Sexual Assault Victims Are Traumatized All Over Again at the Doctor's Office

Survivors of sexual harassment, sexual assault, sexual abuse and their supporters protest during a #MeToo march in Hollywood, California, on November 12. MARK RALSTON/AFP/Getty Images

As survivors of sexual assault and abuse are mobilizing around the #MeToo hashtag and coming forward with their stories in waves, one particularly fraught environment for them is becoming more sensitized: the doctor's office. Routine physical exams can be traumatizing for patients with histories of sexual abuse. Now, a newly published review of trauma research could help doctors better understand those survivors' needs as patients.

"#MeToo is not a trend, it's a cultural shift," Dr. Jane Balbo, a co-author of the new study and an assistant professor of family medicine at the Ohio University Heritage College of Osteopathic Medicine, told Newsweek. "And because of that—because of so many people coming out—I think it will start to change the way doctors behave with their patients."

For a review published December 11 in the Journal of the American Osteopathic Association, medical experts analyzed more than 50 studies on post-traumatic stress to learn more about how brain chemistry and behavior can change in the aftermath of sexual assault. Though its publication coincides with a watershed moment in our culture, this work predates the #MeToo disclosures and the political momentum that surrounds them by several years.

Kristin Cuevas, a medical student at Ohio and the paper's lead author, began the research in 2014. She told Newsweek her two goals with this paper were to educate doctors and medical students about what happens to the brain of someone who has experienced sexual trauma, and then offer guidelines for trauma-informed care.

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Physical touch, for example, is a routine part of medical examinations, but it could be triggering for patients with histories of sexual trauma.

"If I freak them out, it's like getting traumatized all over. Some people never come back to a doctor if they have a bad experience," Balbo told Newsweek. "Touch is a big part of what we do, a big part of what we teach our medical students to do. To me, it's something very simple, but I don't always know if my patient has a trauma history."

Better patient care for survivors could begin before the patient and doctor even step into the same room. Balbo said she recommends hospitals add questions about trauma to their pre-visit intake forms. Those could include "Have you ever been sexually abused or raped?" or "Have you ever felt afraid of your partner?"

"The vast majority of the time, the only reason I know someone has a trauma history is because they check it on the form," Balbo said.

Most of the time they don't want to talk about it, Balbo explained, and that's fine; she'll acknowledge their preference and move on. One of the guidelines the authors outlined is that it's not the job of the physician to investigate assault or suspected assault. Rather, they want doctors to focus on helping patients feel comfortable disclosing if they want to, and on the best practices for avoiding retraumatization.

Cuevas and Balbo said it's not so much about verbalizing every move they're about to make in front of their patients with known trauma histories, but just making sure those patients feel in control of their bodies and that they have the option to say yes or no to any aspect of an exam. That could mean a potentially fraught experience like a pelvic exam, but also things like just touching the patient's stomach to place a stethoscope.

"I'll tell them I want to empower you, as my patient, to tell me at any point if you're not comfortable with something," Balbo said. "You're the patient, I'm your doctor; I'm making recommendations, but I'm not the boss of you. And patients will say, 'Oh, I never knew I could say no; I'm not ready, I don't want you to do that.'"