ONWARD ~ and ~ UPWARD Judith Florian, R.N.

Featuring articles and discussion of diverse topics, including:

Issues concerning Disabilities, Home Health Care, Sexual Abuse of Children, and Advocacy.

Sexual Abuse of Children (SA-C)

Post Traumatic Stress Disorder (PTSD)

Changes As Abuse Survivors Age

Artwork by those who have experienced SA or PTSD

FOCUS:

OPEN LETTER TO PHYSICIANS AND DENTISTS REGARDING THE CARE OF ADULTS  WHO WERE SEXUALLY ABUSED AS CHILDREN

Including Sexual Abuse of Children (SA-C), Post Traumatic Stress, 

Disorder (PTSD), Changes As Abuse Survivors Age

         Survivors need to have a serious heart-to-heart with Physicians, Residents, Physician Assistants, Dentists, and nurses.  But most survivors have a difficult time revealing this often-long held secret, and are often misunderstood when they do reveal a history of childhood abuses.   So I am addressing the topic here.

            There are many issues survivors face, and unfortunately, doctors, dentists and nurses receive inadequate information or misinformation in school, if they receive any information at all.  For example, dentist-students are still instructed that the mouth is a very sexual/sensual area and that many (female) patients will "fall in love with" their dentist.  In Ohio, physicians receive only a few hours about sexual abuse.  For both professionals, the focus in school is on the prevention of child abuse and reporting mandates, and nothing or next-to-nothing on care of adults who experienced childhood abuse.  And for many diagnoses, doctors are generally trained with a bias towards women and "sex" - for example, articles on pain management issues state that physical pain is often an hysterical reaction to unresolved sexual issues (how inaccurate); this results in poor treatment of real physical pain.  (Not surprisingly, men who have physical pain are not thought to have "sexual issues;" their pain is simply believed - and treated.

            Before I lose my audience, I'll describe some of the issues your patients are not telling you.

            First, sexual abuse leaves the adult carrying many issues about being touched or even having someone "look at" them (especially in a situation where they must undress, e.g. doctor appointments).  This will OFTEN result in this patient not seeking care as needed; they will wait until the their medical/dental situation demands that they see a doctor/dentist (even when this means they put up with terrible symptoms or horrible pain, such as an abscessed tooth.. or masses in their body...).   It may seem outrageous that a patient would ignore pain - but - this is part of what childhood abuse has ingrained, to ignore one's own discomfort or outright pain.  Psychologically, it is in most ways "safer" to avoid the humiliation or misunderstanding that patients often feel during an office visit.  (However, psychologically, a secondary issue arises: the reinforcement that the person is not valuable and they do not deserve to be physically healthy.)   While professionals can blame the patient for not seeking care or follow-up care, it is not wholly the patient's fault.  If their experience has been judgmental attitudes from professionals, patients will obviously not seek help for most problems.  Patients will watch how professionals act and listen to what is said.  If the attitude of a doctor is dismissive and demeaning, and the doctor obviously have misinformation about the effects of abuse, your patient will simply avoid you at all costs.

MYTH # 1:

        The effects of sexual abuse are not limited to body areas and organs most associated with "sex."  The entire body "reacts" after childhood abuse.   This means that when you enter within the 3 foot normal "personal space" boundary most people have, that can be a boundary violation for a survivor.  You need to always (always) ask before approaching a patient's "space" rather than just jumping into an exam.  "May I look in your ear now?"  "I'd like to examine your abdomen."  

        Do not assume that you have "permission" to touch a survivor anywhere.  I know, the person is at the doctor, so that should imply they know they will be touched.  But, that attitude needs changed.  Doctors should not assume the presence of a patient infers that they are granting permission to be touched - anywhere, on any body area.   This patient may have finally just gotten up the nerve to visit a doctor... to check you out, so to speak, to see how you act and IF you would be SAFE for them.  So, with every patient, ask permission to invade their personal space.

MYTH # 2:

        A history of sexual abuse does not mean that any/all physical complaints are psycho-somatic or psycho-sexual.   A physical complaint in a previously abused person is not to be dismissed based on that history.  The sad fact is, too many patients' complaints (mostly in women) ARE ignored, dismissed, and minimized.  (I honestly don't know how women sit through classes in which professionals are taught such beliefs, either.)

SPECIFIC BODY AREAS/REGIONS

MOUTH:

        No female patient will "fall in love with" a male looking in their mouth, or doing dental work for them.  If this is what your were taught, please discard this fallacy.   Indeed, sexual abuse survivors find it almost unbearable to have to visit a dentist.  

        During oral sexual abuse, a child's mouth cannot accommodate a male penis (or fingers, or almost whole hand) being forced into their mouth/throat.  The male body in oral abuse, usually positioned above (on top of) the child, restricts breathing from mouth, nose and ribcage, as the male's weight presses down.  Male abusers are NOT concerned with whether the child can BREATHE.  In fact, if the child almost passes out (or does) from lack of air, it is that much easier for the abuser; the child is deemed to be "non-resistant," which abusers interpret as "acceptance" or even "willingness."  But the true fact is a resistant child is typically fighting physically for air, and the "non-resistant" child is often no longer conscious during the act.

        Dentists especially need to be aware of how oral abuse affects the victim.  It is hard to swallow during dental appointments.   Abuse has made it difficult to coordinate breathing with swallowing (and is especially hard to do when a dentist's fingers are pressing on the tongue, restricting the normal movement of the tongue).  A gloved hand too close to the nose at the same time makes breathing that much harder (especially if the patient has sinus problems or deviated septum or even a slight cold).   A dentist who leans ON the patient contributes to feeling unable to breathe.  The combination of all these things can make the patient FEEL like they are suffocating (just like those seconds before passing out when the patient was a child with a 200 pound man forcing his penis into the child's mouth).

         Suctioning during dental procedures is critical to this patient's comfort (and sanity).   Dental assistants need to be instructed to suction frequently, especially toward the back of the mouth where saliva pools.   During abuse, males do not CARE if a child is gagging on ejaculate -- nor do they care if the child is gagging to the point of actually throwing up; abusers often cause gagging with vomiting and the child is forced to swallow not only the male ejaculate but also the child's own vomit.  Yes, it is a disgusting image.  It is so disgusting that survivors have an extremely difficult time describing this situation to anyone, let alone a professional during an appointment to clean their teeth or have a filling done.  If you had been abused, could you easily tell your dentist these facts?  No.  

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Disabilities...... Home Health Care...... Sexual Abuse of Children...... Advocacy......... Jump to: Top of Page      If you have corrections to the content of this site or if you find broken links, please email me. The title "Onward ~ and ~ Upward" is a "motto" I used as a teenager and young adult --- then forgot about for a number of years.  I feel it is a fitting motto to strive for and a fitting title for the topics of this website.   (c) Judith Ann Florian 159 E. Main St. Girard, Ohio 44420 Disclaimer: This website is intended to convey information and discussion ONLY, on a variety of topics, and reflects the views of this author and submitters to this website.  The information provided on this website is not intended as a substitute for a medical opinion or diagnosis.  If you are suffering from an illness, injury, pain or other symptoms, please seek help and diagnosis from a medical professional.  If you are feeling suicidal or are thinking of harming yourself, in any way or by any means, call your therapist, your local 911, your local police department or other law enforcement, your local hospital emergency room, and your local crisis numbers. The webmaster of this site will not reply to emails from any person in a crisis situation. Copyright Notice - Information provided is for personal use only and may not be used on any other website.  All graphics and content on this web site are under copyright.  No portion may be reproduced, in part or in whole.  Contact the webmaster for information about publication rights.  © 2005-present, Judith Florian, Copyright - All rights reserved. Credit: Visit "The Art of Penny Parker" for elegant backgrounds and images.   This page was last updated on Tuesday, May 23, 2006 21:48