When I worked as a nurse practitioner for many years, I developed radar for the patient for whom the prospect of a pelvic exam set off overwhelming panic. I suspect most of these patients were the victims of childhood sexual abuse. I routinely asked everyone about violence, and there was a question on every intake form about childhood abuse, but not everyone remembers or is ready to talk about it. An adolescent just wants to get the pelvic exam over, get their pills, get out. They may be under pressure to have sex with their boyfriend, and may be only dimly aware of unresolved sexual and power issues. I once had a collegeage patient who denied abuse every year, yet when it came time for the insertion of the vaginal speculum, she seemed to drift away. No matter how sensitively done, her eyes would glaze over, she would become unresponsive to my questions, turn her face to the wall and begin a series of deep, croupy coughs that lasted throughout the speculum exam and the manual pelvic exam. I thought with bitter admiration of the little girl, fighting it the best she could with the negative vaginal pressure from the deep coughing, learning to dissociate herself from the awful reality. Her coping armamentarium was maladaptive for normal adult life, but it had gotten her through her desperate childhood situation. Since she never responded to my gentle inquiries about abuse, I just showed her a brochure with the phone number of the rape crisis center and tucked in with her other papers. Whoever knows when or where kindness and sensitivity will bear real fruit and lead to a healthy adulthood?