There is a lack of research on the harmful psychological effects of pelvic exams.  The lack of research highlights how the harmful effects from pelvic exams have largely been ignored, or have been considered not important enough to warrant investigation.  The small amount of research that exists has mainly been conducted with the goal of addressing women’s “anxieties” with the exam, and has been done for the sole purpose of learning how to harness women’s compliance.

In spite of the lack of recognition given to the psychological harms of pelvic exams by the medical community, many of us do experience harm.  Many of the comments from women on this blog and on other sites have revealed that the psychological effects are often significant and can have a detrimental impact on our lives.  In addition, the psychological effects can be difficult to understand, clarify, and articulate.  This post is a compilation of my own and other women’s experiences of pelvic exams presented in a way that attempts to clarify an issue that warrants more attention.

Psychological Harm #1: Trauma

A woman’s first pelvic exam can be traumatizing, especially if she is unaware of the exam’s invasive nature and/or is coerced into the exam while seeing her doctor for a different reason.  In these cases the woman is unprepared and is not expecting an invasive exam to take place.  In addition, many doctors do not fully explain what the exam involves, explain the reasons for the exam, or offer the woman a choice prior to proceeding.

Here is what one woman has to say about her first pelvic exam:  It’s humiliating, degrading, and painful. The first time I had a pap smear done, I was so traumatized, I now have to take prescription Xanax to avoid having panic attacks when I get pap smears done now. And I’m only 24. How many more am I going to have to have for the rest of my life? What am I going to do when I want to have children and every doctor wants to shove his/her fingers and tools inside me? (Scared Guest)  via Women Against Stirrups – What’s your opinion on the pelvic exam/gynecology?.

Psychological Harm #2: Loss of Control

I can think of no position more vulnerable and undignified than naked with legs wide apart, feet up in stirrups, and a fully clothed doctor standing over me.  Feelings of vulnerability and a loss of control in this position are intensified when I am asymptomatic and do not wish to have a pap test/pelvic exam – but have been aggressively pressured and coerced to the point where I feel I have no choice.

Here is another woman’s thoughts on loss of control and vulnerability:  I am 21 and today i went for my first smear..UGHH i freaked out, cried and had to leave with a vicodin prescription…which is pretty straaaaight. but, the point of my frustration is that I, like you, feel as though i am being violated, and sexually assaulted. I feel overly anxious due to the vulnerability of the situation . . . Its not even like ive never had sex. it is just that i have trouble being prodded and fingered by a metal prong. (Anonymous)  via Awkward Things My Mother Never Taught Me: Just How Violating a Pap Smear Really Is….

Psychological Harm #3: Dissociation

Women have been led to believe that a pelvic exam is a vital part of their health for so long that many no longer question it, or feel they have a choice.  When a woman feels she has no choice but to undergo a violently invasive exam she will often develop a sense of detachment, or numbness, in an effort to distance herself from what is happening to her own body.

Here is what Claire T. Porter has to say:  “Closely connected with the absence of self is the dispensing of existence experienced by women… Women undergoing these procedures report a sense of nonbeing” (Raymond 1993, xv). I cannot help feeling that my body, especially the most private areas of it, has been taken away from me. This surgeon and the horny resident both assess my pubic area. Now the vision of my genitals is held in their brains. I feel I possess my sex less and less and feel them both smug in the fact that they own it. What a power trip for them. Bastards.  via Women Against Stirrups – I’m Taking Back My Pussy!.

Psychological Harm #4: Invalidation

The value women place on the privacy of their vagina is in no way reflected by many practitioners’ attitudes.  There is an expectation that we are supposed to be fine with this type of exam.  Yet have we not always been taught to keep our legs together, sit with our legs crossed, and to not let strangers touch us?  The role we are expected to assume during day to day life versus the role we are expected to adopt during a pelvic exam are vastly different.  How a pelvic exam feels and how we are told it is supposed to feel presents a gap of huge proportions.  The lack of acknowledgment for how we feel confuses us, belittles us, and invalidates us. We lose a sense of stability, trust, and safety.

Chrissy (UK) says: This all goes with the ‘get used to it, you’re a woman’ attitude, or ‘I’m a doctor and therefore entitled to see and touch your body’. I don’t know what they are taught when they are medical students, but there is no way they understand what it is like for a woman to be exposed and spreadeagled on an examination table whist they rummage around in the most intimate part of our body. I still remember my first pelvic examination. I was 17 and the (male) doctor forced my knees apart, as I wouldn’t comply with his verbal instructions to spread my legs. I felt violated – I WAS violated . . .  October 2, 2012 at 12:43 pm

Psychological Harm #5: Dehumanization

All women have a right to privacy and dignity, except of course when they are in the presence of a doctor.  The name assigned to the “pelvic” exam is carefully nonsexual and yet what takes place during the exam is something more intimate than most women would allow a spouse or lover to do.  It is cruel to expect women to ever become used to this type of extreme exposure, and it is inaccurate to assume women will become desensitized over time.  To expect women to get used to the exam is cruel and dehumanizing.

Yazzmyne says: . . . I also believe that these gyn exams are rape even when a woman consents to it. She may verbally and rationally agree to it, but her body screams NO and most women do not listen or respect their own bodily feelings in this context. With all the fear mongering about cancer and the fear for the exam itself, she can’t even make a rational decision (and not that it has to be a rational one, because rationality is used to justify the whole ordeal and rationalize her feelings of violation away) because the mind is locked in fear and can’t think clear anymore and this is exactly what doctors want. There are so many benefits for them to keep using the medieval pelvic exam:

to satisfy their sexual lusts
for the powertrip
for the money
and the fear this exam generates in women also keeps them traumatized, in fear, unable to think CRITICAL about the so called need for them   October 10, 2012 at 5:04 pm

Psychological Harm #6: Distrust

A lasting, pervasive sense of distrust is likely to form when one is violated by someone in a position of trust.  The distrust that results from negative experiences during pelvic exams can present a lasting barrier to a woman’s access to health services.  Women who are traumatized by their physician’s practices related to pelvic exams are far less likely to trust the medical system as a whole.

FerretGirl01 says: I have a terrible fear of the OB/GYN mainly because my very first pelvic exam was so traumatic. I was a virgin and it hurt so much that I cried. And even after I told the doctor to stop, she kept trying to collect the sample after telling me she would stop any time. I felt violated…scared…and I hurt so bad I had to take pain relievers. I was bleeding when I got home and discovered my “cherry” had been popped because the doctor was too rough and rushed with the exam. That made me terrified of ever getting one again . . . via Fear of Gynecological Exam – Women’s Health – MedHelp.

Psychological Harm #7: Fear

There are all kinds of fears that go along with this exam.  There is fear of the consequences of refusing, fear of the consequences of complying, and fear of the consequences of speaking out.

Anonymous says:  I’m 22 and I haven’t been to the gyno! Every time I even think about it I get so freaked out and sick. I’m not scared of being in pain – I’m scared of personal intrusion, of being on my back and not having control. Every time I think about it, it makes me feel like it would be some kind of assault, because I really **don’t want** it to happen, and going would just be me trying to get over my fears and knowing that it’s something I need to do. I’m terrified of anyone touching me when I know that I’m forcing myself to let them and that I feel so insecure and invaded. I haven’t been sexually abused . . . But I’m just SO.TERRIFIED. via extreme exam anxiety.

AVEN Member says: Doctors are always pressuring their patients to get it done, and instilling fear of cancer to those who refuse. I think they insist more on a pelvic exam than they do on quitting smoking. Yes, I am doing the ‘unspeakable’ and questioning doctors . . .  I think the procedure is inhumane. If you think I just need to suck it up, please listen. This is ranting towards people like that. People that think women just need to “suck it up” or “get over it”.  Rant on Pelvic Exams – Asexual Visibility and Education Network.

Psychological Harm #8: Despair

When women repeatedly have their way of understanding the world ignored it can lead to feelings of despair.  When their understanding of what is occurring is discounted and invalidated; when their fears, trauma, and other experiences are ignored, then their place in the world and sense of self can shift.  Women are often left with pervasive feelings of hopelessness and despair.

Anonymous says:  I got my first pap smear yesterday. I’m not a big crying type, but I cried like a baby. It was the most traumatizing experience of my life. I’m 18 and I’ve only had one partner for the year I’ve been sexually active . . . The metal “spectrum” upset me and that was bad enough. But the worst part for me, that has left me horrified and with nightmares, is what came next. Nobody told me going into this that the doctor was going to shove her hand all the way up to basically my stomach. EXCUSE ME?! Why does nobody see this as completely violating!! I cried so hard. Today being the day after, I keep reliving it and I don’t want anyone to touch me and I just feel disgusted . . . I should not be subjected to this, especially at my age I don’t think. Not to mention that I was pretty much forced to get one if I wanted birth control. That just seems wrong to me. I try to be save and prevent a child at this time and my life and what am I forced to do? Be humiliated, violated, and traumatized.   via Awkward Things My Mother Never Taught Me: Just How Violating a Pap Smear Really Is….

Elizabeth says:  On one blog a young woman was so stressed about pap tests she wanted to be knocked out…it’s shocking, she should be told to forget about it and enjoy her life – this testing has robbed so many women from the pleasure of being healthy, young and female and often takes our peace of mind, bodily privacy and dignity, damages our health and lives, destroys relationships and takes the shine off sex, especially after traumatic “treatments” and when women are unable to access the Pill without forced testing…and at age 30 if she’s worried about cc, she could test herself for HPV, but that would be too easy and make too much sense…actually doing what’s best for her, she’ll probably end up being sedated for a pap test…so depressing.  http://blogcritics.org/culture/article/unnecessary-pap-smears/comments-page-175/#comments

In conclusion I would like to say that if you find you have “anxieties” regarding pelvic exams you can take heart because, as you can see, your concerns are valid.   On a brighter note, more women are becoming aware that they have the right to informed consent for screening.  In addition there are now alternative ways to test for cervical cancer, such as home HPV self test kits: https://www.bmj.com/content/364/bmj.l1357