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Out of sight, out of mind?

“Trigger Warning: Mentions Child Sexual Abuse”

I have a dilemma.

Just recently I have become increasingly conscious of the fact that there is a group of women that I see each and every day as patients but give little aid to. They walk into my consulting room and we talk about their gynaecological symptoms or their pregnancy. I examine them. I work out a management plan. They usually seem happy. I’m pleased that I have helped them out. But, in a lot of cases I never quite get to the heart of the matter. I never tease out the issue, that for some of them, was the initial step that eventually culminated in them arriving on my doorstep. These women are child sexual abuse survivors.

Women who have been subjected to childhood sexual abuse are far more likely to have various gynaecological problems including vulvar pain, pain with intercourse, chronic pelvic pain and premenstrual syndrome. Therefore, they are very likely to end up seeing a gynaecologist at some point in their adult life. The problem is that not all gynaecologists have been equipped to help survivors and up until recently neither was I.

Medical school taught me to ask about physical or mental illness, medical history, surgical history, allergies, medications, family history, occupation etc etc etc. I remember thinking how intrusive all this questioning seemed to be. It seemed so rude to ask someone how many cigarettes they smoked! Clearly, for me, this was only the start of intrusive questioning because when I specialised in obstetrics and gynaecology I was then asking potentially embarrassing questions to a whole new level. Bladder function, bowel function, libido, vaginal dryness, discharge, bleeding, sex – did it hurt, and on and on it goes. All of this questioning but I don’t recall anyone suggesting I should ask if someone had been sexually abused – full stop, let alone abused as a child.

You might say, “Surely it’s not that common”. “How embarrassing for the woman!” “Why ask such an invasive question?”

Why ? Because it IS that common.

15 to 20% of women have been sexually abused as children.

Let that sink in!

That’s roughly 1 in 5 women.

How many REALLY close female friends do you have? Let’s say 5? On average one of them has been abused sexually as a child. Or maybe it was you that was sexually abused.

These facts are not new. These facts are not alternative facts (a la Donald Trump). These facts are a blight on all societies worldwide. The stark reality of child sexual abuse is not limited by racial, socioeconomic, educational, cultural or religious divides. It affects all.

Sexual abuse includes sexual penetration, sexual touching, or non-contact sexual acts such as exposure or voyeurism. This clinical definition doesn’t begin to describe the disturbing clash of emotions that is activated when those three words – sexual, abuse, child – are in the same sentence together. Sexual and child don’t belong together. Likewise, abuse and child. And all three……

In one American study 12 % of girls in grades 9 to 12 reported they had been sexually abused. Seven percent of girls in grades 5 to 8 reported sexual abuse. Two thirds reported it occurring more than once. In more than half of cases the abuser was a family member and in more than half the cases the abuse occurred at home.

Are you disturbed yet?

Now imagine you were that child and you’re now an adult. Do you rage against the monster? Strike out! Reclaim your self-esteem, your sense of worth, your dignity, your body, your sense of YOU!

Some do; some claim that victory, they take back what is theirs. But all too often the emotions of fear, shame, guilt and self-blame become overwhelming and paralysing. All too often those emotions result in anxiety and depression. Some survivors experience recurring flashbacks and nightmares of the abuse. Some develop a distorted belief that the abuse occurred because of something they did.

This is the second reason why the question should be asked. One simple question might be the start of a discussion that leads to support, both physical and psychological. One simple question might lead to healing, at least in part for some. One simple question might be the difference between light and darkness; life and death.

So back to my dilemma. My dilemma is that I know these women are out there and if we can get to them we can help. But - more than half of these women were abused by someone that they should have been able to trust in a place where they should have felt safe. It seems farcical that I should ask them to trust a stranger (me) in a foreign environment (my consulting rooms) to be able to talk about their past experiences and in doing so facilitate a healing dialogue for their present and future health.

If you are one of these women PLEASE talk with someone – your GP, your partner, your gynaecologist – anyone. If you see me I will listen. I will take time. I will guide you towards skilled counsellors and psychologists who will help you work through your pain. If I need to examine you, I will wait until you are ready to be examined. I will try and make it as comfortable as possible. A nurse will be present if you wish. I will explain any examination or procedure step by step. If you need a speculum examination it will be warmed. You will be in charge and if you feel that you can’t do it – we won’t. Letting me know you’re uncomfortable might be saying something to me. Or sometimes all it takes is the raising of your hand or a glance at my nurse. YOU WILL BE IN CHARGE.

If any of you visit me in the future you may be taken aback if I ask you specifically about being abused sexually. If you find the question awkward then don’t judge me, and don’t judge the 20% of your female friends who may benefit from the same question. For those of you that I’ve seen previously and I’ve never asked you the question but you think I should have – I’m all ears.

Some online resources that you might want to investigate are. Adult Survivors of Child Sexual Abuse

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