The potential for VCUG trauma is unique to each individual and depends on varying factors, so it's difficult to give an exact answer to this question. However, there is longstanding research to support that children can be traumatized during a VCUG (and thus reap the long-term adverse health outcomes) at any age.
VCUG trauma doesn't discriminate. Since its launch in early 2023, the Unsilenced Movement has connected with former patients of who experienced traumatic effects as newborns, toddlers, adolescents, teenagers, and even fully consenting adults.
At the end of the day, it doesn’t matter what age a child undergoes a VCUG, or whether they consciously remember it as a traumatic experience. Regardless of conscious memory formation, any violent act performed upon another person against their will can result in somatic memories, opening the door to traumatization and chronic health problems.
In this blog, we’ll explore how age and other factors impact the potential for VCUG trauma.
Will My Child Remember Their VCUG?
“These two points have led to the pervasive, inaccurate and destructive view that infants do not recall traumatic experience, including sexual abuse. Nothing could be further from the truth. The human brain has multiple ways to ‘recall’ experience.” -American Bar Association
Trauma isn't just a mental or emotional experience—it’s deeply physical as well. In the same way that our brains remember things we feel, think, or hear, the body forms memories of its own during physical trauma through a complex interplay of neurological and physiological responses.
When a child experiences trauma, bodily memories can manifest even if the child does not consciously remember the event. This is because trauma is stored in somatic memory and expressed as changes in the biological stress response (Bessel van der Kolk, 1994).
Young children generally lack the cognitive capacity to process and verbalize traumatic experiences, leading them to carry the physical imprint of VCUG trauma into adulthood, where it can impact future behaviors based on the individual’s original trauma response (“traumatic reenactment”).
For example, a patient who “freezes” during a VCUG may do the same when they are sexually assaulted in young adulthood. Similarly, a patient who demonstrated a “fawn” response during the procedure may engage in excessive people-pleasing or struggle to set healthy boundaries in adolescence and adulthood, putting them at a higher risk of domestic violence and other abusive relationships in the future (“revictimization”).
Can Somatic Memory Formation Lead to Long-Term Health Impacts?
Absolutely. The lack of conscious memory doesn’t negate the impact of early developmental trauma. In fact, it can complicate a child’s recovery. Children who repress traumatic events in early development (“dissociative amnesia”) can face significant challenges in recognizing and articulating their feelings, preventing them from forming healthy relationships, managing stress, and coping with everyday challenges. Unresolved bodily memories of a VCUG can manifest as chronic health issues, emotional dysregulation, and behavioral problems, perpetuating a child’s suffering well into their adult years and leaving them with physical and emotional scars that can last a lifetime.
If I Explain to My Child That a VCUG Is Necessary/Beneficial, Will This Prevent Traumatization?
Not necessarily. While well-meaning adults often stress the medical benefits of a stressful procedure to reduce the risk of trauma, this doesn’t mean that children possess the cognitive ability to comprehend the “benefits” of involuntary genital penetration in early development.
Even in the medical setting where invasive procedures are perceived and communicated as “life-saving” for the child, children can and do process VCUGs as life-threatening and sexually traumatic. As long as the experience is non-consensual and fear-inducing, the child can reap adverse health outcomes.
This can not only result in VCUG patients feeling sexually violated and betrayed by authoritative figures (healthcare professionals) and trusted adults (parents/family), but also confusion about the sexual violation altogether, as most pediatric patients lack the developmental maturity to understand what “sexual” means.
How Can I Reduce the Risk of Trauma During My Child’s VCUG?
"Many diagnostic procedures, while necessary and appropriate, may be experienced by a child as a trauma. Healthcare professionals often perceive invasive procedures such as surgery and needle biopsies as more painful and threatening to the child than [a] 'test' such as voiding cystourethrograms (VCUGs). However, clinical experience indicates that the VCUG is often perceived by children as more highly distressing than other procedures." (Stashinko EE, Goldberger J, 1997).
Explicit, conscious, long-term memory formation is not a prerequisite for experiencing the long-term health effects associated with a traumatic event. Instead of asking, "Is my child young enough not to be traumatized by a VCUG?" a more prudent question is, "What can I do to reduce or prevent long-term health outcomes for my child during a potentially traumatic event?"
As decades of research strongly suggest, there may not be a solution to prevent VCUG trauma entirely. While this depicts the urgent need to incorporate safe, established alternatives like ceVUS (a radiation-free alternative with an equal or superior diagnostic value that the vast majority of parents prefer over VCUG), the good news is that there are steps parents can take to alleviate a child’s distress during a VCUG and reduce the risk of long-lasting health effects.
Even if a child developing PSTD after a VCUG is inevitable—whether it be due to an informed consent violation, biological/environmental factors, or a combination of both—VCUG trauma doesn’t have to be a lifelong burden for the child to carry alone. It doesn’t have to rob them of their childhood, the way generations of former patients were robbed of theirs. It doesn’t have to ruin the parent-child relationship, and it certainly doesn’t mean that healing isn’t possible.
The way the child experiences a potentially traumatic event and interacts with trusted adults around them can enhance or reduce the risk of trauma. Based on testimonies from thousands of former patients, here are some ways to improve a child’s VCUG experience:
Do everything in your power to obtain the child’s consent. Just because a child’s consent isn’t legally recognized doesn’t mean it doesn’t matter. A child’s right to bodily autonomy is no different than that of adults. Even if your child can’t fully comprehend the meaning or purpose of the test, making an effort to prepare them in developmentally appropriate ways can help the patient feel more in control.
Be honest about what your child can expect. When you Google “VCUG,” the internet is chock-full of words like “painless,” “harmless,” and “low risk.” As former patients, we implore guardians and healthcare professionals to avoid sugarcoating the reality of this procedure, which has a high potential for pain at several stages. Many patients describe VCUGs as “excruciating” and “the worst pain they’ve ever experienced.” Being honest with the child about what they’ll experience during the procedure is critical to respecting their bodily autonomy and trust.
Respect the child’s voice before, during, and after the VCUG. If a child expresses pain or psychological distress at any point during the procedure, what will the response in the room be? Who will respond, when, and how? Before the test day, establishing a general consensus among involved parties (including the child) can help alleviate anxiety for parents and patients alike while giving the child a voice in the process. Deciding collectively when to pause or stop the procedure can help the child feel more in control while respecting their right to give (or revoke) consent. This is no different than an adult woman requesting an OB/GYN to pause or stop during IUD insertion or other invasive procedure. In this situation, ignoring the patient's voice can and should open the door to a lawsuit, regardless of age.
Implement an “open-door policy” to ensure your child feels emotionally supported post-VCUG. Processing a VCUG can take years or even a lifetime without emotional support from family and loved ones. Every child needs a trusted adult they can confide in after stressful life events. Many former patients report suffering distress and confusion for decades due to unexplained child sexual abuse symptoms, suicidal ideation, self-harm, and other effects that were never discussed with them. While it may be uncomfortable and even painful to relive the test day, creating a safe space for your child to approach you with questions, concerns, and other “big emotions” is essential to their long-term health. Having an “open-door policy” can help children peel back the different “layers” of VCUG trauma throughout their lives, whether it be in adolescence, teenage years, or young adulthood.
Join the Unsilenced Movement
Since its initiation in the 1960s, the gold-standard VCUG has been repeatedly proven to be sexually traumatic for kids. Despite longstanding research equating it as the “psychological equivalent” of child sexual abuse (CSA), most parents are unaware of the psychological risks, preventing them from giving true informed consent for their child's care. Our mission is to close the gap between providers and families by educating parents about VCUG risks and alternatives and advocating for overdue reform in VUR diagnosis and management.
Join the Unsilenced Movement to help prevent future generations of children from reaping the same life-altering effects as former patients.
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