The panic attack started as soon as I opened my legs. Lying back, stirrups pulling me astride, I heard the gynaecologist tell me to take a deep breath as he plunged a tube-shaped tool inside me. It was fine at first, my hand tightly squeezing that of the kind nurse who could clearly sense my anxiety. Then I felt tears rolling down my cheeks as I waited, still and quiet as a statue, telling myself it would all be over soon.
Smear tests aren’t supposed to be like this. It was only later that afternoon, once I’d taken the rest of the day off work and spoken to friends, that I realised I’d had a trauma response: a physical and psychological reminder that my body had previously been violated; that I had been raped.
“Undergoing smears can be challenging for anyone. However, for survivors of sexual assault, they may well find the experience triggers memories of this,” explains Dr Annabel Sowemimo, community sexual and reproductive health consultant and author of author of Divided: Racism, Medicine And Why We Need To Decolonise Healthcare. “Genital examination is a very intimate procedure, and we know that being relaxed is integral to it being comfortable. If an individual is anxious then that can lead to the pelvic muscles tightening and causing a lot of discomfort.”
During a typical smear test appointment, a speculum is inserted into your vagina to hold the walls of it open, so that the doctor can see your cervix and, using a soft brush, take a small sample of cells to that will be tested for signs of cervical cancer. Generally speaking, it doesn’t hurt and only takes a few minutes. But for survivors like myself, it can be a different encounter entirely.
“I’d never felt pain like that,” recalls Gemma*, 31, from London, who’d been raped by a married man on a backpacking trip several years prior to getting her first smear test. “I’d put it off for ages,” she adds, recalling how she’d arrived late and was quickly rushed through by a nurse, whose hurried abrasiveness put her off explaining she was a survivor. “The nurse kept repeating how tense I was, telling me I was ‘way too dry’. She rolled her eyes and continued probing.” Then, Gemma started bleeding. “She blamed it on me.”
Alice*, 28, from Derbyshire had a similarly difficult experience, crying quietly during her smear test as she was psychologically transported to being assaulted the previous year. “Any medical procedure is triggering [for me] because people are doing something to your body that you can’t control,” she explains. For some, the insertion of the speculum is a physical reminder of being raped. “It felt forceful,” says Nina*, 29, from Essex. “I think it brought back the feelings I had of being put in a position I didn’t like and didn’t feel safe in.”
Much of this is down to how sexual assault impacts our nervous system. “The body keeps the score,” says trauma specialist Olivia James, referencing Bessel van der Kolk’s bestselling book on the subject. “Any situation that reminds the nervous system of that trauma will activate a fight, flight or freeze response. In the case of sexual assault, just the physical position and invasive nature of a smear test can serve as reminders.”
According to the US-based Rape, Abuse & Incest National Network, one in every six American women has been the victim of an attempted or completed rape. Given how integral regular smear tests are for women’s health, a trauma-informed response to healthcare in this area is crucial to prevent further harm. And while one solution is telling your doctor that you’re a rape survivor ahead of the appointment, that’s easier said than done.
“Our research found that roughly one in four survivors don’t want to disclose their rape ahead of having a smear test,” say sexual health consultant Dr Jill Zelin and clinical psychologist Dr Felicity Young of the My Body Back Project (BBP), which offers cervical screening, STI testing and maternity care at clinics in in London and Glasgow for people who’ve experienced sexual violence.
“Healthcare providers should ask women if they are aware of any triggers, phrases or postures that may cause them distress before beginning the smear,” add Dr Zelin and Dr Young. “They should also make it clear that the patient can say ‘stop’ at any point and frame the appointment in a way that makes them feel the doctor is working with them, rather than doing something to them.”
All this would have made an inordinate amount of difference to me and, I suspect, other survivors who’ve found smear tests difficult. “Extra communication could have solved my issue,” says Gemma. “Sending around a short digital form asking patients if they had any worries ahead of the appointment, and if there’s anything else they feel their practitioner should know, could help a lot.”
Perhaps the most important thing is that the onus isn’t placed on the survivor to be forthcoming about their experience in order to make things easier. That in itself might be re-traumatising; I know I wouldn’t feel comfortable telling my gynaecologist I’ve been raped. Regardless, something must change. It just isn’t the mentality of survivors; we’ve been through enough already.
*Names have been changed
Olivia Petter is an award-winning journalist, author, and broadcaster. Her debut novel, Gold Rush, is out on 18 July – pre-order it here
