I’m trying to write a chapter on coming out as an incest or child sexual assault survivor for the book.
There are a lot of reasons to come out, and a lot of reasons not to. I’m not going to say one is always better than the other. You need to decide for yourself what you’re up for and what you need. What I believe is that the situation, persons involved, purpose and your own tolerance for social isolation all have bearing on when and to whom you should disclose you are an abuse survivor. Continue reading What I’ve learned about coming out as an incest survivor (part 1)
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:
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.
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.
I dressed up. I wore business-casual clothing, did my hair, applied light makeup. Office armor.
I introduced myself and my wife to the doctor with our first names, to make us real people.
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.
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.”
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.
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 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 am an amazon! I had a pap test and negotiated for what I needed. Yay me.
I went to the drop in clinic today because I have a stomach bug (at least that’s what I thought) that wasn’t going away. The doctor ruled out the bug pretty quickly and then asked if I had pap tests regularly. I said no. She asked if I was ready to have one today. I decided I was up for it. She wanted to check and see if there was something wrong with my uterus. I decided I was.
She handed me a paper sheet and was about to leave the room when I said “can I sit up for the test?” At first she said no. If I hadn’t already had a perfectly normal pap test sitting up, I would have believed her. I explained how the other woman had done it with the back of the table up. She said “I don’t know how to do it that way”. I said “I’m a rape survivor and I’d be more comfortable.” Her face softened an almost imperceptible amount and she said she would try.
I told her that the other woman had lifted up the back part of the table. She set it to an upright position and left the room so I could change. I’m not sure if she went online and looked up how to do it, because she was gone for awhile.
When she came back she had me sit on the table with my knees bent and my feet touching, then allow my knees to fall apart from each other. I think this was the part she looked up. She didn’t use the stirrups. This was actually even better than sitting up with the stirrups. Then she did the pap test pretty normally and fast. She seemed impressed that it wasn’t any harder to do in that position. I told her that a group of doctors in Alberta had published a booklet that suggested it as a better way to do pap tests for survivors, and it certainly worked better for me. She said it might be a good new way to do it for everyone, since most women don’t like to lay down (it sounded like herself included).
Rape survivor is so much easier to say, and yet still correct, than childhood sexual assault survivor, incest survivor or any of the terms that bring in the messy details of my age when it happened or who was the perpetrator.
Anyhow, I came through unscathed, no meltdown, no triggers, feeling empowered. I think I have this blog to thank for being able to be so articulate with my doctor. I’ve gotten so much more comfortable with thinking about and talking about my vulva and what I need as a survivor. It’s really common after all.
My next step I think is to try and find a specialist to do some reconstructive surgery on my vulva, and get rid of those little sore tags of flesh.
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.)
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) …
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 …
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 …
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.
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.
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.
I am emerging, like coming up from under a pool of cool water into a clear day.
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:
***[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
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.
Okay, so I think I found a safe (to me) place to get a gyne exam. I found out through some friends that the community health centres have nurses that do pap tests, who are allowed to schedule longer appointments than doctors (who under our health system are allowed 15 minutes, if you can believe it!) . Somehow a nurse seems less scary than a doctor, anyhow. Less hierarchical power.
How to Book a PAP test for a survivor in 10 not so easy steps:
Step 1: Look up on the web the community health centre my friends recommended. Read web site. Like web site. Find out I live in the wrong area to access this centre.
Step 2: Find out what community health centre I am allowed to go to for my location. Find that there is no website, no way to check out much about what they’re like. Hmmm…. Find short brochure for local community clinic with single helpful phrase: “Ask us what you’re looking for and we’ll help to connect you” and a phone number. Give up for the day.
Step 3: Go back to web site. Re-read brochure. Print out brochure and put on desk. Give up for the day. Look at brochure several times over the next few days-week.
Step 4: Call number on brochure. Say “I read in your brochure that I could tell you what I was looking for and you’d try and connect me, is that right?” Answer: Yes, I’ll try. (Deep Breath) “I’m a survivor of childhood sexual assault and I haven’t had a PAP test in 8 years. I need to find a place to get a PAP test that will be compassionate.” Listen as woman on the line hems and haws a bit (albeit with sympathetic voice), and then when prompted with what I’d heard about the nurses, she says that they did have a nurse that came in briefly for a couple of times a month. She gave me a name and a phone number and apologized that she couldn’t make the appointment for me. Write number down, thank her and leave room to go to the bathroom, cry, have a snack and tell my wife.
Step 5: Call number. I’ve been given the wrong number and get voicemail that says nothing about the person I’ve been referred to. I call back and ask for the switchboard operator, who confirms that that person is supposed to be at that local. I call again and get a live secretary, who tells me that person has moved to another local, gives me the local. I let her know the operator still thinks the other person is at this local in case she wants to change it.
Step 6: I call the local of the person I was supposed to call. Her voicemail doesn’t say her name or any department that seems related to what I want so I’m still not sure I have the right person, but I leave a message with my phone number.
Step 7: I call back the community clinic and let them know the nurse’s number has changed and give them the new number. The reception nurse remembers me, thanks me for letting her know, and takes my phone number so she can follow up and make sure the other nurse gets back to me, which I appreciated.
Step 8: I get a call back from the secretary for the nurse I’m trying to book an appointment with. She wants to book me in at 9:30 in the morning. I don’t think I can do 9:30, I don’t think I’ll be steady enough by 9:30, since mornings aren’t great for me emotionally. I tell her that I don’t think I can do 9:30 and that the reason I’m booking with this nurse is because I’m a sexual assault survivor and mornings aren’t a good time for me for this sort of thing. She wisely accepts this without comment. We work out that 10:30 would be a lot better. She begins large amounts of hemming and hawing, and proposes a date two months from now when she can fit me in at 10 am. I accept, and then she says that the nurse I was referred to isn’t going to be there that day and someone else will be filling in for her. She asks if someone else would be okay and I say well, I asked the health clinic for someone who would be compassionate and this is who they recommended. I suggest that she root through the schedule and call me back when she has something. She seems relieved to agree.
Step 9: Nurse’s secretary calls me back and can put me in at 10:30 am two weeks from now. I accept. I put it in my computer calendar with lots of reminders and my cell phone becasue I’m likely to ‘forget’ about something that freaks me out.
My therapist is out of town and I accidentally missed last weeks appointment so I have no-one to debrief the yucky images that came up last time I had sex. I find myself not even really remembering them, which I don’t know how I feel about. I do sometimes have intrusive images that aren’t related to actual abuse, like when I replay images from scary movies in my head involuntarily.
My wife just doesn’t get it. Does anyone have a relationship with a non-survivor they think actually gets it? Over time, I’ve trained her to hug me and stroke my hair when I cry, but I’d really like to feel understood and valued.
I pre-paid for a bunch of acupuncture treatments. I’ve got about 8 left. I’d like to have them use them to treat my anxiety, but I don’t know how to ask. I mean I don’t have any classic anxiety disorder symptoms, and I don’t want to get into the child sexual abuse stuff. I’m just not sure how to ask for what I want without feeling hopelessly embarrassed, especially given the language difficulty (The two acupuncturists/TCM doctors speak English less than fluently.).
I’m not practising the guitar, or singing. I slept in till noon today. I’ve been stress eating enough that I’ve gained a pound, which is no big deal, but still a bit disheartening.
I don’t think I’m actually depressed, just a little anxious and frayed. Worn out by all the intensity lately, which, as I write this I’m thinking is probably normal and fine.
I feel like I need to stop. Just stop and nourish myself till I feel full. Hopefully I’ll figure out how to do that.
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.
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.