Tuesday, January 3, 2012

Young children and modesty
by Holly Goodwin

Pediatric modesty is not a subject that is discussed often but certainly must be addressed. Recall experiences with your own children or your own childhood; at what age did the “good touch, bad touch” discussion happen? Healthy children will likely never have to have invasive pelvic procedures done to them and so it is likely not many people have experienced what it’s like to be a child who is forced into one of these examinations and procedures, but for those of us who were it can be a life altering event.
By the age of 5 I knew what a bad touch was. To my mind, it was anyone who wasn’t my parents touching my genitals. I was always told to say “no” if I felt uncomfortable with anything and I would be in the right. I suppose my parents didn’t expect me to begin having pelvic problems at such an early age.
My first episode with Interstitial Cystitis, a painful, incurable bladder disease, was when I was five. It was nap time and about time to go home when I felt the urge to urinate so I asked my teacher if I could go to the bathroom. After urinating I still had the feeling that I really needed to urinate bad but nothing would come out. I stayed on the toilet straining and confused for a long time before I got up and went to my teacher crying and saying it felt like I had to urinate but nothing would come out. Like most people, she assumed I had a UTI and let me go call home.
I cannot remember if I actually had an infection or not when I had to do the pee-in-the-cup test. I’m not sure if this was in the same visit or not, but I know that eventually it was discovered there was no bacteria in my urine anymore (if there even had been any) and the doctor wanted to perform a pelvic exam on me. I was already afraid of doctors from a series of treatments for my lazy eye which eventually ended up being a painful surgery that left me blind for what felt like days.
When I was asked to take off my pants and panties I was confused. I said I didn’t want to because my doctor was a boy. I expected a girl to come in because I was always taught not to let boys touch me there if I was uncomfortable, and of course I was uncomfortable given the setting. With my mom’s aid, they forced my clothing off me while I was screaming and crying for a female doctor. That useless argument that we women always hear came up, but most heart-breakingly, from my own mother – that “He’s seen so many it’s not a big deal” speech. Regardless, I had been told to say no if I didn’t want to be touched there, and I did say no. I screamed no. Despite my struggling, I was too little to fight them off. The doctor didn’t penetrate me with anything but he looked at my urethra and inside my vagina and said he thought I may have a yeast infection causing the problems. He brought a cream out and slathered it all over my genitals and it burned. 
After I put my panties back on all I could feel was that cream slurping around in my privates and making me feel very humiliated, as though I had wet myself. My mom kept making me use the cream at home despite it burning and not helping, but because the doctor said so she made me do it. As to why the doctor insisted on putting the cream on me himself inside the office instead of allowing my mom to do it there or later at home with the prescription I have no idea, but it made me realize I truly had no say-so or autonomy when it came to matters with my body and doctors regardless of everything I’d been taught during my 5 years of life. I was ashamed and depressed, but didn’t know how to express these feelings in words. In the end the cream did nothing. I had Interstitial Cystitis, not a yeast infection. In fact, the irritation of the cream likely made it worse. After that experience I stopped telling my mom when I hurt and lost a lot of trust in her.
A study done by Child Abuse & Neglect: The International Journal says that a child’s ability to recognize a bad or good touch depends mainly on age and if they were educated. Before being educated in the study, 5-year old children were most likely able to distinguish a bad touch from a person of authority, who was usually considered “good,” than 4- or 3-year olds. After being educated over 90% of both 4- and 5-year olds were able to determine a bad touch regardless of its source (Maureen and Wurtele). To me, what had happened had been a “bad” touch despite the position of authority he held since I was old enough to recognize that I was uncomfortable with the idea of a man I hardly knew touching me there. This study shows that children as young as 4, and even some at the age of 3 can have a sense of genital autonomy and social taboos about it as well as knowing about saying “no” to bad touch. To a child, a burning cream forced onto him or her could definitely count as a “bad touch.” A child’s sense of personal autonomy over his or her own body during the years of preschool and elementary school is very strong. They are often modest, have a strong sense of ownership in regard to their bodies, and often may insist on privacy, even from their own parents. The ability to maintain comfortable boundaries is important for a child’s dignity, self-esteem, and a healthy sexual development later on in their lives (Popovich, 12). Children are very vulnerable to psychological disorders caused by the helplessness of hospitalization or invasive procedures (Popovich, 12).
Despite my own experience with the lack of care towards a child’s modesty preferences I had it lucky. If I actually did have an infection then I could have experienced the VCUG [voiding cystourethrogram] . A VCUG is performed to test for kidney reflux in children 5 and younger. The procedure is that the child must disrobe, lay on a table with a gown, have catheter placed through his or her urethra and have dye pumped into the bladder. The child is then forced to urinate on the table while pictures are taken while voiding. Not only is this exam invasive to privacy, it includes painful penetration, and as an act of losing all dignity, the child must pee on themselves in front of a medical team during an age where most have just proudly became fully potty trained. The pamphlets given to parents absolutely do not prepare either the child or the parent for what occurs during the exam (Phoenix Children's Hospital). It mentions discomfort, not pain, and describes the catheter as a “soft like a spaghetti noodle.” Anyone who’s been cathed will likely disagree with this statement. The first step to patient modesty is telling them the truth, especially to parents. Because of the child’s developmental issues at such an age, their feelings of shame or guilt are intensified when he or she is forced to expose the body and experience hurtful, invasive procedures. Children are also very frightened when doctors or other personnel focus on their bodies in ways only their parents have done. Preschool-age children react to this through regressive actions such as crying or thumb sucking. Even worse is for cases when parents are not allowed in the room; children may feel they are “bad” for allowing themselves to be touched, prodded, and probed (Popovich, 13). 
There are pediatric nurses trained for such cases, but evidence suggests that they hardly practice what they were taught due to personal attitudes or a tendency to be reactive instead of proactive. With little research there are few cases to cite, but in 2000 Popovich found that pediatric nurses had knowledge of a child’s physical needs but lacked knowledge in needs relating to psychological growth and emotions (13).
Many studies have concluded that the levels of anxiety experienced by children in a medical setting is unknown, but regressive behaviors like anger, sleep disturbance, and bed wetting is considered “normal” by nurses and doctors while a child is in the hospital. There is no published research on hospitalized children’s need for privacy, modesty, and self-esteem (Popovich, 14). 
The most hurtful thing for me to read are the stories written by mothers about the treatment of their children during the VCUG. Obviously, a good advocating parent will ask for treatment for the pain the child will feel, assuming they researched online rather than just using the hospital’s pamphlets, but nurses and doctors often try to talk parents out of using anesthetics like Versed. General anesthesia cannot be used evidently because the child must pee on him or herself for the test to be complete. As to why anesthetics like Propofol cannot be used I have no idea since it is an extremely short lasting form of general anesthesia commonly used for outpatient procedures like colonoscopies. 
Some grown adults can’t even handle this procedure, me included. Now imagine being a 4-year old child being prepped for this procedure, but you don’t really understand why they need to do this to you. Your parents likely told you what they read on the hospital’s pamphlet about it being “slightly uncomfortable” because it’s the only information they were given, and once you felt you were ready to cope with the embarrassment you find out how agonizing a catheter really is. At this point you may start to fight, but will be held down even as you scream, certainly not giving consent to be touched “there.”
The following are posts from parents I’ve come across during researching pediatric modesty, and especially about the VCUG which not only destroys a child’s privacy, but is actively penetrating their urogenital area and causing severe pain:


"Update: I'm still a little agitated after yesterday's experience and
trying to figure out how I feel about the way things went, so forgive
me if I ramble a little, and vent a bit. But, first of all --
everything's fine. My daughter's tests showed perfectly normal
kidney/bladder function; that's a big relief.

The ultrasound went well-no problems there. However. When the

office staff went to send back the orders for the VCUG, they
found that the ped's office had sent the script without sedation.
Not what we, including our daughter, were prepared for. They
could not get through to the doctor's office (8:30am), and the
voice mailbox was full. Great. I got out my cellphone [sic] and
hit the lobby...within 20 minutes (mostly spent on hold), I had the
office staff faxing the correct prescription. In fact, by the time I
got back to the Radiology waiting room, I was getting the thumbs
up from the office staff. Good.

Then, once in the room, the "intervention" nurses talked us out of
sedation. I believe at first they thought she was going under general
anesthesia, but even when told it was oral Versed, she persisted in
trying to persuade us that the risks were not worth the benefits --
that the catheter would be easily done and that the testing would be
simple. Ok, fine. We're all for less risk.

However, the catheritization [sic] was not simple. Not pain free. Not
un-traumatic. It took 4 nurses/techs to hold her down and get the
catheter in (after 3 tries), and this is with DH and I at her head
talking to her and holding her arms. NOONE [sic], and I mean

NOONE [sic] prepared us or her for the fact that she was going
to be asked to pee on the table. She's 3. She's recently
potty-trained. She doesn't pee on the table. Meanwhile, the
Radiologist is being a screaming cheerleader, which is pumping
up her anxiety level and he WON'T SHUT UP.

Egads. It was really quite the experience. I'd probably feel really
differently if we'd found out something was really wrong, and I

know I'd feel differently if we'd done sedation and something
had gone terribly wrong, but man...I just am so torn about the
process. I'm so pissed that they didn't give us all the
information we needed BEFOREHAND, despite my persistant
[sic] and detailed questioning. It's the things you don't anticipate
that get you.

We've tried to use the experience to continue teaching the ever so
important lesson that it's ok to object to people doing things to your
genitals that you don't like. That it's ok to say no. That it's ok to
scream and yell and put up a fuss if someone is trying to hurt you,
all the while reinforcing that this was a necessary medical procedure.
Such a fine balance. She was so offended, and so hurt that we didn't
do more to protect and defend her. Breaks my heart (Garden_of_darwin)."

Another commenter replied:
"My just turned three year old dd [sic] is going to have to
do the ultra sound and the VCUG. I had reflux from age 2 to age
10 and outgrew just before surgery was going to be ordered. I
had the VCUG procedure done no less than five times
WITHOUT sedation. At age 35, I am still traumatized and
would choose child birth over the procedure any moment of
any day. I INSIST that my dd [sic] has sedation and I think
that the nurses that guilted you out of it are no less than

monsters for doing so. Our pediatrician wants sedation,
which surprised me as I thought I was going to have to
sell her on it, but she insists as well. It is like an ancient
torture method without, believe me. I am soooo [sic]
sorry it happened that way for you and for your daughter.
We all do the best we can and as parents, of course we
don't want to risk our children. However, oral sedation
is not as dangerous as IV/general anasthesia [sic] and I
don't think they must have even had good motives in
scaring you out of it."
On another forum I read that the mother's girl was screaming to get it out of her. How this doesn't qualify as medical rape, I have no idea. I just know that only having a male doctor look at my privates against my will still haunts me and those paper gowns just make me want to die. It's like they take the last defense mechanism you have and toss it away, giving them complete power over you. There needs to be a major overhaul with how children are treated by medical professionals.
Propovich suggests the following enhancements to pediatric care:
· Preschool and early-school-age children are quite vulnerable to feelings of shame. Help them avoid such feelings by providing children with physical and psychological privacy, preparing them appropriately for procedures, and asking permission to look, listen, and touch. Providing for their privacy and respecting their sense of modesty convey to children a recognition of their inherent worth.
· Perform baths, assessments, and procedures with curtains drawn and doors closed.
· Use treatment rooms when appropriate to ensure protection of the pediatric patient’s self-esteem and self-concept.
· Spend time talking to children and walking them through procedures and stressful events in advance.
· Since children of this age group usually do not want to be seen crying, nurses can assist them by encouraging them to express their feelings, taking care not to deny or negate their expressions of fear and shame, and not criticizing out-of-control behavior.
Likewise Rosen-Carole, a helpful family practitioner, wrote about how she deals with pediatric modesty. Last year a pediatrician was charged with 471 counts of sexual abuse towards minors. Delaware Attorney General Beau Biden said, "These were crimes committed against the most vulnerable among us—those without voices (Quinn)." Rosen-Carole says that we have to rethink what we teach our kids in regards to “good touch, bad touch” as doctors are usually seen as being the “good” and parents may mention them as the exception, but from the study posted at the very top of the page it takes education to give a child the power to truly tell the difference. She shared her method of reinforcing the “good touch, bad touch” in Contemporary Pediatrics:

“As I listened to the news reports, I thought back on my own practices and realized that the following clinical pearl might be useful to others. Any time I examine a child more than about the age of 3 (and less than, say, 13) below their underpants, before I pull down their underpants, I point at them and say, "So, who is normally allowed to look down here?" The child will sometimes point at a parent, sometimes shrug, look blank, or even point at me. I look to the caregiver for guidance here and say, "Is that right? Only mommy/daddy/grandma (etc), right?" Then I ask the child, "Can doctor look?" and mostly get yes as an answer. I then answer myself, "NO! Only if mommy or daddy is in the room, right? If mommy or daddy went outside, I couldn't look anymore, right?" I wait for acknowledgement from caregivers and children at this and generally get it. Sometimes, if the child or family doesn't appear to understand yet, I go further and say, "What if someone tries when mommy or daddy isn't around? You say no and kick and shout and run away and tell mommy or daddy, right?" The caregivers look sometimes surprised, but mostly relieved. I think the relief might be that I have brought up a sensitive topic and have shown them how they can bring it up with their kids, too.” Rosen-Carole also mentions how the parents are surprised when once she asks their child the question they seem to not know the answer regardless if they have talked about it or not (Rosen-Carole).

Fellow Interstitial patients have also mentioned experiences with such procedures, stating that they held off diagnosis for years out of the terror that remained since their childhood after having these procedures done without any pain-killers (Interstitial Cystitis Network). I myself held off diagnoses for 3 years simply because of how violated I felt as a child anytime I went to the doctor. Even at age 12 I recall my doctor, who was female, not ask or say nothing to me before grabbing my shirt and looking down the neck hole of my shirt to examine my breasts. I was so shocked I couldn’t say a thing and my mother made no comment. I felt extremely violated as I was very sensitive about the changes happening to my body at the time.
I now struggle every year when it’s time for my annual pap smear. Just knowing that I have to have it done to get birth control turns my mind into a wreck at having my bodily autonomy once again taken from me through this “carrot on a stick method.” I have a wonderful, caring doctor now that I had to seek out for myself but I cannot get rid of those feelings of complete helplessness and bodily violations, especially with the current birth control policies most clinics have.
Preventing iatrophobia, the fear of doctors, starts at childhood. I plead to anyone with children to advocate for them and never leave the room. Listen to their gender preferences if they need to disrobe, and always research beyond what pamphlets the doctors hand out about pediatric procedures. There are many support groups online who will tell it like it is without any sugar coating from the medical community. Research, research, research, and if the doctor or hospital will not provide adequate emotional or physical pain relief then walk out and find one who will focus on what’s best for the child. In the end, it is you who must make the decision. Doctors can only recommend and perform procedures, not tell you what is best for your child and family. They are trying to look after themselves when the issue of pain relief comes up just as you are trying to look after your child’s well being, emotional and physical. Research if their methods are standard and get a second opinion, and even if their method is standard and you disagree, there will always be another doctor who will have a different view on how to diagnose, dispense medication, and treat conditions.

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Works Cited

Garden_of_darwin. "Vcug Renal Us for 3 Year Old: Seeking Information (long) - Kitchens Forum - GardenWeb." That Home Site! Forums - GardenWeb. 7 Feb. 2006. Web. 29 Dec. 2011. <http://ths.gardenweb.com/forums/load/kitchbath/con0212390014095.html?27>.

Kenny, Maureen C., and Sandy K. Wurtele. "Children's Abilities To Recognize A "Good" Person As A Potential Perpetrator Of Childhood Sexual Abuse." Child Abuse & Neglect: The International Journal 34.7 (2010): 490-495. ERIC. Web. 17 Dec. 2011.

Laura. "Interstitial Cystitis Network : Patient Stories : Della." Interstitial Cystitis & Overactive Bladder Network - Overactive Bladder, Bladder Pain Syndrome, Painful Bladder Syndrome, Hypersensitive Bladder Syndrome Information & Support For Patients & Providers. Interstitial Cystitis Network, 29 Apr. 2005. Web. 29 Dec. 2011. <http://www.ic-network.com/patientstories/laura.html>.

Phoenix Children's Hospital. "VCUG." Phoenix Children's Hospital. Phoenix Children's Hospital. Web. 29 Dec. 2011. <http://www.phoenixchildrens.com/PDFs/patients-visitors/VCUG-1.pdf>.

Quinn, Rob. "Pediatrician Earl Bradley Indicted on 471 Counts of Child Sex Abuse." Newser | Headline News Summaries, World News, and Breaking News. Newser, 23 Feb. 2010. Web. 29 Dec. 2011. <http://www.newser.com/story/81556/pediatrician-indicted-on-471-counts-of-sex-abuse.html>.

Rosen-Carole, C. "Good Touch, Bad Touch: Teaching Your Patients Whom To Trust Can Keep Them Safe." Contemporary Pediatrics 27.7 (2010): 66. CINAHL Plus with Full Text. Web. 17 Dec. 2011.

23 comments:

Joel Sherman MD said...

I am of an age which preceded the present concern about pedophilia. I was not raised to be concerned about intimate exposure to strangers and we didn't inculcate that in our children. But it is now routine parenting. Like most behaviors, there are unintended consequences. Making small children petrified of physicians may be one of them. Getting painful shots was bad enough. Obviously parents should prepare children for physicians' visits so that they don't get confused by contradictory instruction. In general parents should always be with small children and they should prepare them for exams done by either males or females. But if the child can't be made comfortable, their wishes must be respected, except in emergencies.

Doug Capra said...

Very interesting and worthwhile article. Embedded in this piece is a problem within medical culture that transcends the specific focus -- young children. That's the problem of true informed consent. So often patients are not told or offered the choice of being told, all the details of a specific procedure, i.e. What exactly will happen? How will the patient be positioned? What will and won't be draped? Who precisely will be in the room and what will their function be? In the case of children, the parents would be much better prepared to prepare the child and possibly require certain changes. Recall a recent study Joel quoted that said men would go for prostate tests and procedures more readily if they knew specifically what would be done. The men wanted more information. They wanted details. I can't help but believe that, at least sometimes, the medical attitude is that if the patient is told the specific details, they may either not go along with the procedure or ask/demand certain changes for their own comfort. Thus, we won't tell them, i.e. what they don't know won't hurt them. We'll help them, cure them, fix them -- so all will be okay. The ends justifies the means.
Unfortunately, with children, parents are often convinced because the trust or coerced out of fear into going along with the system. It's only in hindsight that they see the light, after viewing the fear, embarrassment, humiliation of their child. Recall the doctor who wrote an article about how his wife was humiliated in receiving a bed bath by what appears to be an especially insensitive male nurse. He and his wife tried for a female nurse but were intimidated into not "upsetting the apple cart." as he said.
Fine article about a subject that needs more research.

Maurice Bernstein, M.D. said...

I would say that two social groups should have a learning exercise. The first group is the parents of the young children. They should learn that it is going to mislead their child to teach the child that the child's genitals are only related to only sexual activity. The genitalia have anatomic and functional significance with regard to other functions and disease and that physicians must be able to examine, inspecting and touching them, and make tests to detect the malfunction and disease and to treat. As long as the emphasis of child education is an implication that genitalia are only for sex and that one has to keep concern for unwanted sexual attention by others in mind then one can expect the reaction of children and later adults to severe modesty issues.
Certainly, naturists appear to be teaching their children that there is something more to the exposure of the genitalia than sexual stimulation of themselves or others. So that is what the parents of children has to learn. Teach the full story of genitalia!

Now, the next social group which are the physicians and other medical care providers have also something important to learn about their own views and behavior and the possible views of their patients. They have got to learn a gross misunderstanding: that unlike what they espouse as their professional dictum that their inspection and manipulations of the patient's genitalia is purely an accepted standard of medical practice to serve a single beneficent goal, not related in any way to sexual simulation of either party but is purely the diagnosis of disease and treatment and that every patient comes with that professional standard in mind despite what they will be experiencing. Working with only this view, without adequate advance communication with the patient and, if applicable, with the parents can lead to problems of ethical maleficence including frank maltreatment of the very patient they are trying to heal. Therefore the medical community must be educated themselves to actively consider sexual concerns by the patient and take positive steps to mitigate those concerns.

Whether this learning by the two social groups will take place will depend on the development of teachers who will speak up to both the parents and the doctors. Silence will only allow both groups to go their own ways and the conflict and misunderstandings will continue. ..Maurice.

Doug Capra said...

Maurice: I agree with your assessment. I would add an other important element that we can't neglect -- the power of culture -- especially media culture. And how that culture is reinforced within child peer groups and the power that these peer groups have on children.
What culture teaches children can have much more influence than what parents or schools officially teach.
As an example, I'll use a story from the book "The Committment" by Dan Savage. Savage describes his relationship with another man and the young boy they are raising, named DJ. At four years old, despite being raised by a male gay couple, DJ is convinced that "Boys don't marry boys. Girls don't marry girls." He's convinced that his two "parents" don't love each other and can't love each other because "People who don't love each other don't get married, and since you're not married and can't get married that means you can't love each other. Not really." In fact, DJ says that if the get married he won't go to the wedding, but he will go to the party if there's cake.
Where did DJ learn this? Certainly not from his "parents." He learned this from his peer culture, who probably learned it from their peer culture, who may have learned it from their parents, but more likely from the general culture.
Granted -- in this area the culture is changing. But I would suggest that the mores toward genital privacy is increasing in our culture due to the media focus on child sexual abuse.

Anonymous said...

I am a male and recall as a child of 9 having to have the VCUG due to a problem urinating. I can attest to what Holly went through. A woman from x ray informed my step mother she would be completing the test and she and a woman nurse led me from the waiting room and once inside I was told to strip for the test and to put on a gown which I did as my step mother said it was "necessary". I then was told to lie on the table and the nurse wheeled in a cart and suddenly reached over and pulled up the gown. I immediately sat up and the nurse said something to my step mother who then said its ok please lie down. I remember sitting there with the gown pulled up which made me start crying. The x ray lady kept saying we dont have all day, and I was resistant so they asked my step mother to leave which made me feel ever worse. Then another nurse came in and said if you dont lie down we are going to have to hold you. The test was important or something she said. I remember crying and shaking my head no, and the next thing I knew one of the nurses grabbed my shoulders and the other grabbed my legs and I was then forced to be catheterized and then to pee all over myself although I tried to hold it in. To this day I am anxious in medical settings and have "lab coat" hypertension. I can only hope they now have better ways to handle this and that getting this out in the open will help others. I hope you all continue to post on your blog and allow the experiences of patients as it will help to educate those performig these tests.

Anonymous said...

It was heartbreaking to read about Holly's story. It is sad about how Holly's wishes for a female doctor were not honored when she was a kid. This shows that more parents need to be educated about this serious issue. See an article about teenagers and modesty. This can also apply to kids of course. It is important for parents to work to accommodate their kids' wishes for modesty in medical settings.

When I was a little girl, I was very puzzled about how I was taught that I should not let men and boys including my dad see certain parts of my body after a certain age, but that it was different for doctors. I thought it was very odd when one of my teachers in elementary school said that you should not let anyone except for your parents and your doctor to touch your private parts. I felt that my teacher was wrong about doctors.

I was shocked to learn that my mom went to a male gynecologist when I was a kid. It just contradicted what I was taught about how you should never let any man except for your husband to see you naked after a certain age. I feel this is a cultural blind spot. We have been taught that we should trust everything the medical industry does without questioning. If we question anything, we are often intimidated by doctors or nurses. My mom no longer goes to a male gynecologist. She stopped going about 12 years ago. She has a different opinion now because of the things I brought to her attention.

Doctors are humans. I feel that it makes no difference in how many patients they have seen naked. Patients' wishes should be number 1priority.

Sadly, many children were sexually abused by a Delaware pediatrician. I personally don't think it was the parents' fault. We have been taught that we should trust and submit to medical professionals completely.

Sexual Misconduct by doctors is often underreported because many patients feel that they would not be taken seriously because it's very hard to prosecute doctors.

I have one friend who is still very traumatized by the time she was examined by a male gynecologist when she was about 14 years old. She is 40 today and is still haunted by that experience.

Look at tips about how parents can prevent their children from being sexually abused at http://sexualmisconductbydoctors.com/tipsforparents.aspx.

I agree with Doug that it is important for all patients to be informed exactly what all will happen during a certain procedure.

Doug Capra said...

The article you reference...

(http://sexualmisconductbydoctors.com/tipsforparents.aspx)...

has many good points, but I must be honest and say that it also helps to reinforce the double standard regarding male vs. female modesty. Although the title of the article says it's about "children," the only children referenced and the only examples given are those of female children. What particularly bothers me is the statement that female children should only go to female doctors for genital issues. I don't agree to that as an absolute, but, be that is it may -- if you say that, why not say that all male children should go to male doctors for the same problems? No mention in the article about the humiliation and embarrassment that teenage boys may go through during sports exams for hernia and genital checks with female physicians and female nurses or assistants as chaperones. There are many aspects to vulnerability. Young male children can feel vulnerable, too, in different ways, with opposite gender intimate care.
What I'm saying is this -- The article should clearly state, perhaps in the title, that it's about female children -- because that's the real focus. Or, if the article claims to be about all children, male and female, it should be inclusive. What it does, though unintentionally, is to reinforce that medical modesty in children is basically a female issue and doesn't really apply to boys.

Anonymous said...

Doug,

I feel that male patient modesty is as important as female patient modesty. I appreciate the article about sports physicals. I can understand why many boys especially teenage boys find them embarrassing. Some of them have been traumatized by the fact that female nurses or doctors saw them naked. I honestly feel that boys should be able to opt out of having hernia or genital exams as part of sports physicals. I think that sports physicals should primarily focus on heart & muscles. I think that boys especially teenage boys should be given some literature about how to examine themselves for hernias. If they find hernias, they can always go to a male doctor and request that no female nurses be present.

I believe that parents should also listen to their sons about their wishes for modesty and same gender doctors. Teenage boys are especially sensitive. Have you done any research to find out what age boys usually become sensitive to modesty? I think girls are sensitive at earlier age. Many little boys are allowed to see their mothers naked while little girls never see their fathers naked. After a boy reaches a certain age, he is usually not allowed to see his mother naked anymore.

I heard of an incident where a deaf man in his 30's had to go to the doctor for some male problems. His mother accommodated him to the doctor's office. Sadly, the male doctor insisted that his mom be there for the exam so she could interpret. He was very embarrassed. The doctor should have just communicated with him via writing or a male interpreter.

As you probably know, Dr. Earl Bradley, a pediatrician abused over 100 children. It is my understanding that a majority of them were girls. Doctors can certainly sexually abuse boys as well. I think that all parents should always be present with doctor (either male or female) in the examining rooms with their kids of either gender. I believe that this would help to prevent sexual misconduct. Dr. Bradley convinced parents to leave their kids alone with him. That was a big mistake. Good pediatricians will allow at least parent to be present with them in the examining room the whole time.

When I was a kid, one of my parents was always present in the room with the doctor and me. This helped to protect me.

Anonymous said...

Boys can easily be sexually abused by doctors as well. The best advice we can give to parents is that at least one parent should always be present with their kids in the examining rooms with doctors. A pediatrician who helped kids with learning disabilities sexually abused some boys who were his patients. Check out the article about Dr. Levine.

Nekura said...

Hello, I am the writer of the article. I just wanted to clarify that the only reason boys weren't mentioned was because it is very rare for a boy to need a VCUG done since its usually used on children who have UTIs before the age of five. Due to the length of the penis boys and men rarely get these infections. I in no way intended to leave boys out, but back when my experience happened female doctors were very rare and most doctors were male. Of course, most nurses are female so in a hospital setting I can understand the violation of modesty there for boys, and I completely agree. It doesn't matter what gender you are, your anxieties need to be taken seriously. I just lacked the male perspective to add.

I would also like to note that I've confronted my mom since then and she said she had a fear of authoritative figures which is why she never questioned anything. It was something ingrained in people that "the doctor is always right" and the older generation seems to stick to that. She does regret what happened, but I don't blame her. This was back in '95.

Doug Capra said...

Nekura:
This incident happened back in 1995, and you say back then female doctors were rare? Rare? I question that. Certainly female nurses weren't rare.
Is this issue about a specific procedure that may be rare in men and boys, or is it about medical modesty violations for both genders? Let's focus on the issue.
All I'm suggesting is that, if this article is still available online, that you add something to it -- maybe what you wrote above -- or something to acknowledge that the issue is one that affects both genders and the modesty of one gender is as valuable as the other.

Nekura said...

Well, I'd have to give background on where I live. We live in a very rural area in the deep south where women MDs or NPs were very rare.
When people ask, I tell them I live in the middle of a field. We can't even get cable here. Our choices have always been limited, but I know that there was a female doctor working there(the wife of the doctor who examined me, who, by the way, became a crackhead, literally later in his life. I think they divorced, but still work at the same clinic. As a small town this gossip gets to all of us). For some reason no one even mentioned to have a nurse do the procedure. It was for diagnostic purposes, so I suppose it had to be a doctor, but the touching he did was completely uncalled for since all he did was slide cream all over me which he later gave my mom the bottle. She
could have easily done it herself. Why he wanted to apply in the office and do it himself I have no idea, it was a prescription medication the we obtained the same day.. whichm of course only did more harm than good since I had IC, not an infection.

It's about medical violations to all children. The lies, the unpreparedness, the lack of pain killers.. it's just that girls fall into this more than men due to our genitals being ticking time bombs or something, but I can dig up a story I read about one poor man who was forced to have a stiff cystoscopy forcefully placed into him at the age of 8. These days you must be under GA because of the pain it causes. It gave him PSTD. If you would like I can send that story over for Dr. Sherman to insert into the article.

I am a complete equalist and am disgusted when anyone despite gender, especially children, have their wishes violated due to convenience. I just don't personally know any male who's felt violated, but I know they exist and their concerns are just as important as women. My boyfriend scoffs and says they need to man up and I quickly slash him down with verbal retorts for that attitude.

If you know of any other stories please send them my way. All I've seen are from adults with no childhood perspectives from the other gender except for that one example above. Because of social stigma a lot of men are afraid to come out about these things.

I do appreciate the commenter above stating that he too had the VCUG. If he cares to clarify more I'd be happy to add that, or the clarity can just remain in the comment section if he wishes.

Knitted_in_the_Womb said...

I think I'm going to have to print out Rosen-Carole's method for examining children and give it to my children's pediatrician! My older daughters have both been subjected to physicians who look into their panties without warning to check on development of pubic hair. Is this check REALLY necessary? Why can't the Dr just ASK? My daughters were both upset by this, particularly the younger one (who tends to be more of the "you aren't getting one over on me!" personality than her sister), so after the experience with her, I have made certain to inform the Dr's that they may not look into my children's underpants without explicit consent first.

Dr. Sherman, your generation may have been less concerned with pedophilia, but that doesn't mean that it wasn't a problem! I know multiple women who are likely your age who were abused by fathers, brothers, uncles... My own grandmother, who would be 83 now if she were still alive, was gang raped by her uncle and some of his friends when she was 9 years old. I'm not sure why you make a comment about "making children petrified of physicians?" Where is the evidence that parents are doing this? Most parent I know teach their children that it is okay for Dr's to look at their genitals.

Joel Sherman MD said...

'Knitted', I agree with you. Pedophilia was not much of a concern when I was a kid, but yes, it was definitely prevalent, likely more so than today. No one then would ever have thought that instructing children not to let anyone see their private parts was appropriate. An older cousin of mine recently confided that when she was a young teen a relative tried to molest her. When she told her mother, she was instructed to not talk about it. She never forgave her mother for that advice, but that would have been the most common response of that time. Times are most definitely different.

Parents do have to be careful not to instill in their children a fear of all doctors though. That does not mean that kids should be left alone with doctors until they are old enough to fend for themselves. Assessing sexual development is certainly a recommended part of an adolescent pediatric exam so you shouldn't fault a pediatrician for doing it. I agree though that it is hardly crucial unless there's a problem. Same opinion I have for hernia exams in boys. You do indeed have to make your wishes known.

Anonymous said...

yes we do need a support group. no one likes to believe that this kind of "small" test or procedure can cause emotional disorders. I have tried to get doctors or even my parents that put me through this testing to believe the kind of damage it does to a kid and tht it could be carried into adulthood.
when I was younger I had to get VCUGs routinely done to me. from when I was infant till I was 9 years old. I remember getting this procedure done very well I still start to panic before going to see the doctor, shake uncontrollably when putting on a hospital gown and even when smells, sounds, tone of voice, sights and words are said or mentioned that remind me of the VCUGs I once had to endure, I have to fight the urge to run. I have regular panic attacks I didn't even realize that I had been having them for years till I found out the symptoms of a panic attack.
the thing that pisses me off the most is that when I discovered that these tests scarred me mentally and emotionally as a child I told my parents and told doctors. you want to know what they told me "well those tests needed to be done so u just have to deal with it" or my favorite one is "your 1% of the children that was effected this way, this test is done to many many children a year and they aren't effected like you are." that is the comfort I get no one believes that this procedure affects children long term. the doctors don't want to believe that a test that is done by their profession causes damage. they believe that the good out weighs the bad.
yes this test does need to be done to see reflux and other abnormalities I know this but the technic in which it is done needs to be changed. but first the medical professions needs to understand that no the good of the test does not out weigh the test if it causes trauma, PTSD, depression and anxiety these are long lasting effects that get carried into adulthood.

Anonymous said...

continued....
I mean really adults get relaxers and laughing gas when they get a tube stuck up their ass. this is a much more traumatizing and painful test that gets done to children. even listed in the side effects that can be caused by the test is traumatization to the child under going it. the way this test is preformed needs to stop. it NEEDs to be reevaluated so it doesn't cause lasting affects I speak from experience. but again no one believes me I need help getting people to see.
I believe that all children above the age of 4 should be sedated for this procedure bc this is when memories really start to be made by the child. also by this age the children know what good touch and bad touch is. even when I was told that doctors could touch me there it didn't make it easier for me that area was private to me and to any other child. even if we r told its ok, I still remember walking out of the room when it was over with my head down ashamed that someone in my mind had violated me and my parents allowed it to happen. no matter how much I cried and begged and told them no not to touch me there they still forced me to do it.
also keep in mind when this procedure is done here r a lot of people in the room I remember there being two people near my head and three at my bottom all of them staring at me like i was a zoo animal on display I remember the staff being nice but it didn't take away from what they were doing to me, not only was it embarrassing/violating it also was extremely painful when they put the tube in, it would ache and hurt all through the exam which lasts from 30-45 mins then it hurt afterwards. it would ache and burn like hell when u peed for the first couple times after the exam.
this procedure needs to change for the children undergoing it in the near future and also doctors need to review the lasting damage this has already had on adults that had this done as children so that maybe the medical staff can understand that this is not a small amount of individuals 1% as they like to say. they shouldn't make a person that has been emotionally scarred by this event feel that they are abnormal to feel this way. bc when doing my research on this subject I discovered that many adults have been affected by this if you are one of them dnt let them say that VCUGs couldn't effect you this way or that you r only one of a handful of individuals that were affected. it's not true there are many of us who feel the same. doctors don't like to be proven that they are wrong but they are boo hoo for them.
VCUG children PTSD depression medical procedures voiding csytourethrogram privacy

Anonymous said...

So shocked reading the above. I thought I was the only one with ptsd following vcug. Had one single vcug aged 6. Horrific experience, worst thing in my entire life... the intense searing pain (I actually felt as if I had left my body), the feeling of being held down by so many grown ups, the shock and overwhelming sense of violation. Sort of repressed the memory until my 20s when it came back in flashbacks. 20s were a complete mess... depression, anxiety, lots of self-harming, suicide attempts. I knew, at the back of my mind, that it was to do with this, but didn't want to say to anyone as didn't.think I could explain why something so routine affected me so deeply. Constantly seeing the scene from my vcug replayed over and over in my head. Panic attacks. Have had a lot of therapy for it now. Obviously not enough, otherwise I wouldn't be researching this stuff still. The thing that panics me still is knowing that this still goes on. And that hospital patient information leaflets (on the internet) describe it only as discomfort, whereas if you look further, you find.academic research where they literally studied the effects of vcug on children as a substitute for child rape (as they obviously couldn't rape children as part of s scientific study, yet wanted to study the longterm effects of such things on memory repression etc). Please, I personally need to stop thinking about and reading about this stuff, I can feel myself go into.state of panic and not being able to breathe from all of this. But can those.of you who are strong please find a way to.change what goes on nowadays... at the very least change the Wikipedia page to highlight the research that I just mentioned. I honestly didn't realise that there were others with ptsd from vcug and other violations, I gave that diagnosis to myself and now I read your forum this evening.

Anonymous said...

I am saddened and also relieved to learn that I am not alone in my struggles with PTSD from my experiences undergoing VCUGs once a year for 5 years until the age of 8 or 9.
Anxiety, depression, and dissociation have been common threads in my life. I have been in therapy for 5 years and all of these threads began with my experiences in that hospital room.
I am a woman of 36 and, because of my experiences with this medical procedure as a young child, I am unable to enjoy any kind of pleasurable sensation during intimate moments with a lover. The part of my brain that registers pleasurable sensations from the genital region of my body only lets me feel them when I am by myself.
If your child is in need of a VCUG, please educate them about the procedure, teach them how to self-soothe and self-hypnotize themselves, hold their hand through the procedure, validate their emotions and their physical pain.

Anonymous said...

I appreciate your article very much. I had 2 VCUGs when I was 7 in 1979. ...for bedwetting...no UTIs....

Mom handed me over to 2 xray techs (1 man, 1 woman) and the horror that has defined my life began. The man told me they were going to "fix my bedwetting," so I knew all of the pain of the procedure was my fault. I kicked, fought, screamed, and cried, and they put me in 4-point restraints with my legs spread, totally naked, on a steel table, with incredibly bright lights over me & a huge camera over me. The catheter felt like a knife cutting my vagina...I couldn't lift my head enough to see it. They overfill your bladder until it hurts. I still have anxiety, after 25 years of therapy (I'm 42), when my bladder gets too full. I refused to piss myself on this table...so the man pushed my bladder down with his hands to start the urine flow. Then the sobbing shame and pictures being taken the whole time. I walked out to a smiling mom I didn't want to disappoint (the bedwetting was a huge problem for them). I cried when I got home and peed because I thought they were gonna make it so that I wouldn't pee anymore. I remember telling my mom that my vagina hurt, and she said "well it SHOULDN'T." They didn't get good pictures, so I was taken back for the second VCUG. All I remember about that trip was locking myself in the "changing room" (stripping room, really, since there was no gown involved). I refused to strip and I refused to come out for anyone but my mom. The woman told me that my mom was the one who brought me there and wanted me to do this, and that if I didn't, she was going to leave. me. there.

Please DON'T think that VCUGs today are any better. I've done research on this over years, and the care is only minimally better on average. Do your homework and find pediatricians with psychological support/exercises you can do with your child before procedures, and NEVER leave them.

Trauma behaviors mark my life from age 7 onward. I still have trouble sleeping in a bed when I am stressed, and when I am triggered into a PTSD episode I still curl up in my closet (yes, at 42, after 25 years of therapy). Unfortunately my parents punished me for what were signs of trauma: refusing to sleep in bed, sleeping in closet, sleeping in hallway under the only light left on at night, panic attacks, fight-or-flight episodes, fear of doctors. When I was 10 I realized that I was having panic attacks and started drinking alcohol, suicidal by 12, in therapy by 13. It's a downward spiral from there till 26. I was finally diagnosed with medically-induced PTSD in 2003 (at 32), take medication for it, and have done 10 years of trauma therapy so far.

...

Anonymous said...

...con't...

I do not really associate myself with my body, so self-care is my main task now at 42. I knew I could never go through the process of childbirth because of all the triggers, so I have never had children and never will. I have always had sexual dysfunction and still do -- I have to get up and pee 3-4 times during sex or I cannot do it.

I tried to get more dr. records but it was too late, I wrote to a doctor still in my pediatrician's office and she said they never sent kids for VCUGs for bedwetting (great help she was). I had to have neck surgery last year and demanded from everyone at the hospital that I *NOT* be catheterized -- which was acknowledged by my lead nurse -- but they did it anyway. I went home with a raw urethra, clitoris, labia, and a raging infection started. I went into a 10-day suicide attack, one of the ugliest of my life.

I have managed to have a pap smear about every 8 years...with drugs...with legwarmers, blankets, etc...have to find a doctor who will understand and support me and I cry the entire exam, etc.

This "uncomfortable procedure" has put a stain on my entire sense of self, my growing up, my adult life, my inability to have children -- everything.

I still battle with wanting to die.
I would rather have died at 7 than have this be my life.

Our society doesn't value little girls unless they're compliant and allow themselves to be degraded. There are many many MANY more of us out there -- mostly women, but some men. When I was 24 and started remembering the VCUGs, I first thought it was ritual abuse until the pieces became clearer.

No kid should have to go through this just to make adults comfortable. But that's what it is.

Peace.

http://www.ncbi.nlm.nih.gov/pubmed/10196917

Anonymous said...

...just wanted to add (I'm the 42-y-o 'anonymous' woman):
-- any healthy physical/sexual boundaries were shattered by the VCUG.
-- I was lured by a pedophile into an alley by my house while he was jacking off at me...went home & told my mom, no response from her.
-- Same thing with a man in a car at my college parking lot when I was 19.
-- When I became sexually active, I let men do things I didn't want, for years...
-- I was targeted by a date-raper in college and escaped from underneath him.
-- I didn't re-establish proper sexual boundaries until my 30's
-- I still have constructs of control and domination that stain my interior sexual life/experience/expression

And no, I cut off contact with my parents -- finally -- last year after they were again unable to support me during & after my neck surgery (catheterized against expressed consent, 10-day suicide episode).

Yeah, I wouldn't wish this life on my worst enemy, and a few times a year it becomes too much for me and I lose hope of ever being happy in my skin.

Peace.

Anonymous said...

...re-establish proper sexual boundaries?

NO.

I was abused and learned I was not supposed to have sexual boundaries.

I had to build them myself in my 30's.

It's time the medical profession took some responsibility for traumatizing people in the name of expediency/profit.

Enough.
Peace.

Anonymous said...

I'm seeing a frequent error being made by some of the docs and patients (traumatized people) on this issue. It seems as if some people are only concerned about male doctor/young female patient, then female doctor/young male patient... the comments are that the fact that a woman touching a young boy could traumatize him... however, I don't think that in my case I would have been traumatize had the doctor actually been a woman. There is a certain natural trust that young children have of women (the maternal factor right?).

So there is another dimension also that some of you folks seem to be oblivious to and that is male doctor/young male patient with the mom standing there watching the whole thing. This happened to me at 7 years old and I have never had a healthy sexuality as a result of it, and I have also never recovered from the trauma despite attempts to do it. To this day, I hate my mom with an uncontrollable rage, and if I were to see that doctor again, I sometimes wonder if I wouldn't end up in prison. So, needless to say I live on the other side of the country.

Yes, I know that sounds radical, but hey, I have PTSD because this guy fondled me when I was seven years old... some kids take it well, unfortunately, some of us don't. His fault. Not mine. I have inquired where the origin of this exam came from and because no one seems to know, I greatly fear that perverts began justifying this at some point, and for some reason, some 'scientific necessity' was published, and it caught on. I know that this scenario seems far-fetched, but those of you who are affiliated with the AMA in some form... why don't you try to investigate the origin of this yourselves? I can't get any answers! I honestly believe that the scientific community, especially in medicine, could be fooled under the guise of medical protocol and even at something this big.

I don't find people who work in the fields of health science to be very genuinely empathetic to other people. I think they know how to 'fake it.' They don't appear to me to have a serious heartfelt compassionate nature. Probably though this correlates directly to their ability to focus on menial, tiny, microscopic factors that would just bore the general population to death. Hence, they don't think on a personal level, as in, the whole person... meaning the long term social, psychological health also! They appear to me to be overly pragmatists and this is unfortunate to say the least.