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Distress and Pain During Pelvic Examinations: Effect of Sexual Violence

Weitlauf, Julie C. PhD1,2,3; Finney, John W. PhD1; Ruzek, Josef I. PhD2,4; Lee, Tina T. MD, MS5; Thrailkill, Ann MSN, APRN6; Jones, Surai MS1; Frayne, Susan M. MD, MPH1,7

doi: 10.1097/AOG.0b013e31818e4678
Original Research

OBJECTIVE: To estimate the range and severity of distress and pain during pelvic examinations among female veterans with and without histories of sexual violence, and to examine whether posttraumatic stress disorder explains additional variance in examination-related distress and pain above that accounted for by exposure to sexual violence.

METHODS: We employed a cross-sectional cohort design in which 67 selected female veterans completed self-administered questionnaires to assess history of sexual violence and experiences of distress and pain associated with the pelvic examination. A subsample of 49 completed an assessment for posttraumatic stress disorder approximately 2 weeks later.

RESULTS: Distress associated with the pelvic examination was highest for women with prior sexual violence and posttraumatic stress disorder (median 5.49), next highest for women with sexual violence only (median 2.44), and lowest for women with neither (median 0), P=.015. Higher ratings of pain were also found among women with sexual violence (median 2.5) compared with those without (median 0), P=.04. However, posttraumatic stress disorder was not linked with increased pain from speculum insertion beyond that accounted for by sexual violence; limited power may have precluded detection of this effect.

CONCLUSION: Distress and pain during pelvic examinations may indicate a history of previous sexual violence, particularly in those with posttraumatic stress disorder. Extra sensitivity to the special needs of this population is warranted and may contribute positively to the quality of patients' experiences.


Prior exposure to sexual violence is linked to greater distress during pelvic examinations; the presence of posttraumatic stress disorder explains additional variation in distress.

From the 1Center for Health Care Evaluation, 2Sierra Pacific Mental Illness, Research, Education and Clinical Center, 4National Center for Posttraumatic Stress Disorder, 5Department of Psychiatry, and 6Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California; and 3Department of Psychiatry and Behavioral Sciences and 7Division of General Internal Medicine, Stanford University School of Medicine, Stanford, California.

Supported by a Department of Veterans Affairs, Veterans' Health Administration, Health Services Research and Development Associate Investigator Award (AIA-040245-1).

The authors thank Dr. Rudolf Moos for his consultation regarding the development of measures and Dr. Phillip Lavori for his input on statistical analyses.

Presented in part at the national meeting of the Association of Military Surgeons of the United States (AMSUS) Annual Meeting, San Antonio, Texas, November 5–10, 2006.

The views expressed are those of authors and do not necessarily represent the views of the Department of Veterans Affairs.

Corresponding author: Julie Weitlauf, PhD, VA Palo Alto Health Care System (152 MPD), Center for Health Care Evaluation, 795 Willow Road, Menlo Park, CA 94025; e-mail: or

Financial Disclosure The authors have no potential conflicts of interest to disclose.

© 2008 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.