A sexual health screening appointment can be very difficult if you’ve experienced a sexual assault. Even the anticipation of going can be temporarily re-triggering of PTSD symptoms. What this might look like depends on each individual but typically it includes anxiety attacks; freezing; emotional or visual flashbacks; pain in the areas of body that were assaulted.
However, a smear is really a important procedure for your physical health, I hope this blog will help you to prepare psychologically and practically for attending when the time comes.
Getting the letter informing you that your smear is due
This may be the first time you’ve considered going for your smear following an assault and it might be quite frightening. You may have an urge to ignore the letter or put it in a drawer so that you can’t see it (and therefore forget to sort it out). Making the practical and emotional preparations in advance will help you to feel more able to book the date and time. Ask for support from a friend or partner if this will help to get the appointment booked.
Practical preparation for attending the appointment
Let the reception know in advance that you need to book a double appointment due to anxiety, don’t feel obliged to say more than this if you do not wish to disclose the assault. They should be able make adaptations based on this information alone.
If you’re working with a psychologist or therapist then ask them to write a letter to give the nurse with their recommendations for the appointment (or download this free letter template to print out and take this along instead).
Block the rest of the day out to relax, feeling anxious is very draining so it’s better to be prepared for this. Prioritise self-care straight afterwards and congratulate yourself for going to the appointment (even if the full procedure wasn’t completed on the first occasion).
Emotional preparation before the day
Before you attend I recommend practicing techniques to manage the possible anxiety reactions of panic, freeze, flashbacks or dissociation. Doing any calming skills when you are very emotional is hard so it is essential to practice them for several weeks at moments when you aren’t stressed so that you can use them more easily when you are.
Grounding: this is a way of staying present. Use one of your five senses to bring yourself back to the present, ideally something that feels like an intense sensation and is therefore tricky to ignore. Examples are sucking on an extra strong mint, wafting smelling salts under your nose (Mackenzie smelling salts are good); flicking a hairband on your wrist; popping bubble-wrap.
Relaxation techniques: Listen to an audio guiding you through a mindfulness or breathing exercise e.g. (try this one I’ve recorded or an app such as Calm or Insight Timer). Do this before leaving home for the appointment, in the waiting room and again in the appointment too if you think this will help.
Distraction: You may prefer something distracting to listen to rather than a relaxing audio e.g. a game on your phone like Candy Crush or a podcast or videos on your phone that you know make you feel happy (cute kittens and puppies, videos of your nieces, nephews, kids laughing etc). When you are using a game that involves thinking you are pulling your brain out of the threat centre into the pre-frontal cortex so this can help your rational thinking to come back online.
If you have affirmations or coping statements that you need to hear write them down in advance put them on the notes section of your phone to read before, during and after. Examples include "My brain is misinterpreting the situation as dangerous, I am safe now"; "My PTSD has been triggered but I know it will pass"; "I can come back to my breath when I feel overwhelmed".
When you arrive on the day
Bring someone with you to the waiting room if you think this would help, so that they can talk to you and support you with the anticipatory anxiety. For some people the anticipatory anxiety is the worst part.
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Let the nurse know that you will be doing relaxation techniques during the appointment to manage anxiety and ask her to agree that she will pause at any point to allow you to use them. Ask her to talk you through everything that is happening and not to proceed to the next part until she has asked your permission and checked you are ready.
If you have a sense of your most likely anxiety reaction and what it looks like let the nurse know so that she can be attuned to this too. Then explain in advance what she should do if you have a panic attack, freeze or dissociate e.g. that she will help you to practice your breathing, get you a cold glass of water or simply that she will cover you and sit and wait whilst you use your calming techniques. (See this downloadable letter template if you think you will struggle with this in the moment)
Let the nurse know if there are any body positions or words that are particularly triggering and that you would like her to avoid. You may also feel more comfortable inserting the speculum yourself so could ask if this can be accommodated.
It may not be completed on the first appointment
Getting to the appointment at all will be a big achievement. Instead of approaching the outcome in an all or nothing manner (If I go through with the whole thing then I’ve succeeded, otherwise I’ve failed) try to approach it in the way that a psychologist would support you to do – in a graded way. So it might be that the first appointment you only get as far as lying on the coach; holding the speculum; or putting the speculum part of the way in. If you are going slowly and using your relaxation skills then you can tap into what feels manageable and will be able to tell the nurse when to pause. All of these steps will be an achievement. If you would like the nurse to be made more fully aware of this psychological approach please download my letter template which can explain it to them.
Extra Support
The Body Back Project is a specialist service carrying out Pap Smears with women who have been sexually assaulted. They have clinics in London and Glasgow but are open to anyone in the UK if you can travel to their clinic. Their staff have specialist training so the appointments are longer and they will go at a very slow pace, pausing and stopping the procedure whenever you feel overwhelmed. www.mybodybackproject.com
If you need support with the emotional preparation I’d recommend speaking to a psychologist you can access this at your local Sexual Assault Referral Centre, Rape Crisis or privately if the other options have too long a waiting time for therapy.
Now go read these:
1) My Guide to recovery from sexual assault helpful.
2) My blog on the freeze response.