title: Distress and pain during pelvic examinations: effect of sexual violence.
abstract: OBJECTIVE
  To estimate the range and severity of distress and pain during pelvic examinations among female veterans with and without histories of sexual violence, and to examine whether posttraumatic stress disorder explains additional variance in examination-related distress and pain above that accounted for by exposure to sexual violence.
  
  
  METHODS
  We employed a cross-sectional cohort design in which 67 selected female veterans completed self-administered questionnaires to assess history of sexual violence and experiences of distress and pain associated with the pelvic examination. A subsample of 49 completed an assessment for posttraumatic stress disorder approximately 2 weeks later.
  
  
  RESULTS
  Distress associated with the pelvic examination was highest for women with prior sexual violence and posttraumatic stress disorder (median 5.49), next highest for women with sexual violence only (median 2.44), and lowest for women with neither (median 0), P=.015. Higher ratings of pain were also found among women with sexual violence (median 2.5) compared with those without (median 0), P=.04. However, posttraumatic stress disorder was not linked with increased pain from speculum insertion beyond that accounted for by sexual violence; limited power may have precluded detection of this effect.
  
  
  CONCLUSIONS
  Distress and pain during pelvic examinations may indicate a history of previous sexual violence, particularly in those with posttraumatic stress disorder. Extra sensitivity to the special needs of this population is warranted and may contribute positively to the quality of patients' experiences.
  
  
  METHODS
  II.
authors.affiliation: From the Center for Health Care Evaluation, Sierra Pacific Mental Illness, Research, Education and Clinical Center, National Center for Posttraumatic Stress Disorder, Department of Psychiatry, and Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California; and Department of Psychiatry and Behavioral Sciences and Division of General Internal Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: Julie C
authors.initials: JC
authors.lastname: Weitlauf
authors.forename: John W
authors.initials: JW
authors.lastname: Finney
authors.forename: Josef I
authors.initials: JI
authors.lastname: Ruzek
authors.forename: Tina T
authors.initials: TT
authors.lastname: Lee
authors.forename: Ann
authors.initials: A
authors.lastname: Thrailkill
authors.forename: Surai
authors.initials: S
authors.lastname: Jones
authors.forename: Susan M
authors.initials: SM
authors.lastname: Frayne
mesh_terms: D000328:Adult; D054523:Adult Survivors of Child Abuse; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D017699:Pelvic Pain / Q000209:etiology / Q000523:psychology*; D010808:Physical Examination / Q000009:adverse effects / Q000523:psychology*; D011902:Rape / Q000523:psychology*; D013313:Stress Disorders, Post-Traumatic / Q000150:complications / Q000523:psychology*; D014728:Veterans