Health and wellness touch each of us differently. This is one person’s story.
Despite the sexual health field being full of invasive procedures, they’re often not accompanied by an appropriate level of gentleness, informed consent, and care for the patient. This means survivors of trauma, like myself, are often left to carve a path for themselves in order to find care that meets our needs.
Given the stats — that at least 17 percent of American women have survived a sexual assault or attempted assault and almost half of transgender people have experienced sexual violence — trauma-informed health practitioners, especially in sexual health, shouldn’t be hard to come by.
Yet this is often not the case, as I recently discovered firsthand when trying to find trauma-informed care for myself.
The pain was manageable at first — until it wasn’t
The symptoms first started a few years ago: a bit of achy pain in the left side of my pelvis when I was ovulating. Some cycles it was a little worse, sending tendrils of pain into my inner thigh.
“It’s just a bit of mittelschmirz,” said the first gynecologist I saw. (Mittelschmirz is pain linked with ovulation, often 14 days before your next period. It’s typically one-sided and occurs in the lower abdomen.)
“Nothing to worry about.”
I nodded, a bit skeptical, but happy for permission to ignore it.
For those of us with sexual trauma, a transvaginal ultrasound can be triggering, even retraumatizing. The momentary pinch of a speculum during pelvic exams could bring me to tears.
Over the next several months the pain came and went, rarely bad enough to be remarkable. But then it got much worse. Once while I was walking to work, it got so intense I had to stop, hold my belly, and breathe through the pain. I saw another gynecologist, who gave me a manual pelvic exam, but told me she couldn’t find anything.
“The next step would be a transvaginal ultrasound,” she explained. “That can give us a much clearer picture of what’s happening.”
Yet that next step wasn’t trivial. This procedure — in which an ultrasound wand is inserted into the vagina and rotated to offer views of the pelvic organs — is deeply invasive and can feel violating to just about anyone.
But for those of us with sexual trauma, a transvaginal ultrasound can be triggering, even retraumatizing. The momentary pinch of a speculum during pelvic exams could bring me to tears.
How was I going to get through this?
I quickly realized finding the right care for me wasn’t going to be easy
After a bout of excruciating pain in the fall of 2018 that lasted for days and barely responded to medication, I knew I had to get it checked out after having refused the ultrasound at first. But when I attempted to find answers about how to make the process as gentle as possible, I quickly learned there isn’t much in the way of trauma-informed healthcare in the United States.
I started online. I’m part of a large Facebook group for parents in the San Francisco Bay Area, where I live. I asked them to recommend a trauma-informed gynecologist — someone well-versed in trauma and PTSD, who knew how to be gentle with patients like myself. I was especially looking for a healthcare practitioner who could do the sonogram in-house, rather than sending me to a radiology clinic, so I could get to know them before the scan.
Upon hearing that she couldn’t do the ultrasound, especially given how caring she was, I burst into tears.
And yet, few people responded to my plea. One person who did, however, was a local midwife who suggested several doctors. Luckily, one of them — Dr. Homaifar, who’s part of the women’s health team at the University of California at San Francisco (UCSF) medical center — was taking patients at the time.
Despite finding the right doctor, I would still need someone else to do the ultrasound
The day of my appointment, I noticed Dr. Homaifar’s kind eyes and warm smile right away. She shook my hand and asked what brought me in to see her.
I told her my history — the sexual trauma, the pelvic pain, my sense that I should get the ultrasound. I said I wanted to establish a relationship with a gynecologist and have her be the one to do the scan.
She thanked me for my candor and explained that, given my symptoms, it might be a cyst, a twisted ovary, or an egg follicle that bled when I ovulated.
“I agree that a transvaginal ultrasound will help us see what’s going on,” she said. “Unfortunately, that’s not something I can do here. I’d have to send you to radiology.”
Until that point I’d been able to keep calm. But upon hearing that she couldn’t do the ultrasound, especially given how caring she was, I burst into tears.
Scheduling an ultrasound to align with ovulation is challenging.
Seeing how difficult this was for me, we agreed that she’d set up the referral and I’d figure out how to move forward. As Dr. Homaifar said goodbye, she let me stay in the exam room until I pulled myself together. Sitting there on my own, I was disappointed, even hurt, that a stranger would have to do the ultrasound. I honestly wasn’t sure if I’d go through with it.
Though, in the end, I did.
Even the process of finding the right date wasn’t easy
Scheduling an ultrasound to align with ovulation is challenging. Not many of us have ovaries that reliably produce an egg every 28 days, and there’s no way to know which ovary is on the job that month.
While I was in the adjacent bathroom getting ready, the technician admitted to my partner that these ultrasounds are uncomfortable even for people who haven’t experienced trauma.
After my visit with Dr. Homaifar, I made numerous calls to the radiology lab. Dr. Homaifar told me we’d have our best chance of finding answers if I came in when I was ovulating and when I was having the pain. I scheduled appointments, canceled them when I didn’t feel pain that month, and tried again.
To my surprise, the receptionists didn’t understand why the next available appointment wouldn’t do. Unfortunately, many ovary-having patients have endured this sort of merry-go-round experience. That I was doing so for a procedure that would likely be triggering, however, made this whole situation especially infuriating. A less persistent person would’ve given up.
Preparation and communication helped me make it through the appointment
In early December, the pain and my appointment finally aligned.
On the day of the visit, my partner came with me into the exam room, and I handed the female technician a note I had typed the night before. I had chosen to write it down because I knew saying the words would upset me.
The note said: Hi, I am a sexual trauma survivor and I have PTSD. Vaginal pain is triggering for me. Please be really gentle. Let me know what you’re going to do and how it might feel before you do it. If you can, show me the monitor and tell me what we’re looking at. Thank you.
She said it was the first time she’d gotten such a request, but that she’d do her best. While I was in the adjacent bathroom getting ready, she admitted to my partner that these ultrasounds are uncomfortable even for people who haven’t experienced trauma.
Gentle, transparent, and consent-driven care should be the standard, not the exception.
As my partner held my hand, the technician talked me through the scan, showing me my uterus, ovaries, and bladder on a wall-mounted screen. The pressure of the probe made my pelvis feel bruised, and my thighs kept tensing like I was ready to run.
But I made it through the scan and was only a little shaky afterward. The technician even checked in with me to make sure she had done OK.
Protecting the needs of trauma survivors should be the standard, not the exception
Unfortunately, the ultrasound didn’t show anything amiss. My ovaries and uterus look perfectly healthy. That might seem like good news, but it means we still don’t know what’s causing the pain. Dr. Homaifar and I are trying to figure out what’s next. But when I saw her last month, she praised me for going through it, knowing how hard it might be.
I’m thankful I was able to find her and a path through this process that protected my needs as a trauma survivor. But the thing is, I shouldn’t have to. Given how many women and nonbinary folks have endured trauma, gentle, transparent, and consent-driven care — which is kinder to all patients — should be the standard, not the exception.
Tips for seeing a doctor if you’ve experienced trauma
- Bring a friend or family member along with you for support
- Consider questions you might have for your doctor (and make sure to ask them before your visit).
- Be proactive and express any concerns you have during the exam or procedure.
- Keep yourself grounded during the exam or procedure.
- And remember: You can always stop the exam or procedure at any point during your appointment.
You can find more information about how to navigate a routine doctor’s visit as a person who has experienced trauma here.
Beth Winegarner is a widely published journalist, essayist, and author whose work has appeared in The New Yorker, The Guardian, Wired, Mother Jones, and many SF Bay Area publications. Her latest book is “Tenacity: Heavy Metal in the Middle East and Africa.” Find out more at www.bethwinegarner.com.