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Abstract

Prior work suggests that women with a history of sexual violence, particularly those who develop posttraumatic stress disorder (PTSD), are vulnerable to emotional distress during the pelvic examination. However, intensity of pelvic examination–related distress is variable, even among women with prior trauma. Additional research that helps to identify potentially modifiable factors most directly associated with examination-related distress (e.g., specific trauma symptoms) is needed to guide the clinical practice of professionals in women's health care.

In this cross-sectional and descriptive study, 40 female veterans with prior sexual violence completed (1) a pelvic examination, (2) immediate retrospective measures of examination-related distress, and (3) the Clinician Administered PTSD Scale. Forward-step linear regression models evaluated the relationship of each reported trauma symptom cluster (traumatic re-experiencing, avoidance/numbing, traumatic hyperarousal) and examination-related distress, controlling for total trauma symptom severity. Exploratory item analysis was performed on all symptom clusters that were associated with examination-related distress. Traumatic hyperarousal emerged as a significant predictor of examination-related distress (t=2.5, R=0.40, Adj. R²=0.14, p=0.02). Item analysis revealed that examination-related distress was most closely linked with hypervigilance (r=0.54, p<0.001). Increased awareness of the potential role of traumatic hyperarousal in women's experience of distress during the pelvic examination is warranted. Clinicians who perform the pelvic examination may benefit from education on identification and effective management of patients' physiological symptoms (hyperarousal) of trauma.

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A New Perspective on Distress During the Pelvic Examination: The Role of Traumatic Hyperarousal in Women with Histories of Sexual Violence

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