Trigger Warning: Child Sexual Abuse, Suicidality
Does the voiding cystourethrogram (VCUG) procedure cause sexual trauma? The question has been a topic of intense debate online in TikTok and Reddit comment sections despite hundreds of survivors’ lived experiences and a high volume of critically appraised research studies dating all the way back to the 90’s revealing that they do, in fact, have extremely strong potential to do so. If you don’t believe neither science nor reality, you may as well stop reading now; there’s no saving you in my eyes. But, if you’d like to read about the precise ways in which this test gave me sexual trauma, you’re in the right place!
My Backstory
If you haven’t read my story or any of my blogs on this site, hi! I’m Ashley. Pushing 20, I am from Ontario, Canada and I had two VCUGs within the first 3 years of my life. After I was born and monitored in the hospital during those first primordial days of my life, they sent my parents home with a note saying “watch for voiding”—I did not pee like a healthy infant would in those first few days of my life. So, it was clear that from birth, something was not right with my urinary system.
Fast forward a year and a half later (give or take a couple months), and I was having recurrent urinary tract infections. Thus begins an initial few years of life that I would spend in pain every time I urinated, going to the hospital and emergency room, feeling cool ultrasound gel on my abdomen, peeing into a cup, and sipping liquid sulfamethoxazole-trimethoprim from a spoon every morning for four years with my breakfast.
Hold on… I’m missing something. Oh, right! The two VCUGs I repressed.
The purpose of these VCUGs were to figure out what was going on with me. They would end up diagnosing my low-grade unilateral vesicoureteral reflux (VUR), which has a high rate of spontaneously resolving later in childhood. This high likelihood of a positive outcome means that the good urologists today tend to hold off on conducting VCUGs until the child is older and can understand what’s happening to them–that is, if the healthcare provider cares enough to explain it carefully to them and help them understand that the test is meant to help them.
These two VCUGs would be conducted on me while I was fully awake and unanesthetized, at ages one and a half and two/three. My parents had some concerns about this procedure–what do you mean you want to catheterize an awake toddler without any pain relief? Isn’t that a recipe for raw life-altering trauma?
In response to these valid concerns, they were told that if I did not get the VCUG, I would get kidney disease sometime in the future (not something they can factually state with certainty by the way). This made my parents scared. In this state of fear for their daughter, the risk of trauma they were once concerned about seemed to fade away towards the back of their minds. However, by my second VCUG, their secondhand experience of watching me go through this procedure was a concrete reminder of that trauma they had once forgotten, and they decided that that would be my last VCUG. I’d be taking antibiotics for as long as I had UTIs anyways, so what truly was the reason to continue repeating this torture?
Maybe it’s true that kidney disease could’ve paid me a visit if I hadn't got any VCUGs, so I guess if I had had no VCUG there’s a possibility that I would be on dialysis right now and barely scraping by to see this day because of that. But I can also tell you that having two VCUGs did, in fact, have me barely scraping by to see this day (hello to a lifetime of suicidality!). I think about this a lot–I guess being born with VUR is truly a lose-lose situation. There’s no winning; no happy ending. I was born sick, I spent the first years of my life sick, and the trauma that wreaks havoc on my nervous system because of this will ensure that I remain sick for the rest of my life.
Okayyyy enough with the depressing stuff! Actually, nevermind–not sure why I would say that. We’re about to talk about how my childhood was filled with signs of sexual abuse…
Classic Signs of Child Sexual Abuse, According to RAINN
Rainn.org is the Rape, Abuse, & Incest National Network. This organization has plenty of resources for anyone who has experienced sexual violence, from hotline services to ways to get involved in the cause with advocacy and public policy. Their website lists some the warning signs for child sexual abuse in young children. Let’s take a look!
Physical Signs of Child Sexual Abuse
Starting off with the physical signs.
Sexually transmitted infections are not a sign of child sexual abuse that VCUGs would typically cause, although the procedure does carry a risk of causing urinary tract infections, acquired via catheterization (one of the numerous risks of VCUG that goes undisclosed to parents).
The second sign, however, is quite common in pediatric patients post-VCUG. Many children who have had VCUGs within the past couple days will bleed into their underwear or during urination. Some VCUG survivors have even reported that the VCUG itself made them bleed such that they looked down at their genitals after the procedure and saw blood. Personally, I bled in the first couple times that I urinated after the procedure. My urine would be tinted pink and it would be pretty painful.
Behavioral Signs of Child Sexual Abuse
Now for some behavioral signs. With a bigger list here, I will speak only to my experience since every survivor’s experience with this procedure and its aftermath looks different.
Personally, I did not exhibit excessive talk about or knowledge of sexual topics (the VCUGs were never even brought up let alone discussed with me, which created an uncomfortable culture of secrecy and shame surrounding the topic) or spending an unusual amount of time alone–although, it depends what you consider an unusual amount of time alone. I exhibited the third-to-last sign but I am not comfortable explaining it on here.
At age 3 I did not have many secrets to be keeping but I certainly did not talk as much as usual after the VCUGs. In the few videos I have of myself from before this procedure, I can be seen playfully running and crawling around, happily babbling and trying to form words (which sounded more like high-pitched screeches) to communicate with my family, and even getting joy out of being scared by my older brother. I squeal-laughed in response to him popping his head around the corner sharply yelling “boo!” at me. I had no sense of fear. I was happy and I was communicative. Post-VCUGs, this completely changed: I became quiet and reserved. I stopped talking to random strangers who I would once greet and introduce myself to in the grocery store. I became scared and selectively mute around anyone who wasn’t a family member and until a certain age, I did not talk to peers unless I was spoken to.
After the VCUGs I was also extremely clingy and afraid of being away from my parents, specifically my mother. If we left the house to go anywhere, I had to be in physical contact with her at all times, either being held by her, holding her hand, or holding onto her legs. This was not the case before the VCUGs; it was a new behaviour.
Regressive behaviours were something I exhibited as well. During a VCUG, the child is required to void in the presence of the medical staff. If already potty trained, this can cause developmental regression. To be completely honest, I have no idea if I was potty trained before my VCUGs but as a child it certainly took me much longer to become potty trained because of the procedure. I did not like pulling down my pants to pee and I was scared of toilets. Speaking of this, we can jump to the last sign–I hated removing my clothing/having my clothing removed. I couldn’t stand baths; they were the part of my day that I dreaded the most.
Overly compliant behaviour was also something I showed. I’ve mentioned before that when this procedure is done to children at such a young age, it engrains in them the belief that they don’t have autonomy. Boundaries never even existed for me in the first place. The people who conducted my VCUG entered my body like it was theirs to invade.
Although I resisted hugs from peers, I knew no better than to be compliant with any sexual contact. This set me up to be revictimized later in childhood. At around 7 or 8 I would go on to become a victim of child-on-child sexual assault. In this situation, I froze. I didn’t know what to do and I didn’t have the words to say no, so I complied.
Emotional Signs of Child Sexual Abuse
Lastly, the emotional signs. I experienced all of these.
My appetite was reduced following my VCUGs. I ate less and took longer to eat what I could manage. My mood and personality changed as well. I was much more irritable and generally unhappier. Little things that didn’t bother me before bothered me a lot. As discussed in the behavioral signs section, my personality was completely flipped from being outgoing to being afraid of other people. I showed excessive worry and fearfulness and I was always hypervigilant: constantly feeling on-edge and anticipating something bad happening. I also suffered from a lot of paranoia from a very young age, which was scary and isolating.
As far as a decrease in confidence or self-image goes, I can’t say I really had a self-image until at least the age of eight. But once I did develop some sort of identity, I certainly struggled with my self-esteem. In fact, I truly hated myself to the deepest extent for the longest time. I think I was conditioned to hate myself because people had continuously hurt me throughout my life. I didn’t believe my existence was of any value, and sometimes I even thought that people wanted me to disappear from the Earth. When I struggled with suicidal ideation during my preteen years I would imagine what the world would look like when I was gone, and I used to imagine that people would celebrate and throw parties after hearing the news of my death. I hated everything about myself: the way I was, the way I acted and the way I thought, the way I looked, all of it. I hated myself so much that I regularly engaged in self-injurious behaviours (checking off that last item on the emotional signs list) and would plan my own suicide in order to do other people, and my future self, a favour. With self-esteem this bad, anything resembling confidence for me was obviously out of the question as well.
As a kid I certainly had quite a few unexplained health problems, both of which include stomachaches and headaches. I had very frequent stomachaches with seemingly no cause. I had somewhat frequent headaches which often came in certain periods of a couple months–there was one summer where I had migraines that were so bad that they were accompanied with vomiting. A few years after getting my period, I would start to experience extremely intense period cramps that would have me laying on the floor in the fetal position, debilitated and unable to do or think about anything until after the pain went away.
During the first times that I was introduced to other children my age, I seemed to exhibit no interest in approaching and befriending them. I only made friends if they approached me first, and even then, I stuck to one friend at all times. My mother desperately tried to change this about me, urging me throughout my childhood to branch out and make more than one friend, but it just wasn’t in my nature.
My sleep troubles as a kid were extensive. I experienced both nightmares and a fear of being alone at night. After the procedure, I barely slept. A feeling of terror took over me at night. I had a large amount of trouble falling asleep and would get out of my bed every night and walk to my parents’ bed so I could sleep with them. This would be the only way that I could fall asleep, but, to be frank, it annoyed my parents quite a bit because not only was I interrupting their sleep to wake them up and ask to sleep in their bed, but also because once I would fall asleep I would be moving a lot in my sleep. I often had nightmares which took place in medical settings. I had nightmares and visions of people in white coats performing female genital mutilation on me by using sharp tools to cut and/or cauterize my genitals.
Sexual Trauma From VCUG In Adulthood
Evidently, the impact of sexual trauma was pervasive throughout my childhood.
In adulthood, I still face the ramifications of the sexual trauma from this procedure to this day. I am terrified of intimacy and I cannot let anyone go anywhere near that part of my body. Not only have I been relatively scared of my genitals for my whole life, but also, I have been quite disconnected from my sexuality. In theory, I can manage to be comfortable with the idea of someone else perceiving me in a sexual context, but in practice, it makes me feel wildly uncomfortable. I simply can’t trust anyone to not hurt me.
At the intersection between this sexual and medical trauma, the idea of going to a gynecology appointment or having a pelvic exam is simply not something I can do. I cried watching a demonstration of an ECG on YouTube knowing that I would have to go through one… and with that test there isn’t even any dimension of being exposed from the waist down (for anyone wondering though, I'm happy to report that the ECG luckily went well!).
There’s something in me that won’t let me receive this type of medical care, no matter what. I hope it will change soon, for the benefit of my own health. Along with a billion other symptoms, I have recurrently experienced intensely painful and sometimes debilitating pain in my pelvis since puberty, especially during my menstrual cycle. This has been a cause for concern for both me and the people who have witnessed it. I’d love to know what’s going on with that (or would I?), but not enough to have a pelvic exam. I’ll pass out from pain before I book that appointment; that’s just where I’m at right now.
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