As many as one in five women aged between 16 and 59 in England and Wales have experienced some form of sexual violence, according to official figures. For those who have survived abuse, check-ups such as cervical screenings can be extremely tough.
A cervical screening generally involves gently opening the vagina using a speculum – a long plastic or metal device – and collecting cells from the cervix using a thin, soft brush or spatula. This procedure, also known as a smear test, prevents 75% of cervical cancers. As cervical cancer is most common form for the condition in women aged under 35, those between 25 to 49 are advised by the NHS to undergo the procedure every three years. But a new survey by Jo's Cancer Charity to mark Cervical Cancer Prevention Week showed that a third of women avoid such tests because they are ashamed of their genitals.
And due to the nature gynaecological examinations, some survivors of abuse would rather avoid appointments rather than risk bringing up traumatic emotions. But survivors and clinicians want this to change, and urge people to try their best to attend potentially life-saving sessions.
"I have put off many screenings or left without a procedure being completed," Adah*, a 40-year-old psychotherapist based in London who experienced sexual violence both as an adult and a child, told IBTimes UK.
"[A cervical screening] is an invasive procedure in an intimate area where there is a loss of a feeling of control. Many memories can be triggered, the body can go into a freeze state, clench up, the person may dissociate or experience flashbacks and feelings of shame or confusion," she said.
By using phrases they believe will put a patient at ease, such as "just relax", clinicians may also unwittingly mirror language used by perpetrators of sexual violence, she explained.
"I have had many experiences where the nurse or doctor got frustrated with me for not being able to relax and sometimes they have told me they couldn't do it," Adah said.
"Once a nurse said 'I'm not raping you, you've had something much bigger in there or you wouldn't be here'. Most professionals didn't speak this harshly but I've heard over and over, 'relax or I might hurt you'. This was very shaming and scary, and I'm not sure they were aware of the resonance of an expression like that to a survivor."
Adah is emphatic that the reactions and fears of survivors are "more than understandable". However with the right provisions, it can be possible to complete examinations.
"Sometimes when the nurse or doctor has been sensitive and respectful and done the procedure in a quick way or I've had a friend or partner come with me, it's been possible to get through," she said.
Dr Sadaf Ghaem-Maghami, a Royal College of Gynaecologist spokesperson and expert in gynaecological cancer, told IBTimes UK that doctors receive training on how to treat patients in case they are survivors of sexual violence. However, a lot of these skills come with experience. Clinics such as My Body Back in London, for instance, are specially trained to help survivors get their health checked.
Although patients may not be aware, it is perfectly acceptable to ask to see a male or female practitioner, or someone with expertise that could accommodate them – without needing to explain why.
A clinician can then confidentially discuss with a patient what might make them uncomfortable, including touching particular areas of the body, and using specific words. Doctors can also explain the instruments used in a preliminary appointment before trying to perform a procedure in a separate session.
"There are always ways around it," said Dr Sadaf Ghaem-Maghami. "You can want to be in a different position [during the examination]. You can even get the patient to put the speculum in if that is what makes them feel most comfortable".
Dr Ghaem-Maghami urged all women to try their best to complete important check-ups, including cervical screenings and STI appointments. "Don't be put off by expressing how you feel and asking to be seen by someone who has experience."
*Name has been changed.