivors avoiding gyne exams is a known and documented issue. It’s particularly bad for survivors who get pregnant and have to deal with all the intrusiveness and insensitivity that can happen. In my region, you can hire a doula, or birth support person, who can help with that at least. I wonder if I could hire a doula to come to my pap test appointment?

A research group in Saskatchewan has put together a guide for doctors on how to offer sensitive care to survivors. It’s good, but what I really want is a one page ‘survivor safety lecture’ on some nice authauritative medical association letterhead that says. “the patient who has handed this to you is a child sexual assault survivor. She/he would like the following accomodations in the care you provide to accomodate her/his condition”, with a bunch of check boxes for things survivors commonly want. Maybe with a paragraph at the top explaining how these practices, if selected by the patient,  are recommended care for patients who have been exposed to childhood sexual assault with a nice official medical association signoff.

I’ve mocked uf an Information Sheet for Gynecological Care Providers to use since I couldn’t find anything like it. I don’t know if I’ll use it, but you’re welcome to, if it’s helpful. The suggestions are based on the document quoted near the top.

My wife has said she’ll come to my appointment , if I can find a doctor.  Oh, and by the way, women family doctors are in short supply in Canada. Apparently over 150,000 people in my province can’t find a family doctor. It’s hardly a buyers market out there. I’ve been to a woman doctor who explained in the first session that she had a part time practice and was there only for basic medical care. I forget her exact words, but in essence, if I was the least bit high maintenance I should find another doctor, if I can. I had a problem with painful ears which turned out to be blocked eustacian tubes. She did a quick exam and sent me for hearing testing, when really all I needed was to gently clear my ears and apply moist heat.  The ear specialist was cold and basically told me I was making up not being able to hear well (my ears weren’t blocked that day) and when I figured out what I needed to do on my own using the internet, I wrote my doctor a letter of complaint for not having spotted this simple thing. She called me in to discuss the letter, which essentially was her being defensive and blaming and I left her office in tears. I haven’t had a family doctor since.

I’ve gone to the drop in clinics, which are easier to get an appointment at, but a doctor I didn’t have to explain things to every time would be a blessing.

I’ve given up for today, maybe for awhile. I can only take on so much.

Photcredit: Ric e Ette, title: Lost (Perdito)
Photcredit: Ric e Ette, title: Lost (Perdito)