Sexual violence, posttraumatic stress disorder, and the pelvic examination: how do beliefs about the safety, necessity, and utility of the examination influence patient experiences?
BACKGROUND
Sexual violence and posttraumatic stress disorder (PTSD) have been linked to increased reports of distress and pain during the pelvic examination. Efforts to more fully characterize these reactions and identify core factors (i.e., beliefs about the examination) that may influence these reactions are warranted.


OBJECTIVE
This descriptive, cross-sectional study examines the relationship between sexual violence, PTSD, and women's negative reactions to the pelvic examination. Additional analyses highlight how maladaptive beliefs about the safety, necessity, and utility of the pelvic examination may contribute to these reactions.


METHODS
A total of 165 eligible women veterans were identified via medical record review and mailed a survey that assessed: (1) background information; (2) history of sexual violence; (3) current symptoms of posttraumatic stress disorder; (4) fear, embarrassment, distress, and pain during the pelvic examination; and (5) core beliefs about the examination. Ninety women (55% response rate) completed the survey.


RESULTS
Women with both sexual violence and PTSD reported the highest levels of examination related fear: chi(2) = 18.8, p < .001; embarrassment: chi(2) = 21.2, p < .001; and distress: chi(2) = 18.2, p < .001. Beliefs that the examination was unnecessary or unsafe or not useful were more commonly reported in this group and were associated with higher levels of examination-related fear and embarrassment.


CONCLUSIONS
Women with sexual violence and PTSD find the pelvic examination distressing, embarrassing, and frightening. Efforts to develop interventions to help reduce distress during the examination are warranted.
Center for Health Care Evaluation, Veterans Affairs Palo Alto Health Care System, Palo Alto, California 94025, USA. wjulie1@stanford.edu
Julie C
JC
Weitlauf
Susan M
SM
Frayne
John W
JW
Finney
Rudolf H
RH
Moos
Surai
S
Jones
Kirsten
K
Hu
David
D
Spiegel
D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D017773:Pelvic Floor; D010808:Physical Examination / Q000523:psychology*; D011902:Rape; D013313:Stress Disorders, Post-Traumatic