Trigger Warning: If you're a former VCUG patient, please read with care. This post contains graphic descriptions of the VCUG patient experience.
Reliving past trauma is one of the worst things anyone can experience. When it comes to VCUGs, many survivors experience constant invalidation from medical professionals and internet users alike, not to mention friends and family. One disturbing pattern embodied by VCUG defenders is the inability to understand the sexual nature of this pediatric test.
In today's polarized society, black-and-white thinking is often king. Is the VCUG sexual or not? Many less educated parties promote the latter, scoffing at the idea that the VCUG is traumatic, let alone similar to rape. For VCUG patients who had the procedure as children, this isn’t only invalidating—it’s inaccurate.
For starters, some VCUG survivors also experienced non-medical child sexual abuse outside of their VCUG, yet express that the VCUG was significantly more harmful to their well-being. In the majority of cases, survivors add that the VCUG made them vulnerable to CSA in the first place. (Let that sink in before letting non-VCUG patients debate the “sexual” nature of the test.)
In this post, we’ll debunk the myths surrounding VCUG and sexual trauma to give outsiders a better perspective of what it was actually like to have this test as a toddler.
VCUG Through the Child’s Lens
Many argue that the VCUG is not “sexual” because it entails urethral penetration instead of vaginal penetration. Others say that because the test is designed to image the child’s kidneys and urinary tract, it isn’t sexual simply because its purpose is not sexual.
Regardless of the argument, here are some helpful facts—well-researched and well-documented—to debunk these claims.
By definition, “sexual” is defined as “relating to the instincts, physiological processes, and activities connected with physical attraction or intimate physical contact between individuals.” Numerous studies dating as far back as the 1990s make it explicitly clear that the VCUG entails “direct, painful, and embarrassing genital contact” and “being genitally penetrated and voiding in the presence of the medical staff” (1997). Another study describes the VCUG as a “painful and potentially embarrassing procedure involving genital penetration” (2013).
Now that we’ve established that genital penetration is always a feature of the VCUG test, we can finally evaluate the unique elements that make the VCUG extremely sexually traumatic for pediatric patients.
When evaluating the sexual nature of the VCUG test, it's crucial to assess these key factors:
VCUG & Female Anatomy
Women's bodies are still a mystery to many. From more women dying in car crashes because safety features are specifically designed for males to being more likely to die of heart attacks due to a lack of knowledge of female symptoms, the female experience is often overlooked and absent, both in history and healthcare.
Our reproductive health is no exception. From the fixation on female orgasms and the "G-spot" to the strict abortion bans that prevent women from seeking care before they know they are pregnant, sexual responses in women are often treated as an afterthought—especially in healthcare, where it’s perfectly legal to perform nonconsensual pelvic exams on unconscious female patients at teaching hospitals.
The VCUG paints another interesting picture of society's inability to understand female anatomy. To understand what little girls feel during the VCUG, it's essential to first understand the positioning of female sex organs.
During VCUG, catheter insertion occurs centimeters away from the “epicenter” of sexual pleasure in women.
The clitoris, known as the “epicenter” of sexual pleasure in women, is the most sensitive part of the female body, with over 10,000 nerve endings on average. These extend beyond the visible glans, reaching into the shaft and surrounding tissues.
The clitoris serves the sole purpose of allowing women to experience sexual pleasure. It’s located approximately 1.6 to 4.5 cm from the urethral opening, where the catheter is inserted into the child during the VCUG.
When one considers adult-sized hands forcing a catheter into a toddler's genitalia—in many cases, with improperly sized equipment and technique—it's plausible that zero contact with the clitoris is simply impossible, given the widespread internal structure of this highly sensitive sexual organ and the sheer quantity of nerve endings.
Remember, the vast majority of VCUG patients are forcibly restrained on the table during their test by techs and nurses or with actual physical restraints (such as the Papoose board). The violent struggle of VCUG patients being overpowered by physical force makes it hard to believe that any procedure wouldn’t entail at least some degree of clitoral contact.
Debunking the “wrong hole” argument.
While the external glans of the clitoris is visible, the organ is also largely internal, extending backward and surrounding the urethra. The entire clitoral complex, including the hood and shaft, is responsive to stimulation.
In fact, experts have demonstrated through consistent research that the infamous “G-spot” in women isn’t actually a spot at all, but an extension of erogenous tissue belonging to the clitoris. This tissue is “a general excitable area along the whole length of the urethra running along the anterior vaginal wall.”
Moreover, “the digital stroking of the anterior vagina along the urethra, especially in the region of the base of the bladder, sexually aroused female subjects greatly” (Boston University School of Medicine).
Put simply, the G-spot is comprised of erogenous tissue connected to the urethra, vaginal wall, and bladder. Just like that, we’ve connected the clitoris—the most sensitive sexual organ in the female body, which has approximately 10,000 nerve endings—to the primary organs involved in the VCUG.
If defenders of this decades-old procedure would take a moment to brush up on knowledge of female anatomy, it would quickly become apparent that female sexual arousal is far more complex than “which hole” is being penetrated.
Instead, let’s consider the science. The female sexual response is a close-knit system comprised of various interconnected organs whose functions are largely internal, debunking the outdated “wrong hole!” argument perpetuated by Unsilenced critics.
VCUG from the Child’s Perspective
Often, the most common argument promoting the VCUG as non-sexual is the lack of vaginal penetration. To understand the absurdity of this statement, it’s crucial to examine the VCUG experience from the child’s perspective—specifically, the little girls who had the test while strapped to the table.
One study on VCUG trauma states, “In the literature, psychological trauma resulting from VCUG was considered the same as from a violent rape, especially in girls” (2014). As you can imagine, this claim—supported by decades of research—has drawn significant controversy.
Nonetheless, this claim has validated former VCUG patients time and time again. For many Unsilenced survivors, stumbling across this study was lifesaving, a breath of fresh air in a world that constantly belittles and commands us to “get over” the procedure that patients and parents alike describe as “barbaric.”
So, why do children experience this test as “violent” and rape-like? There are countless answers to this question that vary based on each individual’s unique experience. However, one common thread is the child’s inability to differentiate between vaginal penetration and urethral penetration.
As we determined above, the female sexual response is complex and largely misunderstood by the general public. Most or all children have no knowledge of "sex" or sexual organs. (Why else would we have to repeatedly teach our children that it isn't okay to run around naked in front of guests?)
During a VCUG, the child typically does not understand:
What genital penetration feels like.
Differences between vaginal and urethral penetration.
That their body has separate openings, let alone any openings at all.
The purpose or medical necessity of the VCUG.
Why it’s okay for adult strangers to touch their genitals, contrary to what their parents likely taught them.
During a VCUG, the child typically does understand:
That they are in tremendous pain that isn't taken seriously by the adults in the room, especially when the test involves improperly sized equipment or technique.
That they are being forcibly penetrated (e.g., internal bodily sensations of being violated, comparable to that of child sexual abuse).
That no amount of struggling, screaming, fighting, clawing, or crying can save them.
That their parents are locked out of the room or, at best, located a safe distance away (such as behind a wall or barrier) to reduce radiation exposure.
Before scoffing at the 2014 study equating VCUG to “violent rape,” take a moment to consider this test through the child’s lens.
The Child’s Perspective of Voiding Cystourethrogram
Imagine: You’re two years old, recently potty trained. Your parents nervously prepare you for an “uncomfortable” test. But as the event unfolds, you start to feel scared. By the time the nurses arrive, impatient and on busy schedules, to take you back to the exam room, you realize something is off.
The doctors aren’t as nice as you remember, and your parents look more anxious than usual. The impatient strangers take your hand and instruct your parents to “stay behind.” They take you behind a locked door and undress you, leaving you naked in a hospital gown.
They place you on the table and painfully spread your legs into “froggy” position. When they start to clean your genitals, it’s rough and stings, making you close your legs. The nurse yanks them back open, holds them down on the table.
You start screaming when they insert the catheter. You’ve never endured such awful sensations before. You can’t help yourself. You kick and thrash, convinced that the pain will never end, that you’ll die from the sharp, stabbing pain. It feels like a knife. They’re trying to pry you open. The pain is paired with this foreign feeling, almost like tickling. Your first "sexual" experience.
The pain drowns it out, leaving you confused and all the more desperate to escape. You have no way of knowing that this test will forever alter your brain to associate sex with excruciating pain, humiliation, and violent, involuntary penetration.
When you try to close your legs, shrieking for your parents to save you, more men surround your face. They restrain your sweaty, thrashing body on the freezing steel table. They force down your legs harder so you can’t move, pinning you down like an insect, exposing your vulva.
Minutes pass. Your screams grow too hoarse to make a difference. You realize for the first time: I can’t win.
The adults are angry with you. “Just stay still! It hurts worse when you move.”
Your body accepts it, but your mind can’t. You let yourself drift, dissociating as you realize you’re unable to move, unable to beat the strength of multiple strangers holding down your naked body. When you look down, you glimpse drops of blood. You fade in and out of the scene, preferring to watch it happen from above, hovering near the ceiling as they penetrate you. You lose. You watch yourself lose.
No one saves you.
The pain recedes to a dull throb, but the bodily sensations—the penetrative ones—you never forget those. You wonder why these adults gave you them. Your body bears those awful, violating feelings like scars for the rest of your life. You never asked for them. You were never warned about them. You could never truly understand them, because no one seems to be comfortable discussing them.
You learn to keep it a secret. You’re too fearful to ever ask why your family let such a horrific thing happen to you. They don’t seem to be open to talking about it, either. They seem…ashamed? Embarrassed?
Probably best not to ask. What if you're the problem? Worse, what if your parents take you back to that terrible, painful place?
So you just carry it.
Compassionate Advocacy for VUR Families
After reviewing 33 years of critically appraised research, the Unsilenced Movement is committed to reforming and retiring the "gold standard" VCUG in favor of safer available alternatives. The gap between healthcare providers and the pediatric patients they treat is extensive, and evidence of patient distress during VCUG, as well as long-term psychological effects, is damning. Unsilenced isn’t here to vilify healthcare professionals, but unite providers and patients in hopes of working together to provide better care to families and kids with VUR.
This test caused me severe, life-altering, sexual and medical trauma.