Today, VCUG is the “gold standard” test to diagnose vesicoureteral reflux (VUR), also known as kidney reflux, in infants and children. Sadly, many caregivers are robbed of the ability to give informed consent for their child’s procedure due to a longstanding lack of disclosure of VCUG risks, which include well-evidenced similarities to child sexual abuse.
The vast majority of providers’ websites promote VCUG as safe and routine with a low-risk profile, often describing the test as “painless” or uncomfortable at worst.
This couldn't be further from the truth. As former VCUG patients, we’re committed to raising awareness about the real and lasting harm of VCUG trauma. If providers insist on performing VCUG without disclosing known risks to parents, including severe psychological trauma, the Unsilenced Movement must insist on filling in the gaps about VCUG. Our mission is to put families back in the driver’s seat by ensuring they have all necessary information to make fully informed decisions for their child’s medical care.
In this blog, we’ll answer your FAQs about VCUG and break down critical information about this “gold standard” test that you won’t find online—a whopping 34 years after the first critically appraised study established a direct correlation between VCUG and child sexual abuse.
What Is the Voiding Cystourethrogram (VCUG) Test?
VCUG (voiding cystourethrogram) is the "gold standard" test to diagnose VUR in pediatric patients. It’s primarily performed on toddlers and preschool-aged little girls, in whom VUR is more common.
VCUG procedural steps involve removing the child’s clothing, positioning them flat on their back beneath large X-ray machinery, cleaning their genitals, and forced catheterization that often requires immobilization using physical restraints or force by multiple adults. Many former VCUG patients recall being held down, legs held apart, by multiple medical professionals in the room. In the majority of cases, parents are not allowed in the exam room.
Following catheterization, which is most often conducted without any topical agent or numbing gel, the child’s bladder is pumped full of a contrast dye that has been linked to genitourinary cancers. Critically appraised research has confirmed that the radiation dose “varies widely” for VCUG. The child must refrain from voiding until their bladder is (often painfully) full. Then, they must void on command in a crowded room of nurses, doctors, and techs without a parent present.
If the child cannot void on command, the test must be repeated.
If the child voids too early, the test must be repeated.
During voiding, the child’s pelvic region will be projected and recorded as they void on the X-ray screen. The test can take anywhere from 20 minutes to over an hour.
What Condition Does VCUG Diagnose?
VCUG is used to diagnose VUR, also known as kidney reflux, in pediatric patients. This condition occurs in infants and toddlers when one or both ureters is too short, causing urine to wash back up toward the kidneys. Recurring UTIs are the primary indication for VCUG.
Given the high rate of children without VUR who experience frequent UTIs, not to mention the broad range of potential causes, decades of research suggests that VCUG is widely over-performed today, subjecting hundreds of thousands of children to severe and potentially unnecessary sexual and medical trauma on an annual basis.
VUR is a condition in which urine flows backward through the ureters and sometimes, to the kidneys. There are 5 grades, with Grade 1 being the most mild and Grade 5 being the most severe. This condition can be asymptomatic and spontaneously resolve at any time. However, high-grade VUR can cause recurrent UTIs, kidney infections, and renal scarring. It depends on the child. In boys, VUR usually spontaneously resolves before age 2.
How Often Are VCUGs Performed?
An estimated 1 million children undergo VCUG every year. For many patients, VCUG is performed at least once a year until their VUR spontaneously resolves, subjecting them to severe recurring trauma with the potential for lifelong effects.
Who Is in the Exam Room for VCUG?
Occasionally, one parent may be allowed in the room with the child, but due to ionizing radiation, they cannot stay close to their child while the test is being administered. In the majority of cases, parents must wait outside of the room during catheterization or remain behind a barrier or wall, out of their child's sight and reach.
Only one caregiver, if any, is generally allowed. Siblings and other family members are generally prohibited from the testing room. At least several medical professionals, such as radiologists, urologists, nurses, child life specialists, and medical students, will be present to watch the child's voiding being recorded.
VCUG & Child Sexual Abuse (CSA)
It has long been known by the medical community that VCUG causes psychological trauma that is the same as that of violent rape, especially in girls. In fact, VCUG patients are used in studies as proxies for child sexual abuse victims to study memory recall of traumatic incidents.
Child sexual abuse and VCUG share many similar features, including:
Forced genital contact
Removal of clothing
Feelings of anxiety and distress
Encouragement to "relax" and "not resist"
The child attempts to distract themselves during the incident, similar to dissociation
The incident isn't voluntary
The incident is carried out by a trusted authority figure (doctors, parents, etc.)
What VCUG Providers Say
Websites funded by hospitals, such as Cleveland Clinic and Boston Children's Hospital, promote the procedure as "harmless," "painless," and "low-risk." However, medical studies and research point to the procedure being highly distressing with devastating long-term consequences, including irreparable trauma and cognitive impairments.
What VCUG Patients Say
Former VCUG patients of this procedure recall it as an extremely traumatic and highly distressing experience. Many can remember the entire test, while others remember none of it, but experience the same PTSD symptoms and long-term health effects as patients who didn’t develop dissociative amnesia.
The majority of survivors that have spoken out about the test describe it as rape-like and have suffered lifelong effects as a result, significantly impacting their childhood and adulthood. Many former patients describe VCUG as the “worst” or “most painful” experience of their entire life.
5 Facts About VCUG That Hospitals Don't Mention
An alarming number of trusted medical organizations continue to invalidate the patient experience by dismissing VCUG trauma and disregarding the high potential for severe psychological trauma. Some go as far as to suggest that VCUG is actually fun, adding enthusiastic references like, “Be sure to smile! We're going to take your picture!”
"This information can be a bit confusing," reads one VCUG guide for kids at a California children's hospital. "We will need you to take your pants or skirt off (so they don't get wet). A small, thin tube [...] will gently slide into your bladder. This is the tough part...The rest is easy. Next you should be able to watch on the TV screen as your bladder fills up, that is if you're not too busy watching the movie!”
As any former VCUG patient will tell you, "tough" is an understatement. Here are some well-known truths about VCUG that you won’t find online:
1. The VCUG test is very painful for many children.
When we refer to “VCUG patients,” we are largely referring to newborns, infants, toddlers, and preschool-aged children. This procedure most often involves involuntary catheterization while the child has an active UTI—so, yes, of course VCUG is painful for many, many children. However, complaints of pain from pediatric patients are routinely dismissed as ingenuine, exaggerated, or attention-seeking behavior. “It's just soap and water,” one survivor remembers the nurse saying when she resisted painful genital cleaning, while naked and restrained with an active UTI.
2. The VCUG test is difficult for observers and medical personnel.
Parents, patients, and medical personnel can struggle to stay in the room for VCUG. This is especially true for nurses and Child Life Specialists who aren’t properly prepared for their task, and often develop secondary trauma after witnessing the VCUG procedure. Medical students in attendance have been known to walk out of the room before the test is completed due to their discomfort. On one occasion, a nurse confessed that being present during the VCUG “felt like we were molesting [the child].”
3. The VCUG test isn't routine or forgettable.
Current promotions of VCUG border on negligence. The few hospitals that offer any sort of preparation do little to improve the lack of informed consent for VCUG. “Relatively painless,” concludes one pamphlet aimed at preparing families, adding that “no special preparation is needed” for VCUG.
This is contradicted in following sections, which recommend parents have their child “practice" deep breathing with their legs spread apart, or urinate in the bathtub to prepare for the VCUG test. Such materials appear to favor teaching little girls how to submit to forced sexual touch rather than resist and report, let alone understand the necessity and impact of VCUG on their developing brains and bodies.
It’s no wonder that so many former patients grow up to experience sexual assault, plagued by a high susceptibility to sexual abuse.
4. Children don’t just “forget” VCUG.
Most hospitals promote the VCUG test as painless, low-risk, and safe. At best, doctors may inform parents that VCUG is "just uncomfortable." This isn't the case, as evidenced by extensive testimonies from former patients. In the wise words of Bessel van der Kolk, the body keeps the score. Dissociative amnesia or not, the vast majority of us have experienced the same severe effects on our health and well-being.
5. There are safe, available sedation methods for VCUG.
Today, the majority of providers don’t offer sedation for VCUG, despite the availability of safe, effective sedation methods. Most hospitals assert that sedation compromises test results. This is not the case. Many children benefit from sedation while still being able to void. But you don’t have to take our word for it—check out this article by a pediatric radiologist with over 25 years of experience.
What Are the Risks of VCUG?
Short-term risks of VCUG include:
Urinary bladder rupture due to overfilling of contrast dye
Urosepsis and death as a result of VCUG-related UTIs
Developmental regression
Nightmares and sleep disturbances
Personality changes
Blood in urine and pain when urinating
Long-term risks of VCUG include:
Increased cancer risk, especially in the genitourinary system
Susceptibility to abuse in adulthood, especially in sexual and medical settings
Social and speech impairments
Academic difficulties, including ADHD
Long-term avoidance of medical care
Sleep disturbances and nightmares
Memory loss (dissociative amnesia)
Post-traumatic stress disorder (PTSD)
Traumatic reenactment ("traumatic play")
Pelvic floor dysfunction
Difficulties with sex and intimacy
Depression and anxiety
Isolation, especially from any family members during the test
Active and passive suicidality
Vaginismus or pain with vaginal penetration, such as while using menstrual products, sexual intercourse, pap smears/OBGYN exams, etc.
Can Sedation Prevent VCUG Trauma?
While sedation can be very beneficial in certain cases, there's never a guarantee that children will walk away less traumatized as a result. In many cases, former VCUG patients who were sedated during the procedure—often as a last resort when their resistance makes it impossible to proceed with the catheterization—experience severe trauma.
This is largely because, in the majority of cases, children are still fully aware of what's happening and can feel everything. The only difference is being unable to move their bodies or speak—a terrifying state similar to date rape. One former patient sedated for "severe distress" during her procedure repressed the memory, but relived it in a nightmare well into young adulthood, unable to move as she witnessed the forced instrumentation of her lower body by male doctors.
How Can I Help the Unsilenced Movement?
We're glad you ask! Here are some great ways to support the Unsilenced Movement in our mission to hold providers accountable for their ethical obligations under the informed consent doctrine:
Get connected with us on Facebook.
Share your story. Survivors can email their stories to theunsilencedmovement@gmail.com.
Support and actively listen to survivors of VCUG by respecting and validating their experience.
Explore our blog and resources on our website to educate yourself.
Join the Unsilenced Movement to help us raise awareness about VCUG trauma and end child sexual abuse in pediatric care.
If your child has been referred for a VCUG procedure, the Unsilenced Movement is here to help. Our grassroots organization was founded by former VCUG patients whose lives were irreparably damaged by the effects of VCUG trauma. We hope to this information will give caregivers the opportunity to take control and better understand the lasting harm that many children experience as a result of VCUG.
Thank you for revealing the truth. It is so wrong that healthcare professionals are failing parents by forsaking their ethical duty to act in accordance with principles of informed consent.