Strong discomfort during vaginal examination: why consider a history of abuse?

To study factors associated with strong discomfort during vaginal examinations (SD/VE) by means of four hypotheses.

A cross sectional postal questionnaire study, conducted at three Swedish departments of obstetrics and gynaecology and with a random population sample (n=4453).

The associations between a self-reported history of emotional, physical and sexual abuse and abuse in health care, flashbacks during the previous year, emotional contact with the examiner, and SD/VE during the index visit (discomfort estimated on a ten-point scale; six-ten=SD). Statistical analyses used were Chi-square, Binary logistic regression, and Pearson Correlation.

Eighteen percent of the women reported SD/VE. There was an association between SD/VE and a lifetime history of abuse. Having experienced combinations of abuse, especially combinations including emotional abuse and abuse in health care, was strongly associated with SD/VE. SD/VE was furthermore associated with flashbacks during the previous year, and negative emotional contact with the examiner during the index visit.

We conclude that women who unexpectedly react with SD/VE are more likely to have a background of abuse, and may even run a risk of feeling re-traumatised during the VE. A clinical implication is to consider a history of abuse in patients who react with SD/VE or experience negative emotional contact during the consultation.