This is a personal story I want to share with loved ones and colleagues who supported me through a dark time not knowing what my damage was.
Several years back, a patient (early 20’s) I did a vaginal ultrasound on, accused me of violating her during the exam. She made the accusation in an email to her Gynecologist, a doctor I knew and adored, two weeks after her visit.
My manager at the time was uncomfortable with anything having to do with women’s health which is odd considering his position, but — he recently passed away so my thoughts on that will rest in peace alongside him. He had me sit down at his desk in front of his computer to read an email the patient had written. That’s how I found out a young woman was accusing me of “violating” her during what I remembered to be a basic, run-of-the-mill pelvic ultrasound.
I did not violate anyone, but I did begin to hyperventilate right there at his desk. I felt like a piece of garbage. Anxious thoughts filled my mind in milliseconds. ‘Why didn’t she say anything? I tell everyone they can halt the exam at anytime. Is she going to sue me? Come after our home?’ I didn’t do anything wrong, but I obviously didn’t make her feel as comfortable as I thought I had either.
Once I was able to compose myself, I pulled up the exam to review the images. My transverse images of the uterus had both plump, fertile, 20 something year old ovaries standing at attention practically giving me a salute from each side. I did not have to work hard to get the optimal images taken.
In usual fashion, I had documented in EPIC that I offered a chaperone and one was declined. I don’t recall ever sensing the patient was uncomfortable at the time and she never said a word. Why didn’t she say something?!? We want you to say something!!
That’s all folks! End of story!
What, were you expecting more? Me too— but, when you work for a healthcare giant that prefers to keep everything under wraps in order to save their reputation—that’s where it ends. Even at the expense of their staff’s mental health and well-being.
After writing an email explaining what I remembered of the patient interaction, and forwarding it to my manager— he then forwarded it on to the Gynecologist and I never heard another word about it. I assume the Gynecologist counseled the patient accordingly and that was that, but I don’t know for sure because nobody ever counseled Me.
You don’t learn about this part of the job in school.
I tanked. I was deeply depressed because though in my mind I did a simple, easy-peasy vaginal ultrasound, someone in the world felt I “violated” her. VIOLATED! You don’t understand the gravity of that word until you’ve been accused of it. I’ve personally had several vaginal ultrasounds and I’ve actually been violated. I know the difference.
I started telling my story to a couple of close friends and co-workers. “Oh, that happened to me.” Was the most common response.
Is this a thing?? I need to know. Have any of you been accused of violating someone during a vaginal ultrasound exam? It’s not just the male sonographers who need a chaperone these days. Unfortunately, nobody has staff available for such an unproductive, zero revenue task.
I get frustrated because so many women arrive having no idea a pelvic ultrasound involves a vaginal approach. In my opinion, if a clinician is ordering a pelvic ultrasound, it is the responsibility of that clinician to explain it to their patient. We don’t know if the patient has a history of sexual violence or severe anxiety surrounding the unknown and we often find ourselves trying to convince the patient to have the exam done once WE make them privy to the uncomfortable part. This should not be the case.
To my loved ones: I would like to point out, that if you have a doctor’s appointment, you will most definitely get an after-visit summary. REMEMBER to Read the after-visit summary!! The clinicians depend on you reading it! If you feel uninformed by your doctor, a court of law will ask if you were provided with an after-visit summary. You were. In an email or in physical paper form as you left the office.
I would like to describe what you can expect during your pelvic ultrasound.
We ask a lot of questions, be prepared with answers. When was your last menstrual period? How many times have you been pregnant? How many births? Are you on hormones? What is your form of birth control? Have you had any surgeries?
Please– worry NOT if you don’t have freshly shaven legs or pubic area. Soap is nice, but honestly — most of us are immune. I’ve scanned open wounds with maggots. I couldn’t care less about your unshaven stubble, but again– soap is great.
Where were we…?
The abdominal approach is done by scanning on your belly over a full bladder. We don’t need you to be completely uncomfortable, but we use your full bladder as an acoustic window. With this approach we evaluate the uterus, adnexa–the area adjacent to your uterus which contains your fallopian tubes, ovaries, legaments etc. The vaginal approach alone sometimes cannot visualize the ovaries or a mass potentially sitting a little higher than what the vaginal probe can penetrate.
The vaginal approach is to get a closer look at the uterus, ovaries and adnexa. We ask you to undress from the waist down for a reason, we can’t get our probe through your panties ladies. “Should I pull these to the side?” ‘If that’s you’re typical mode to penetration, honey. Let’s do this…’
I have seen it all!
You’re the boss here ladies! You can insert the probe yourself or have the sonographer do it for you. You can also halt the exam at anytime if you are unable to tolerate it. Please be aware– our transducer is not a point and shoot camera. We need to push a little bit. The ovaries can be illusive little shits and we are hunters. We often wrestle with your intestines while trying to avoid the pain that brought you to us in the first place.
The probe goes into the vagina only. It does not enter the cervix. “Is the probe going to push my IUD out of place?” This is a common question. My first thought is always, ‘I sure fucking hope not, Sharon!!’, but it is indeed a fantastic question. The centrally localized IUD is in the uterus and only the strings are in the cervix. The vaginal probe does not enter the cervix.
Seniors– I once had an elderly patient with a walker. She was 81 years old and was upset with her doctor because she informed the clinician she could not do GYN type healthcare as she couldn’t tolerate pelvic exams anymore due to mobility issues. She was a retired nurse. She was having too much hip and leg pain and couldn’t get into the stirrups let alone have something in her vagina which had been “vacant for 30 years”. She declined the vaginal exam in the end and it took me 50 mins and two attempts abdominally to obtain non-diagnositic images. We do try, but we aren’t miracle workers.
Please be sure to advocate for yourselves and if you are unsure about something, ask someone you know in the healthcare field to help you. There are lots of resources out there.
Did I mention soap is great?
