ASHLEY G.

I was a bold, fearless, and joyful girl until I underwent a VCUG at toddler age; after which everything changed. This procedure remains the most painful and distressing experience I have ever had to endure in my entire twenty years of living, despite also being a survivor of abuse and sexual assault outside of a medical context as many VCUG survivors tend to be. This procedure changed me in every way possible and effectively turned me into a shell of a human being for years. The short clip of it stored in my memory haunts me to this day.
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If you're reading this right now and you are not a VCUG survivor, there is absolutely never any way that you could understand what it is like to experience this procedure as a child. But if you'd like to try, imagine that you are a young child and your parents have taken you to an intimidating place where strangers begin to take your clothes off. They tell you to lay naked from the waist down on a cold hard table, and depending on how compliant you are to their insistent orders, they may or may not restrain you while they insert an object into your urethra against your will, fill up your bladder with fluid, and then make you pee it out on the table in front of them.

This is violent sexual assault, no?

So, how come it suddenly cannot be considered that when it's in a medical setting?

Because it could help in the long run? Because the doctors may have good intentions?

I'd like to see you try to explain that to two-year-old me.

All she knows is that she was forcefully hurt by strangers who invaded her body.​

Although I don't remember them, the first few years of my life were characterized by a painful burning sensation nearly every time I would urinate, hospital and emergency room visits, ultrasounds, and antibiotics. I suffered recurrent urinary tract infections, and it was because of this that I was subject to a VCUG two times: the first as a one-and-a-half-year-old and the second as a toddler. I was diagnosed with low-grade unilateral vesicoureteral reflux (VUR), which is fortunately known to have a relatively high likelihood of spontaneously resolving on its own (which it did) without medical intervention considered to be "invasive" such as surgery.​

However, if it were up to me, I can declare with full confidence that I honestly would rather have had exploratory surgery under general anesthesia than a VCUG at the age of two or three, fully awake, unanesthetized, and completely unaware of what was being done to me. No one prepared me for the amount of pain I would feel as the doctors catheterized my actively infected urethra while I was fully conscious. In fact, my parents were told that the procedure would not be painful for me, which they quickly found to be untrue once they watched me experience it.​

VCUGs are done without sedation because they require the child to void (urinate) on the table. You'd think then they would at least use some local anesthetic, but only some boys are lucky enough to get this treatment – which, might I add, is quite bizarre considering the female versus the male anatomy.

If the actual pain from the procedure was not enough, the pain of having my dignity stripped away from me was ensured to be added on. Not only will my body never forget how painful and torturous the actual procedure was, but it will also never forget the way it was violated, and the way the healthcare providers conducting my VCUG dismissed my panicked cries telling them they were hurting me, only further tightening their grip on me as I cried in pain. I will never forget the helplessness and powerlessness I felt as they actively disrespected my wishes and took agency over my body as if it was never mine in the first place. 

In doing this, they taught me, a toddler, that there is nothing I can do to get someone to stop hurting me; that no matter how much I tell someone to stop, I do not get to have any control over whether they hurt me. This imposed a malignant vulnerability and helplessness upon me, which gave me an ingrained belief that what I want can and will always be overpowered by other people. I learned that what other people want to do to me matters more than what I want and what makes me feel safe.

They invaded and reshaped me with their foreign object which I, from my one short memory clip, remember thinking was an electrical plug/prongs after looking down at it as they were about to insert it; my memory goes blank at this point. I was reshaped both figuratively, as they destroyed my extroverted personality that was beginning to bloom and caused me to disconnect from my body, and literally, as they pumped my bladder full of contrast.

Looking down at myself, I watched—with the most fear I have ever felt in my life—as they moved the perceived electrical prong closer to me, about to insert it. In this moment, I had a sudden and startling premonition that this would be the end; that this electrical prong would take my life. My mind could never comprehend what would happen once it entered my body, and so as I watched them about to insert it into me, unable to fight back or make them stop, my body prepared me for death--the same level of fight or flight as a goat whose legs have been broken and can’t move and watches helplessly as their predator is just about to go in for the kill. Similarly, right as they go in for the kill, everything goes black, and I do not remember the rest. This event, I can say with certainty, was not only experienced by my toddler self as rape, but even further, death. My body experienced this event as death. Through the dismissal of this as a bodily experience of death by those around me, any hope for being saved disintegrated and subsequently my mind experienced this event as death. The small fragments of a person I was and the person I was developing into, all died that day. I will never know who I could’ve been. I only know the person I became afterwards, a person who reaps the consequences of the death of my developing self, the consequences of being violated, disrespected, disregarded, and humiliated so blatantly and brutally, and the consequences of being at the utter mercy of those who undertook the denigration of my personhood—those consequences being so extensive that they eroded my psychological and physical health, are central to my identity and sense of self, and permeate through the way I live my life: my ways of thinking and acting, my perspectives and beliefs about myself and others, my habits, my connections, my values, my worldview, my everything.

Although I could write pages about the long-term effects of this procedure that I am aware of (and I still haven't uncovered all of them), I will keep it relatively short.

My development, personality, and outlook on life were irrevocably damaged by the VCUG. I don't remember the whole procedure and I don't remember much from my childhood because of dissociative amnesia, but I do remember feeling scared any time I left the house.

For the first couple of years after the procedure, I genuinely clung to my parents any time we went out. I went from being a happy and social toddler to a terrified and reserved child. I shouted in fear at random men I saw in public who looked like the healthcare provider who had done the procedure on me. My interest and curiosity for the world around me were extinguished and replaced with distrust and hypervigilance.

Each day for years I suffered from stomachaches from what I now know to be functional abdominal pain syndrome, a condition associated with my PTSD. I had trouble sleeping every night for years, waking up my parents each night and asking them if I could sleep in their bed but then keeping them awake for the rest of the night as I tossed, turned, and kicked in my sleep while having nightmares. Many of my nightmares as a young child consisted of doctors performing female genital mutilation on me. A lot of times when I closed my eyes I would have visions of men in white coats leaning over me holding sharp objects while I, an exposed child, cried and laid helplessly on the cold table to which I was tied, anticipating and then reliving the intense pain of being penetrated.

I went a decade and a half without seeing a doctor because I intensely objected any time my parents brought up bringing me to the doctor—which happened to be often, as I experienced (and continue to experience) intermittent physical health issues and lifelong mental health crises which have had me on the brink of death by suicide a countless number of times starting from the age of only eleven years old. I have coped using every single unhealthy and self-destructive behaviour you can think of.​ I was ultimately robbed of a healthy or remotely normal childhood, and even after healing, I will always struggle with things like intimacy and accessing medical care to some extent.

Once I had found out later in my childhood that I had undergone a medical procedure involving catheterization as a very young child, I knew that I had medical trauma–this was also evidenced to me by the fact that growing up I had always refused to see any medical professional for any reason (sometimes even choosing to get through painful symptoms that warrant emergency medical attention on my own in order to avoid medical professionals) and had intense fear surrounding medical settings. In my teen years, I struggled to get anyone to understand what having this procedure was like. I sometimes referred to it as "pee-hole rape." I didn't realize that other people who had undergone this procedure had felt the same way.

​It wasn't until I was eighteen years old, while I was doing some research after my medical PTSD was triggered (I had a negative experience in a medical setting, and this was my first time being in a medical setting in a decade and a half), that I found studies using children who underwent a VCUG as proxies for child sexual abuse, and I was finally faced head-on with a fact that, deep-down, I had known all along: the trauma I experienced at the hands of this procedure was not just medical.​

Realizing what this procedure was (both medical and sexual trauma) and discovering the evidence supporting that fact was both validating and emotionally devastating. I felt overwhelming feelings of shame, guilt, and disgustingness as I had to figure out how to process and accept the fact that what I went through as a toddler was perceived as rape by my brain. It made complete sense but it was difficult to confront. I felt intense sadness and anguish and then later felt uncontrollable anger and rage, especially as I read numerous medical websites describing the most traumatizing and life-defining event I have ever experienced as "painless" and "noninvasive.” 

At the same time, suddenly after learning the truth my childhood made sense, my undiagnosed PTSD was valid, and I wasn't overreacting or overestimating the effect that the procedure had had on me like everyone had led me to think—rather, I was underestimating the effect the procedure had on me.

Finally, if I could just manage to verbalize to people that there is literature asserting that the procedure I went through as a toddler is psychologically equivalent to violent rape—a task which should not be underestimated in difficulty and ideally should not have to be carried out by me or other survivors, but I guess someone has to do it since medical professionals clearly won't—they would listen to me and take me seriously instead of doubting the validity of my experiences, brushing me off, assuming that I'm exaggerating, or trying to play devil's advocate by defending or justifying the procedure. 

I went through my entire life getting these responses from people who I was close to and had felt comfortable enough to confide in about this, and the whole time I felt crazy for just existing with the trauma from this procedure and for the way my brain was dealing with its aftermath. This procedure has made me feel every negative emotion at its greatest intensity. Sometimes though, I feel profoundly empowered. I feel empowered when I write about it, I feel empowered when I connect with other survivors, I feel empowered when I educate other people on the detrimental effects of this procedure and advocate for other children, and, most of all, I feel empowered when I remember that I am alive and fighting for justice despite what happened to me. 

If we care at all about the health and care of children, we need to recognize this procedure for what it is—extremely painful, distressing, and traumatizing non-consensual genital penetration—and opt for viable alternatives such as drinkable contrast fluid (colour flow Doppler sonography), CT urograms, renal DMSA scans, ultrasounds, and MRIs, in addition to devoting funding and effort towards researching and developing alternatives. When hundreds of thousands of children have essentially experienced rape at the hands of the medical system, is it not worth it to dedicate the necessary resources and effort to finding an alternative to the VCUG and in doing so save the millions of children who may undergo this procedure in the future from the severe trauma it can cause, or do physicians and researchers just not care enough? 

When will it be time to listen to children and take them and their pain seriously, treat them with dignity and respect, and prioritize their care and well-being over profit, personal gain, gratification, or other selfish reasons? 

How many more children have to suffer through violent rape until physicians stop abusing their power and actually adhere to the Hippocratic oath, and the medical community and general public realize that something has to change?