I have a chronic anal fissure; persistent for years. When I first went, I was given a digital and visual rectal exam. I did inform them of past trauma before the appointment, and again to the nurse who was documenting my information just before. My doctor was a man so I was more nervous about that, but he was gentle and went slow. I shook through the exam so badly he was triple informing of each movement and asking if I was okay. The digital exam was physically uncomfortable because of the fissure, but he didn’t apply too much pressure or anything.

They later did a sigmoidoscopy (looking at the anus and lower portion/colon). I had had the fissure for years before seeking help, and had some other issues, too. I was put under general anesthesia for that. They usually use a lighter sedation, but I think they went with general for me because of my past trauma, and since I had never had issues with it through other surgeries so I was lower risk.

I tried the nitroglycerin briefly as mentioned by someone else, and I had to stop using it; it gave me instant intense pounding headaches, and is impractical to apply twice daily for me. Among other offered treatments that just wouldn’t work for me. The treatments are meant to relax the anal muscles so over time it can get blood flow and will heal, but those aren’t muscles I want to relax so I’ve been reluctant to go forward with any treatment.

My fissure seems like it’s gotten worse over the past few months, and it bleeds so much sometimes it leaves me light-headed. One time recently I wondered if I’d need to go to the hospital because it was so much blood, but it stopped after a while thankfully.

Definitely tell them you have sexual trauma. It’s still uncomfortable to get the exam even telling them you have sexual trauma, but they will be gentle and slow in the exam making sure you’re okay with each step, and so you’ll know what they’re doing before they do it.