The impact of trauma and cervical screening

As a trauma counsellor and a woman, I thought that I would write about how trauma impacts those who experience sexual abuse and body trauma and medical treatments such as cervical screening (smear tests).

Cervical screening can be more triggering for those who have experienced sexual abuse because it requires someone putting a tube called a speculum into your vagina to widen it so that a nurse or doctor can see your cervix.

Another factor is we are often disconnected from our bodies so we do not understand our bodies responses and communication around physical experiences. For someone who has gone through sexual abuse this disconnect from the body goes deeper and often leads to dissociation from the body. Dissociation from the body can include high pain thresholds and not picking up on the bodies internal sensations, and at times of stress and trauma floaty out of body sensations or feeling like you are out of your body looking down on it can be common). It means that people who have experienced sexual abuse can fail to notice when their body is in pain and needs attention.

With smear tests and pelvic exams, your mind understands why these are necessary but often your body can not differentiate between the exam and the assault it experienced, so the smear test can feel both painful and like a violation to the body. I can say that if my vagina could speak when it comes smear tests, it would be screaming, I do not want to go, LEAVE ME ALONE!!!

The first smear test I went to was done by a caring and chatty nurse, she talked the whole way through and did not mind that I was not that responsive. I had become quiet and still and was overwhelmed by anxiety. She did not notice the pain the smear test caused me and that I was not ok.  Because it was so painful for me and I had not felt comfortable asking her to stop, I avoided going for a smear test for about 10 years after that.

When I finally decided to go for a smear test again, after much work on my own connection to my body and talking my body through the procedure and why it was important, I felt hopeful and anxious at the same time. Unfortunately, the improved relationship with my body didn’t lead to instant success, it meant I heard her “No” much louder, I could feel the anxiety rising and my vagina literally clamping up. This time when the nurse tried to put the speculum inside me, I actually started saying “ow!” rather than disconnecting from my body. I was in so much pain that she said she was going to have to send me home but that I should rebook with the specialist because I really needed to get checked out. On my way home I remember feeling such shame, hopelessness, and failure and like I did not have it in me to rebook and try this again, I just wanted to disappear, cry, and eat tones of ice cream. It took me awhile to crawl out of the shame pit of my failed smear test, but when I did, I realised that I should actually be celebrating because I had not silenced my body or bullied it into going through with the smear test, I had actually listened and communicated with it.

A week or so later I got up the courage to phone and book with the specialist who does difficult smear tests at my surgery. When I went, the specialist told me that experiencing difficulties with smear tests is common. She also explained that they have smaller tubes they can use if you ask for them along with more lubricant if needed, which I found empowering. Because she already knew this was hard for me, she kept checking in with me, asking if I was ok and happy to proceed, and the smear test was a success that left me feeling shaky but pleased that my body and I had been a team. Through my work and personal experiences, I have learned some valuable tips for those of you who may find smear tests more than simply unpleasant but traumatic:

• Stay engaged in the process, do not allow it to be an act being done to you and dissociate as that trigger’s your body into a replaying of the trauma dynamic.
• See someone who is aware of your needs and anxiety in this area and requesting a specialist or a professional who knows your history, ask to see the same person regularly.
• You can ask for the smallest speculum or ask if you can insert it yourself.
• You can ask if you can do a home test for the HPV virus first before proceeding with the full smear test at the GP surgery because if you do not have the HPV virus, they do not need to check your cervix.
• Communicate with your body about what is going to happen before going for the test, as this helps the body to feel safer and if you notice your body going into a fight, flight freeze trauma response, it is ok to ask the professional to stop and try again another day, the worst thing to do is force your body to go through it in silence while you’re dissociating.
• If communicating verbally while traumatized is difficult for you then discuss with the professional before they begin the procedure how they can tell if you are not ok, because often it can be an added quietness and absence that they need to notice.
• Practice talking with people you trust about your vaginal experiences, particularly if you have gone through trauma this will help you communicate more comfortably and find the words to for the professionals.

Your health is important and your body matters. Cervical screening is a part of our self-care but it is important that we find ways to go have this done that don’t make us feel unsafe. If in doubt you can always ask to stop and try again another time.