traumatic pelvic exam

CoheteGato

New Here
I recently had a horrible pelvic exam. I had gone into the ER after experiencing severe pelvic pain the night before. The kind that stops you when you're trying to walk. I had experienced a ruptured ovarian cyst about ten years before. It's something you don't forget, but that experience wasn't scarring by any means. Just surprising. The situation was however severe enough to require emergency surgery and my recovery went well. I guess being told that I was not allowed to leave the hospital was scary, but the surgeon and hospital staff were very supportive and made the experience as good as it could have been given the circumstances. With that knowledge, I did exactly what I did the last time - went into the emergency room and explained my pain and medical history. Waiting for a gynecological exam that would ultimately send me in for the same round of exams that I would get in the ER seemed like an unnecessary delay. The intake MD was understanding and trusted my assessment. I was on my way to imaging via transabdominal and transvaginal ultrasound within about 25 minutes of being assigned a bed. The transvaginal ultrasound was uncofmortable, but the technician was professional and provided a few comforts when she could.

When the test results came back, that's when things flew off the rails. I was indeed correct about what I came in for. I had a cyst on the same side that had ruptured and was actively bleeding, but did not require surgery. Additionally, they found two endometrial polyps, which to that point had been asymptomatic but were large enough to be a cause for concern. The resident who came in seemed to only somewhat understand what my condition meant. She also seemed weirdly fixated on conducting a pelvic exam, which I thought was odd but I (mistakenly) thought it was part of the necessary course for my diagnosis, so I agreed. There were no stirrups, so she advised that she would use a solid object to prop up my hips and conduct the exam. The "chaperone", who I think was a PA and had no authority, participated in this process. I thought she was supposed to be looking out for my well-being? When the resident inserted the speculum I experienced a deep and visceral pain, and I let her know. I groaned out loud. I couldn't not vocalize anything else. She did not ask if I was okay. She did not stop. She continued inserting the speculum and then tightening the screw to rotate and expose my cervix. I felt like I was being disemboweled. Everything up to my neck froze. I could not breathe. When I was finally able to get a real breath, I asked her to take it out and started crying. She said something like, "wait, just hold on..." She did not stop the exam. I don't know how long she was inside of me but this was a pain worse than anything I had experienced in my life aside from the ruptured ovarian cyst. After she finished her business she went on to say, "because you are in so much pain, I think you have gonorrhea."

What. The. Hell. I didn't come in for an STD screening. I came in for a ruptured ovarian cyst, which they found. Case closed. My partner of three years, who was with me at the time yelled at her for making such an asinine accusation. We're two women in our thirties who don't have sex outside of our own relationship. Basically the least likely demographic for STD transmission. She then apologized that the procedure hurt, not that she had done a bad job or ignored my pleas to stop what she was doing. I asked her if she thought that, maybe, MAYBE because I had a ruptured cyst and had just undergone 25 minutes of transvaginal ultrasound. She said, "No, I think it's gonorrhea." She then suggested a manual exam to examine the structural integrity of my cervix to again screen for gonorrhea. I was delirious and feeling completely helpless and wanted her to leave, so I agreed. I passed that exam! My cervix felt normal, and the manual exam was not painful like the speculum was. She then began pressuring me to take two courses of antibiotics, one for gonorrhea and one for chlamydia. It seems inappropriate to pressure someone into further medical treatment when they are crying and unable to move. I declined and said that I would wait for the test results. I asked for her to get my partner. I'm not sure how long I was lying there but I wasn't able to move for a long time.

As I've read more about the workup for diagnosing an ovarian cyst - this resources is also excellent (every person with ovaries needs to read these, medscape is a free subscription service) , I learned about differential diagnoses. A differential diagnosis is a condition that presents with similar symptoms to the suspected condition. For example, if we look back to the first time I had an ovarian cyst about a decade ago, the doctors weren't sure if it was actually my appendix, so they put me in CT scan for a full abdominal scan to rule out an extremely dangerous burst appendix. During the most recent workup, the intake MD ordered a urinalysis and a blood test to rule out pregnancy and to examine whether or not there was bacteria in my blood (burst appendix risk). He was very clear about the purpose of the tests being performed, and even though I hadn't had sex with a man since the first Obama administration, I appreciate his concern for ruling out an immaculate ectopic pregnancy.

Gotta get my laughs in somewhere...

The resident who performed the pelvic exam was not honest about why she was performing the exam. After talking to two other gynecologists who have been practicing for over twenty-five years each, they both advised that if the cause that I originally came in for had been determined, the pelvic exam for STDs was not necessary. Additionally, if she really felt it necessary, less painful vaginal swabs are just as effective at detecting STDs. Unlike the intake MD, this resident was dishonest about why she was performing the procedure. She hid her desire to screen me for STDs behind the diagnosis I had come in for. She did not ask me about my sexual history, when my last PAP was, or whether or not I had any concerns that I could have an STD. There was no indication that at this point, after a highly invasive transvaginal ultrasound and firm diagnosis that this screening was elective. I understand that Pelvic Inflammatory Disease also presents with similar symptoms and qualifies as a differential diagnosis, but nobody mentioned that condition as something to screen for. Furthermore, after a bit of research, I learned that if I had PID, it would have shown up in the ultrasound, as transvaginal ultrasound is the main way to diagnose that condition. This is awful.

....

I've been lucky to have made it to the age of 31 without experiencing rape, especially after having once upon a time having engaged in heterosexual relationships. Sad that such a thing has to be lucky. It's not my goal to create a false equivalency to my experience and those who have experienced rape across the full spectrum of coercion and brutality that rape can entail. There are however so many parallels, to what happened to me.

She blamed me for the bad experience. She was deceptive. She took no responsibility for the pain she caused me. She ignored me when I told her to stop. She tried to coerce me into ongoing contact when I was clearly traumatized. I was never given the opportunity to give informed consent. The only thing that keeps this experience from qualifying as rape is that she was performing a medical procedure.

The sexual abuse I experienced as a child was not penetrative, but it has taken me many years to adapt to the problems it has caused in my relationships and with my own self-image. It's something that I live with, and as far as routine pelvic exams go they have never been a problem when performed by an actual professional. This has set me back. Beyond having severe pelvic inflammation for two weeks after this experience, I haven't been able to do anything more than hug and kiss my partner. The thought of doing anything else terrifies me.

It's hard to tell why this experience was so much worse than my first. Ten years ago, the doctors were transparent about what they were doing. To them it was a mystery, but they did a thorough job of ruling out differential diagnoses using methods that were non-invasive and caused the least pain. This time, I don't know what happened. Lack of experience, sure... to a point. I don't know if it was homophobia or racism. This was the most violent experience I've ever had. Before trying to argue that it wasn't racism, you should educate yourself on medical trauma histories in black (specifically Sara "Saartjie" Baartman), indigenous, and Latinized communities, read about the disproportionate amount of negative medical experiences that blacks and people of color experience, and the failures of American gynecologists to address black maternal and infant mortality rates. I'm not here to do your homework for you. My body and the bodies of women of color, or women broadly, are not your battleground for debate. I just want to be treated equitably by my medical providers. It's not much to ask. Trying to receive care in a medical landscape that is built on violence towards people of color is in itself a terrifying challenge.
 

CoheteGato

New Here
As for what's going on now... I filed a complaint, and spoke to the director of the ER. That was about a week after the incident. He was half-way apologetic and in many ways dismissive. He also said that I was partially responsible for the bad experiences because I agreed to the procedure... a procedure that was not medically necessary and I was deceived into having. That was a dead end with no accountability. A month later an acquaintance directed me to some others to talk about what happened. That meeting is pending.

I've also undergone a follow-up appointment to discuss the endometrial polyps with a gynecologist at the same hospital. She did not pressure me for a pelvic exam. She has recommended surgery, and initially offered a rapid turn-around for the procedure. I appreciate her earnestness, but I'm not ready for that. I am afraid. I don't want anyone touching me, and I am so far unimpressed with how this hospital handles misconduct from its practitioners. I don't know what to do. My health insurance does allow the flexibility to utilize other hospitals. I know that delaying care isn't good for my health, but I don't know what to do. I'm not ready. I don't feel safe. I still have pain on and off. Not sure if it's just the cyst healing of it is related to the resident's procedures. I don't know what to do.

Thanks for listening.
 

joeylittle

Administrator
Hi, @CoheteGato - I'm really sorry to hear about that absolutely wrong medical experience. And it sounds like the person at the hospital that you first went in to talk to, gave you part of the cover-your-ass response, the whole "you consented" thing. It really doesn't undo the wrong thing that happened....like you said, at that point, a speculum exam was unnecessary.
I don't know what to do.
I'd say, try and go one step at a time, so long as it's not drastically increasing your health risk. You've got another meeting with the hospital folks coming up (if I read that right), and the gyno you saw who offered to do the surgery sounded like a doctor you could build some trust with. Perhaps something you could ask the hospital for is to secure a pre-approval from your insurance for an additional meeting or two with that gyno (the latest one, who would do the surgery), so you can get to build trust?
 
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