How to Support Someone Who is Traumatised by Sexual Abuse When They Are Using a Health Service
Sharon Belshaw is the CEO of Clinical of Break the Silence, a charity working with people who have experienced sexual trauma. She also has a private practice working with not only people who have experienced trauma but a variety of issues. She works with adolescents and adults and is studying for her Doctorate in Psychological Trauma.
Many people who have experienced sexual abuse can be fearful of using health services for several reasons. They may be anxious that the procedure could trigger their memories or that they have no control over what is happening to their bodies. There are also concerns about feeling the need to explain themselves and disclose when they don't wish to.
What types of health procedures could affect a survivor?
Maternity services
Scans and vaginal examinations require gel, which can replicate the feeling of semen on someone's body. Particular body positions, feeling held down, and being unable to control what is happening inside them can be triggering. Some women even report that, aside from the pain, the sensations of pressure inside can be distressing. Expectations of skin-to-skin contact with a newborn covered in body fluids can be traumatizing for some women. The pressure to breastfeed and feelings of shame if they are unable to do so are significant. According to Cho et al. (2019), the impact of childhood sexual abuse indicates a 2.73-fold increase in women developing postnatal depression.
Dental services
When we visit a dentist, we often don't think about the impact of the experience on survivors. Being placed in a chair that is difficult to escape from, having someone control your position when the chair moves, can be hugely frightening. If someone has been orally abused, saliva and blood filling their mouths, being unable to talk, and feeling like they can't breathe would be terrifying. In addition, even with pain relief, the sensation of pressure in your mouth can bring back emotional and physical memories.
Internal invasive procedures
We hear about campaigns encouraging women to get smear tests and how important this is, which is true. However, as yet, I have never seen a campaign address sexual abuse as a factor that fills women with fear of undergoing this procedure. There have been certain services that give more control back to women and explain what is happening. Staff at these services are also trauma-informed. The Survivors Trust and the Eve Appeal have a guide that provides both staff and survivors with helpful tips, such as allowing women to hold and use the speculum themselves. There is also a pilot program for HPV self-screening in the UK, which aims to help a wider range of women going forward.
Colonoscopy Procedures will also affect survivors of all genders. The pressure in the body and fecal matter being discharged, combined with the inability to fully see everyone in the room and the inability to move once the process begins, can all affect someone's decision to attend the appointment.
Physical health for survivors of childhood sexual abuse can be impacted by the trauma to such a degree that it is indicated that "research suggests that people with a history of CSA have a greater number of doctor and hospital contacts, 20 percent higher than those who have not experienced CSA, which can be an indicator of poor physical health. Some victims and survivors report 'medically unexplained' symptoms, which can include non-epileptic seizures and chronic pain." Fisher et al. (2017).
What can be done to help make it easier?
If you take a trauma-informed approach and consider that the next patient you see might have experienced CSA, you are thinking about how someone could be triggered. What can you do to make the process less traumatizing? With this mindset, you do not need to ask, as it should not be up to the survivor to disclose when they feel vulnerable, especially if they do not have a relationship with you that makes them feel comfortable and secure enough to share.
Inform the patient of what will be happening and what to expect.
Give over control if possible, allow choice, and listen to any concerns someone may have.
Educate yourself around some of the literature on CSA and survivors' stories. Some good resources include here and this link. Both organizations offer training for you and your teams.
Read more from Sharon Belshaw
Sharon Belshaw, CEO-Clinical of Break the Silence
Sharon Belshaw, CEO-Clinical of Break the Silence and Psychotherapist, works with people who have experienced trauma, loss and anxiety. She also supports staff who have experienced vicarious trauma through their work. She has written and published articles on autism and sexual abuse awareness for parents, supporting vulnerable women in maternity services and sexual abuse awareness.
References
Fisher, C., Goldsmith, A., Hurcombe, R. and Soares, C. (2017) The impacts of child sexual abuse: A rapid evidence assessment iicsa-impacts-child-sexual-abuse-rapid-evidence-assessment-full-report-english.pdf
