I understand how tricky this can be and have found a few things that have helped me.
Do you feel able to give the person conducting the exam a heads up beforehand? That may sound like a terrible idea, but I started doing this a year or so ago after my therapist suggested it. When she suggested it I thought she was mad! But actually, it has been really helpful - it's made the examination feel more manageable and it's also been quite empowering and giving me a sense of control over the situation. In fact, my therapist called one consultant's PA for me ahead of my first appointment with him (we agreed it - she didn't just go off and do it!) And for a few subsequent things with different nurses/consultants, I've said something to them at the start of the appointment before the examination starts.
You don't have to give any details, of course. Just put some boundaries down/make some requests/say what you'd find helpful etc.
My key line is usually: "Can you tell me where you're going to touch me before you touch me otherwise I can get a bit spooked!" I say it in quite a light way but I've always had people agree and then be really good about doing it. They're not stupid - if a patient is flagging something in that kind of way, they must know there's good reason and to tread carefully.
Other things that may help:
- Ask for a chaperone to be present.
- Think about how you can dress comfortably and in order to avoid being more exposed than you need to - you could also take a blanket to drape around you. They will often be quick to ask you to take pretty much everything off - if that feels unnecessary to you, challenge it and make a counter offer. Eg I was asked to take off everything but my underwear for a hip exam. I asked if I could wear shorts instead and he said that would be fine - hence I magically produced shorts from my bag! I also always wear snuggly socks for medical exams now, so that I feel cosy and can focus on my toasty feet.
- Maybe consider taking a valium just before.
- Don't feel shy about asking them to stop if it all gets a bit much. Again, you don't need to say why. A simple "Can you just give me a minute?" can be very helpful. Whenever I've done this, people have been very happy to oblige and that bit of time has enabled me to calm down and then continue. If you can't continue though? Say you need to stop and will have to come back another day. If that's your decision (and, if it is, you will likely look very stressed anyway), they will just have to go with that. Don't allow yourself to be rushed if you need a break. I have asked for a pause several times in various medical exams and that has been enough to help me so I have never got to the point of needing to stop altogether and leave. But if you need to do that, it's fine.
- If possible, keep the rest of the day (before and after the appointment) easy - try to stay as relaxed and grounded as possible before and after.
- Perhaps have someone give you a lift to/from the appointment - if you're super stressed or spacey, driving/traveling alone may not be the wisest thing.
I avoided medical things and got triggered then dissociated (though I didn't know it at the time) during the things I didn't avoid for years, so I do really feel for you and understand how challenging it is. It's still a big issue for me - I'm currently avoiding two things I really should be sorting out! But the above things have really helped. It's a lot to do with taking some control back for me, I think.
Good luck!
