MOST women take the necessity of internal pelvic examinations for granted, even if they are not a particularly happy aspect of adult life. But for some it is such an ordeal that they suffer long-term distress, anxiety, anger, sleep disturbance and recurring nightmares.

Research carried out by a Warwickshire GP, Janet Menage, has revealed that in some cases post-traumatic stress disorder - usually suffered by people who have been involved in disasters and life-threatening situations - can result from obstetric and gynaecological procedures such as vaginal examinations, smear tests and laser treatment of the cervix.

Five hundred women took part in the study, responding to a request in women's magazines and newspapers asking for help with research into psychological stress and vaginal examinations.

They women then completed a questionnaire based on one devised in America for Vietnam war veterans. Fifty were found to have post- traumatic stress disorder - with scores as high as those suffered by the soldiers.

Are these women sexually repressed or wimps terrified by the prospect of a cold speculum? Neither, according to Dr Menage. She found that just under a third of the women said they had suffered previous sexual abuse or rape, so the experience reawakened distressing memories. The majority reported no problems.

They were normal women with no apparent hang-ups about sex or about being examined. They were surprised and horrified at the way they were treated. In other words, it was not the women who were the problem, but the professionals carrying out the procedure.

Many women also wrote at length about their treatment at the hands of doctors: painful, terrifying, brutal and humiliating, were among the terms they used.

'I came away hurting and feeling violated,' said one. 'I cried and shouted but was held down and told to keep quiet,' said another.

'The women's views were ignored and they had no control over what was happening,' says Dr Menage. 'Some had been examined with the door open on to the corridor. One woman was having an episiotomy stitched without adequate anaesthetic and was screaming, but the doctor told her to be quiet and carried on.'

Further analysis showed that those who were most traumatised scored significantly higher than the others on three counts: the pain of the procedure, the perceived hostility of the doctor, and feelings of powerlessness - echoes of the experience of rape victims. They also felt they had not been given enough information, and were unsure if they had given their consent to the procedure.

The women's ages ranged from 18 to 45, and the time since the event ranged from six months to 13 years. Some had never told anyone before.

Dr Menage believes the problem is bigger. 'One doesn't want to appear anti-male, but the majority of doctors dealing with women's problems are men, and in this society women are not necessarily listened to. It looks as though what happens in society is reflected in the consulting room.'

She points out that medical undergraduate training does not incorporate any listening or empathising skills. 'Medical training teaches you not to have any emotional contact with your patients. And these are very sensitive issues - examining a woman's sexual parts and the relationship between men and women. If a woman says: 'Stop doing that to my body', a doctor should stop. Women should be given control over what happens to them. They should feel it is their right to have their opinions listened to, to refuse procedures they are unhappy about, or to have the treatment carried out by a different doctor. If the procedure has to be stopped or done at another time, then so be it.'

Dr Menage's aim is to develop a counselling programme to help traumatised women. She has also set up a telephone network to enable women to share their experiences. Because the research was based on a self-selected group, it does not indicate the scale of the problem. She says: 'I would guess there are a lot of women who are keeping quiet about distressing experiences. We will probably never know how many there are, but one thing is certain - it's too many.'

SAE to: Dr Janet Menage, 28 Squires Road, Stretton on Dunsmore, Rugby, Warwickshire.

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