why we need trauma informed gynecologists
originally posted Oct 6th 2020
I am writing this from my own experience as a survivor of trauma seeking medical support and diagnosis of 15+ years of chronic pelvic pain. In a recent attempt to receive an endometrial biopsy, I was acutely re-traumatized by a gynecologist and her assistant. I am writing from my perspective as a Somatic Sex Educator in training, which has helped me develop capacity to process and articulate my body’s exquisite survival responses. As a practitioner of somatic sex education, I understand consent to be dynamic and continuous. Empowering choice and voice is a vital component of touching others, and especially, of touching others genitally. As a survivor of trauma, I understand the need for transparent communication, compassion and slowness in regards to my body being touched. I am also writing as a white person of mixed lineages and nonbinary gender.
* Note and Content Warning *
This essay describes details of subtle yet impactful transgressions made by a gynecologist, as well as explicit details of an internal pelvic procedure that led to re-traumatization.
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Since the age of 11 I have resisted seeking medical support to address my chronic pelvic pain. My family was poor working class, and my pain was often belittled. I didn’t have the language to describe exactly what I was feeling or where in my body I was feeling it. As a teenager the pain was so excruciating I was sent home from school on a regular basis. The sensations I experienced around my cycle caused a great deal of body dysphoria and self-hatred. I link certain continued patterns of dissociation and habitual numbing out with substances to this dysphoria and pelvic pain. Bleeding has never been a special and sacred time of the month for me.
So here I am now, 31 yrs old and going to see the only gynecologist in the hi-desert that takes medi-cal insurance. I’ve been scanned for a large and complicated cyst on one of my ovaries, and I want to inquire about pelvic pain, severe blood clotting and the possible diagnosis of endometriosis (endometriosis occurs when endometrial tissue grows outside of the uterine cavity and onto ovaries, bowels and the pelvis and gets inflamed with hormonal cycles).
In the initial 10 minutes of meeting the gynecologist, she didn’t ask about my pronouns. She made condescending assumptions about my choice to seek medical support and to experiment with plant medicine instead of taking birth control. When I inquired about an endometrial biopsy (a procedure done to test uterine tissue for abnormalities including cancer), I was told it was only done for women 45 and older. After a grueling hour of what felt like me defending my need for support, she agreed to do it, but she did not explain to me what I should expect beyond stating it would be short and uncomfortable. I was rushed out the door before I could ask any questions.
The lack of trauma-informed care was made clear to me in this first meeting by the doctor’s flippant communication. I noticed the urgent need she created to “fix” my problem with pills and talk over me about my own body assuming I didn’t know what I was experiencing. Despite this disappointing interaction, I decided I would still go through with it and do my own research online to prepare myself for the procedure.
On the morning of the procedure I could feel my pelvis clenching and noticed I was psychically bracing for the worst possible outcome of pain. I popped an anti-anxiety med to quell my nerves. When I arrived at the exam room the gynecologist’s assistant handed me a waiver to sign which stated that the details and risks of the procedure had been described to me (which they had not). Seemingly annoyed with my slow reading pace, she rolled her eyes and said “Just keep it then, and give it to the doctor. Take your pants off and sit there. She will be here in a minute.”
The assistant’s obvious impatience with me, and the fact that she simply demanded that I undress without asking if I had questions or concerns, was startling. My heart rate drastically increased and my pelvis clenched even more as I began to feel the biophysical consequences of an unsafe container.
When the gynecologist came into the room, I asked her to explain to me in detail what was going to happen, and to speak it out loud as it was happening. Had I not asked this of her, I really believe she would have gone inside me without checking in, and with no accountability to her process. I expressed that I was a survivor of trauma and nervous about having a PTSD response to this procedure. She described what tools she was using in what order and how long it would take, but there was no further acknowledgement of my concerns.
I laid back, closed my eyes and prayed for ease.
After inserting the speculum she tried to go into my cervix with a dilator. She exclaimed that I was “too closed up”, making it hard for her to get in. She then said she would have to clamp my cervix apart and that It would feel uncomfortable. As she clamped, the cramping sensation was unbearable. Already breathing heavily with a mask on, I screamed out in pain and felt my lower body begin to contact and shake. I tried to stay connected to my breath. I began creating sound with my exhales as she continued clamping apart on my cervix. Her assistant was frazzled by my intense vocal response to the pain and kept dropping tools. At this point my legs were shaking uncontrollably and I was in tears. Finally, after a few more attempts she said “Okay I’m gonna pull out. This doesn’t seem to be working, and we don’t have what we need here to handle the type of pain you’re experiencing.” As she was pulling out the speculum she asked “Do you want to try the birth control hormones? That might be best for you.” Without taking a breath or waiting for me to say I was okay, she proceeded to lift the chair abruptly so that I was facing her again. From here she continued to talk about hormones as if nothing activating had happened, even though I was still visibily shaking and crying. After handing me some water she haphazardly apologized, and suggested I make an appointment to do this again with anesthesia which is really her “preferred way of doing this procedure.” Again rushing me out of the room, I left the clinic feeling confused, overwhelmed and violated.
What I want to illuminate by sharing this story in detail is the lack of emphasis on client safety and consent practices within gynecological establishments. I want to break this down a bit from the perspective of Somatic Sex Education. First of all, gynecologists who tell you that you’re “too tight”, “too closed up” or use language that frames any type of pain you are experiencing as your body’s fault, are working within a normalization paradigm that is rooted in shame. This shaming and blaming of the body is so common in mainstream culture that when medical staff project these stories onto us, we often don’t notice its happening and internalize them as the truth. The approach of immediately seeking to “ fix” your body’s “problem” with pharmaceuticals to get it back to “normal” can be traumatizing in and of itself. I’m deeply saddened about the way this normalization approach impacts queer and trans people who are already being misgendered and neglected in these spaces. Our genitals and pelvic regions can be such a vulnerable and supercharged sensitive place for many of us. Getting touched invasively by people who don’t value our concerns or see our humanity is really terrible.
Somatic Sex Education focuses on helping people to build their somatic awareness in a counter-normative framework that supports expansion of pleasure and empowered choice and voice. This means, as Caffyn Jesse puts it in “Pelvic Pain Clinic”, that “trauma informed practitioners understand that safety and choice are built by acts, attitudes and experiences that foster trust. This means slowing down enough for clients to attend to their feelings and guide their own experience.”
For people with unresolved trauma (which is so many of us), our nervous systems will respond uniquely to the circumstance. Autonomic nervous system responses of hypo or hyper arousal states show up in the pelvic floor, which is inextricably linked to the jaw through the spinal column. A trauma-informed practitioner understands this mirroring effect, and would have not for instance been surprised but instead reassured my body’s need to open the jaw and let out sound in an effort to sooth the contracting pains of my pelvis.
Had trauma awareness been foundational to my gynecologists training, this is how my experience would have been different:
I would have been asked what my concerns were, and how the staff could better support me through them.
My pronouns would have been inquired about and honored.
The procedure would have been thoroughly explained to me before I was asked to take my pants off.
I would have been asked to guide the movement of putting the speculum inside of me, or even encouraged to do it myself.
I would have been offered options for speculum sizes that fit more comfortably.
The doctor would have connected me to other sexual trauma resources for additional support.
Most importantly I would have been tended to with care and acceptance of my body’s response. By which I mean, even in the most optimal care conditions, having to stop the procedure STILL would have been okay. My “No”- my body’s “No”- would have been honored with respect.
This brings me to the encapsulation of this piece, which is to remind people that the field of gynecology is deeply rooted in racism, exploitation and the torture of enslaved African women by white slave owning doctors. I am in awe of the work of historian Deirde Cooper Owens, who has done incredible research on this in her book ‘Medical Bondage: Race, Gender and the origins of Medical Gynecology.’ Owens dives into the legacy of medical racism, experimentation and unethical practices which continue to disparage marginalized communities today. When we understand these foundations, we understand the reasons why Black, Indigenous, disabled, immigrants, and trans people are more likely to experience gaslighting, abuse and neglect from medical professionals. Learning this helped me to understand another core aspect of the problem. Standard gynecology practices emerged from trauma, and they need to be dismantled and re-imagined from a trauma-informed ethic. I’d like to consider Somatic Sex Education as a generative place to start in the re-imagining of care in these spaces.
Special thanks and immense gratitude to my mentors: Caffyn Jesse, author of Pelvic Pain Clinic and head faculty member at ISSE and Pamela Samuelson of embodyworkla + creator of Take Back the Speculum / Ecstatic Body workshops.
