Content Warning: This content includes graphic descriptions of VCUG and strong elements of sexual and medical trauma. Please read with care.
Most people have never heard the term “VCUG” before. While this procedure is not well known and even less understood, VCUGs are performed on up to one million children every year.
Since the 1960s, VCUGs have inflicted life-altering trauma on generations of children. The hybrid nature of sexual and medical trauma can be incredibly isolating for patients, who often suffer chronic avoidance of medical care, fear of intimacy, poor sexual health, suicidality, and countless other adverse health effects well into their adult years.
Even if you've never heard of a VCUG, there's a good chance you already know someone who has. As the gold-standard diagnostic test for vesicoureteral reflux (VUR), VCUGs are performed on approximately 400,000 pediatric patients every year in the U.S., often repeatedly.
In this blog, we review the meaning of VCUG trauma and its significant impacts on patient welfare in the U.S., Canada, Europe, and beyond.
Why Are VCUGs Performed?
The VCUG test is primarily performed on toddler-aged children. Little girls are more likely to have VUR for anatomical reasons. While voiding cystourethrograms are typically pitched to families as the only life-saving solution for kidney reflux, the procedure is strictly designed to confirm or rule out a VUR diagnosis. It does not “treat” or alleviate any medical condition.
Nonetheless, VCUGs are often performed repeatedly throughout a patient’s childhood to monitor their condition, even after VUR is initially diagnosed. In some cases, this distances the patient from receiving the quality care they need to restore their health, such as antibiotics or corrective valve surgery.
Defining VCUG Trauma
A wealth of research exists to support the severe trauma caused by VCUGs, including VCUG patients being used as proxies in child sexual abuse studies (CSA) as early as 1990. The primary outcome of pediatric VCUGs is a combination of debilitating medical and sexual trauma. These dual elements can create substantial challenges and health problems throughout a patient’s life. Many children develop complex trauma and PTSD as a result of their procedures.
Several components make the VCUG a traumatic and life-altering experience for kids. Some key elements include:
No pain management. Despite a longstanding consensus that a numbing gel should be used for urethral catheterizations in both genders (Nursing Times, 2009), topical agents and pain relief methods are still rarely used for catheter insertion during pediatric VCUGs. Some tests also involve the use of improperly sized equipment, exacerbating pain in patients.
No sedation. While sedation has been established as safe, effective, and necessary for children undergoing VCUGs since the early 2000s, the majority of hospitals do not offer or allow sedation due to misinformation and efficiency purposes. Conductors rely heavily on restraining resistant children using physical force or actual restraints instead of improving the patient experience with sedation or pain management.
Separation from parents. Often, young children are separated from their parents and loved ones for the actual procedure. Some former patients recall their parents banging on locked doors or windows in an effort to reach their screaming/crying child after the procedure begins. This stressful separation, especially while unclothed and in pain, can lead to abandonment trauma, familial dysfunction, and a general mistrust of adults, doctors, and authority figures.
Procedural steps akin to child sexual abuse. A VCUG involves the child being undressed, physically restrained by adults (potentially without a parent present), forcibly catheterized while their legs are pulled apart and held down on the table, having their bladder pumped full of a contrast agent, and commanded to void in a crowded room while lying on their back beneath huge fluoroscopy machinery. If the child cannot void, they must repeat this process all over again.
Persistent powerlessness. VCUGs render patients completely dependent on the medical staff in the room. While many adults argue that involuntary VCUGs are “for the child’s own good,” the lack of respect, empathy, and compassion in the room do not benefit the child in any capacity. Despite the intimate and often violent nature of the exam, the patient’s voice is overwhelmingly disregarded during VCUGs. When complaints of pain or requests to stop/pause are ignored, the child learns that they have no say in what is being done to their bodies, leading to potential revictimization later in life (CSA, sexual assault, domestic violence, etc.).
Lack of support. Unsilenced is the first-ever organization to address the lasting effects of VCUG trauma. Sadly, the vast majority of patients have been left to navigate PTSD and other challenges alone due to a lack of awareness among families and providers alike. Parents may fail to give children the support they need after VCUG trauma due to their own lack of understanding—an issue perpetuated by informed consent violations in the medical community to this day.
The Double-Edged Sword of VCUG Trauma
Medical Trauma
VCUGs often lead patients to avoid medical care for the majority of their lives, even in urgent circumstances. This not only fosters a lifelong distrust of all medical professionals, but also prevents them from establishing healthy provider-patient relationships, robbing them of the quality care they need and deserve. This is especially problematic when it comes to annual wellness checks and cancer screenings, particularly among high-risk populations.
Sexual Trauma
While many adults mistakenly assume that young children are incapable of feeling embarrassment or humiliation during genital exposure, this could not be further from the truth. Often, a VCUG is the patient’s first “sexual” experience. Although some argue that sexual trauma stemming from VCUG is “impossible” due to the lack of vaginal penetration, urethral penetration can and is perceived as a sexually violating experience.
Even if a child does not understand what sex is, they can still experience biological responses to genital penetration and pain. Learn more about the sexual nature of VCUGs here.
VCUGs: Violating the Informed Consent Doctrine Since the 1960s
For decades, providers have violated the informed consent doctrine by failing to disclose all reasonable information to parents prior to ordering and performing VCUGs. Consequently, many VCUGs are performed without medical necessity, resulting in over-performance and unnecessary exposure to ionizing radiation. By failing to disclose the potential risks, benefits, and alternative treatment options for VCUGs, healthcare professionals have continuously robbed parents of their right to give informed consent for their child’s care.
Join the Unsilenced Movement
The Unsilenced Movement was founded in 2023 to empower former VCUG patients to speak their truth and reclaim the narrative stolen from them at an early age. Whether you underwent a voiding cystourethrogram or a similarly violating procedure in early childhood, you’re not alone. Hope and healing are possible. No matter what you’re feeling—fury, grief, sorrow, pain, apathy, fear—your feelings are valid. This is a safe space to share your story and make your voice heard.
Join the Unsilenced Movement to connect with fellow survivors in advocacy and recovery after VCUG trauma. Because kids deserve better. #MoreThanATest
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