Sexual Violence in Medical Settings

Sexual aggression and attacks against women are all too common and horrifying. For immigrant women, the risk of experiencing sexual assault is even greater, particularly when pursuing education, employment, and access to social and healthcare services. Unfortunately, even when they seek medical care, they are often subjected to sexual assault by medical professionals.

I recount the story of 18-year-old Victoria, an immigrant indigenous woman who had a horrendous experience when she had her first physical exam. Like many immigrants living in poverty, Victoria had no medical insurance and lacked knowledge of what to look for in a physician. Therefore, she relied on a random surgeon she met through a family member. The surgeon was aware of this young woman’s financial constraints and offered to conduct the annual exam at a lower rate. Victoria believed the surgeon’s gesture of goodwill and felt relieved that he was not charging exorbitant prices for medical care, which she had seen with other physicians. On the day of the physical, Victoria went with her mother, but the surgeon did not allow her mother to enter the exam room. Victoria did not know what to expect, so she trusted the surgeon who examined her. Unfortunately, the experience was highly traumatic as the surgeon violated her body by fondling, penetrating, and abusing her during the examination.  Despite feeling violated, Victoria was too scared to do or say anything and feared that doing so would jeopardize her college admissions application, which required her to submit a completed physical exam form. Her lack of knowledge about available resources, shame, disbelief about the assault and fear of repercussions caused her to remain silent. Victoria had nowhere to turn. 

Like Victoria, many immigrant survivors often experience sexual violence at the hands of medical professionals. Their lack of knowledge of Western culture and the healthcare system, insufficient financial resources, limited access to quality healthcare, and the absence of medical insurance puts them in a vulnerable position.  Similar to Victoria, survivors often find themselves silenced by feelings of shame, guilt, and fear of being judged and not believed, which makes it difficult for them to speak up and share their experiences.  As a result, they are often forced to choose between poor quality healthcare services where they feel unsafe, abused, or gaslit and not addressing their medical conditions, leading to comorbidities. The intersection of poverty, trauma, sexual violence, and racism has created a vicious cycle that negatively impacts the physical and mental health of many Latinx immigrants.

There are not enough laws to protect Victoria or other women, and the laws that do exist often reflect misogynistic and sexist ideologies. The recent overturning of Hollywood producer Harvey Weinstein’s rape conviction, despite numerous survivors coming forward, is an example of this and highlights the devaluation of women that still exists in many systems. Meanwhile, women continue to face physical and sexual assault at alarming rates, and not just at the hands of producers, physicians, or sex traffickers. Women have to constantly prove that their lives and bodies have value and are usually seen as disposable and rarely seen as victims.

It is crucial that we take action to change the reality for immigrant Latinx sexual assault survivors. As mental health professionals, we can advocate and educate different communities about this form of sexual violence. Educating our medical community about the significance of utilizing trauma-informed care (TIC) is one way to do this. TIC is a practice that recognizes the widespread impact of trauma on patients/survivors, identifies signs and symptoms of trauma, and treats patients/survivors by integrating trauma knowledge into procedures to prevent re-traumatization.[1]  It is important for medical settings to be transparent with patients/survivors and inform them about all procedures from beginning to end. This can help patients/survivors distinguish routine procedures from ones that are not. Procedures such as annual exams, dentist appointments, abortions, STI testing, and pap smears, among others, can be intrusive in nature and cause emotional turmoil, especially for survivors.  Hence, doctors should be aware that many patients have experienced sexual assault and may be triggered by certain procedures. It is essential for all mental health professionals to advocate for transparency to ensure that survivors receive appropriate care and treatment. It is critical to educate healthcare providers about the significance of providing both physical and emotional safety to survivors of sexual assault. They must also strive to develop trustworthiness and transparency in their practice, empower survivors by offering them a voice and choice, and understand the cultural, historical, and gender factors affecting their care.

In addition to this, mental health professionals need to work with survivors of sexual assault to develop healthcare safety plans. They must be sensitive to the fear that survivors may feel about medical appointments and work to challenge the stigma surrounding sex, sexuality, and sexually transmitted infections. They must also offer accurate information about medical procedures and develop a list of practitioners trained in trauma-informed care.  Mental health professionals must also work with survivors to help them understand and articulate their triggers to their doctor and explore individualized medical care options that meet their specific needs.  Cultivating a space where survivors learn about their medical rights contributes to creating a safer and more supportive healthcare environment for survivors of sexual trauma.  Lastly, more advocacy work needs to be done to help survivors identify sexual violations in medical settings and where to report them.

I am Victoria, the young indigenous woman in this story. Like many immigrant girls and women, my voice was lost in a system unbeknown to me, and I felt powerless against this horrendous abuse.  No one deserves to be assaulted when accessing medical care. As mental health professionals, we must take a stand against sexual assault in medical environments. Every individual has the right to access quality and safe medical care, and we must work tirelessly to ensure that all survivors receive high-quality medical treatment without the fear of having their bodies subjected to sexual violations and rape.  As mental health professionals, let’s strive to make medical environments a safe and secure space for everyone.

---

[1] AMA Policy Finder (2023). Violence and Abuse. Accessed on April 28, 2024 https://www.ama-assn.org/delivering-care/population-care/what-doctors-wish-patients-knew-about-trauma-informed-care

Photo Credit:

Detail of ‘Susanna and the Elders’ by Artemisia Gentileschi. (1593–1653)