My Experience at the Gynecologist as Someone With a History of Sexual Assault
This article contains descriptive details of a gynecological procedure. If you experience vaginismus or vulvodynia, or have a history of sexual abuse, sexual assault, or medical trauma, the following post could be potentially triggering. You can contact The National Sexual Assault Telephone Hotline at 1-800-656-4673.
In my experience as a 27-year-old, very few people with a uterus discuss their choice of birth control publicly, and if they do choose to speak about it with friends, the pill (either combined or progesterone only) and condoms (external) are the main forms discussed.
I have spent the last eight years of my life on the pill, initially the combined, then changing over to the progesterone-only pill due to migraines with aurora and my increased risk of developing blood clots.
In those eight years, I was sexually assaulted on multiple occasions and in a relationship where my partner controlled my use of contraception. Though I am now out of this abusive relationship, I wanted a form of contraception that only I have full control over.
Last week I made a booking at my local family planning centre to discuss what options I had for birth control based on my desired use for it – for me I wanted something that would decrease the pain associated with my periods, as well as something to decrease my likelihood of falling pregnant. My doctor and I decided that an intrauterine device would be the most appropriate, more specifically the Mirena hormonal IUD.
The Mirena IUD is a small, T-shaped plastic device that sits within the uterus, slowly releasing levonorgestrel — a synthetic hormone similar to progesterone — into the uterus, in turn, thickening the cervical mucus, making it difficult for sperm to pass through the cervix to fertilize an egg in the uterus. The levonorgestrel also helps thin the lining of the uterus, making it a poor environment for a fertilized egg to mature.
During my appointment at family planning, my doctor explained in detail all aspects of the IUD insertion. They showed me the sound used to measure the length of the uterus, the applicator to insert the IUD and the speculum to open the vagina for the procedure. At this point in my life, I had avoided cervical screenings (formally known as Pap Tests) due to my trauma, so had never seen a speculum. The doctor encouraged me to touch the instruments they would be using to ease my anxiety and have a sense of familiarity during the procedure – this was all initiated without me disclosing my experience of sexual trauma.
At the end of my appointment, my doctor asked if I wanted a prescription for Endone (oxycodone – opioid pain relief) and ondansetron (anti-sickness). I gladly accepted and was then booked in for the procedure and given a prescription for the Mirena IUD.
The day before insertion, the doctor performing my procedure rang me to walk me through every detail of the insertion again and all the risks involved, so that I could give informed consent. It was during this 25 minute phone consultation that I disclosed my history of sexual trauma, to which they thanked me for sharing and asked if I would also give consent to a cervical screening, as I was overdue by two years. They told me the procedure would take roughly 30 minutes in total with the cervical screening and reiterated numerous times that I would be in control of both procedures and that I could have as many breaks as I needed and that we could stop at any time, that it was OK for me to say no. I consented to both the IUD insertion and cervical screening.
The following day I woke up nervous. I had spent the night tossing and turning and googling videos on how the procedure is performed so that I knew exactly what the doctor would be touching and doing to me. I spent the morning working, trying to take my mind off the fact that I was willingly letting a doctor look at and touch a part of me that held so much shame.
I arrived at my appointment 10 minutes before, so that I could submit a urine sample for a pregnancy test. I sat in the waiting room unable to control my legs from shaking; at this point, I couldn’t believe that I had made it to the clinic. My doctor called my name on time and introduced themselves in person. They took me into the procedure room – I was anticipating a bed with stirrups but found myself looking at a chair instead. The doctor introduced the nurse who would be my chaperone during the procedures and ran through how our appointment was going to work, again reiterating that I had full control over every aspect and that they only asked that I communicated with them.
The doctor pulled the curtain closed around the chair and me, allowing me to take my trousers and underwear off, sit in the chair and cover myself with a paper blanket. I let the doctor know that I was ready and the opened the curtain, told me they were going to adjust the chair so I was laying down at an angle, and to put my feet in the stirrups so they could take the bottom of the chair away and I would be in position.
Initially, I couldn’t stop my legs from shaking and I couldn’t open them. The nurse came and held my hand whilst the doctor gently asked if I was OK to begin and if so if I was able to open my legs.
I consented for the doctor to begin, and they helped me slowly open my legs in the stirrups. The doctor verbalized every step of the procedure, asking me if I was OK to go ahead. They used lubricant on two fingers to penetrate the vagina, whilst placing their other hand just above the pubic area to help feel for the uterus and distinguish what direction it was facing.
Next, they inserted the speculum into the vagina and slowly opened up the canal until they could view the cervix. This was the first difficult part, as the speculum wasn’t long enough to reach the cervix and the muscles in my vagina were constantly contracting and moving the cervix. Using a different speculum, they were able to reach the and took a swab for the cervical screening and sprayed a local anesthetic onto the cervix. After waiting three minutes — which gave me time to focus on my breathing — the doctor asked if they were OK to clamp my cervix.
Once my cervix was clamped, the doctor asked if I was OK to proceed with measuring the length of my uterus for the IUD.
The doctor attempted to penetrate my cervix with a sound, though found that my cervix was too tight to take the sound. I couldn’t feel what they were doing other than slight pressure and a twisting sensation, but it wasn’t painful due to the local anesthetic. They decided to use a smaller sound to attempt to dilate the cervix enough to accept the larger sound. This was a success, and my uterus measured a length of 7cm.
By this point, I was in tears. I wasn’t in any pain, I just felt extremely vulnerable and angry at myself that so far my body wasn’t allowing the procedure to be straightforward. The nurse was lovely and stroked my head, whilst applying pressure on my abdomen. This helped ground my body, as I had begun to dissociate, and they needed me to be present to give consent to each step of the procedure.
Unfortunately, when the doctor took out the sound to insert the IUD applicator, my cervix closed up and they were unable to penetrate with the applicator. They attempted to use the small sound again to dilate the cervix and I asked them to do whatever they had to in order to implant the IUD — I had worked myself up to finally getting one, I didn’t care if it was painful, I just wanted it inserted.
I was getting distressed at the thought of going home without an IUD and that I had submitted myself to this for nothing. The nurse helped ground me and calm me whilst the doctor asked if they could continue.
They ended up getting the applicator partially into the cervix, but were unable to get it into the uterus. At my request to keep going, the doctor attempted to reach my cervix multiple times and ended up getting another doctor in to attempt as well.
After the second doctor attempted to get the applicator through the cervix I was told they would need to stop the procedure, as I have an anteverted cervical curve and the IUD itself was not flexible enough to reach the uterus.
Everyone told me how brave I was for going through the procedure and that they knew how devastated I was and that they understood how difficult it was for me to come in and that everyone tried their hardest to make it work.
After I was dressed, I fainted. I was given oxygen, had my vitals taken and eventually taken to a recovery room where I was given jellybeans and water.
Once recovered, the doctor came and spoke to me, apologizing that they couldn’t place it today, but referred me to a clinic that would implant the IUD under general anesthetic, where they would be able to utilize more techniques to dilate the cervix enough that the curve wouldn’t be an issue.
In total, the procedure took just over an hour, a lot longer than any of us anticipated. Even though my previous sexual trauma made it more difficult for me to relax and stay calm, the doctors and nurse made sure that I had full autonomy over every aspect and remained calm and caring when I couldn’t be. This experience had every opportunity to be traumatic, however, with proper care and compassion, I’ve come out of it feeling relatively OK. I’m just thankful that my practitioners were trauma-informed and believe that all practitioners should be.
Getty image by Phil Boorman