title: Strong discomfort during vaginal examination: why consider a history of abuse?
abstract: OBJECTIVE
  To study factors associated with strong discomfort during vaginal examinations (SD/VE) by means of four hypotheses.
  
  
  METHODS
  A cross sectional postal questionnaire study, conducted at three Swedish departments of obstetrics and gynaecology and with a random population sample (n=4453).
  
  
  METHODS
  The associations between a self-reported history of emotional, physical and sexual abuse and abuse in health care, flashbacks during the previous year, emotional contact with the examiner, and SD/VE during the index visit (discomfort estimated on a ten-point scale; six-ten=SD). Statistical analyses used were Chi-square, Binary logistic regression, and Pearson Correlation.
  
  
  RESULTS
  Eighteen percent of the women reported SD/VE. There was an association between SD/VE and a lifetime history of abuse. Having experienced combinations of abuse, especially combinations including emotional abuse and abuse in health care, was strongly associated with SD/VE. SD/VE was furthermore associated with flashbacks during the previous year, and negative emotional contact with the examiner during the index visit.
  
  
  CONCLUSIONS
  We conclude that women who unexpectedly react with SD/VE are more likely to have a background of abuse, and may even run a risk of feeling re-traumatised during the VE. A clinical implication is to consider a history of abuse in patients who react with SD/VE or experience negative emotional contact during the consultation.
authors.affiliation: Division of Gender and Medicine, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, S-581 83 Linkoping, Sweden. katarina.berg@liu.se
authors.forename: Katarina
authors.initials: K
authors.lastname: Swahnberg
authors.forename: Barbro
authors.initials: B
authors.lastname: Wijma
authors.forename: Karin
authors.initials: K
authors.lastname: Siwe
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D058869:Gynecological Examination / Q000523:psychology*; D006801:Humans; D008487:Medical History Taking; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012742:Sex Offenses / Q000523:psychology*; D011795:Surveys and Questionnaires; D013548:Sweden; D055815:Young Adult