Is a VCUG Traumatic?

The voiding cystourethrogram (VCUG) procedure is commonly performed on infants and toddlers who experience UTIs. While the VCUG is the longstanding “gold standard” for diagnosing kidney reflux (VUR) in pediatric patients, this procedure is known to be extremely traumatic for children—a fact that is well-documented in the literature since the 1990s, but is not currently disclosed to parents and families.

In this blog, we explain the traumatic nature of VCUGs and why this test can be so detrimental to children’s emotional and psychological well-being.

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Why Is a VCUG Traumatic?

While not every patient experiences trauma during a VCUG, the potential for severe medical and sexual trauma is high.

There are numerous reasons for this, including:

1. Violated Autonomy & Sense of Self

VCUGs are not elective for children and are rarely performed with the actual patient’s consent, leading to persistent powerlessness and a high likelihood of revictimization in adolescence and adulthood (sexual assault, domestic violence, etc.). In many cases, children are forcibly restrained by adults and medical personnel to proceed with involuntary catheterization/genital penetration.

“My body was trained from an early age to not resist. My trauma response is a reminder of something I had always believed to be true: That I have no power; that I have no choice; that I have no agency. That my body isn’t mine; it never was.”

Former VCUG Patient

2. Rape-Like Experience

Multiple studies have reaffirmed stark similarities between VCUGs and child sexual abuse (CSA). Many patients go on to exhibit the same symptoms as child sexual abuse victims after VCUGs (Azarfar et al., 2014), to the point where VCUG patients were used as proxies in multiple CSA studies (Goodman et al., 1990; Merritt et al., 1994; Pezdek et al., 2004).

“In the literature, psychological trauma resulting from VCUG was considered the same as from a violent rape, especially in girls.”

“Oral midazolam for voiding dysfunction in children undergoing voiding cystourethrography: a controlled randomized clinical trial.” Nephrourol Mon. 2014 May.

3. Lack of Pain Management & Sedation

Children are rarely sedated during VCUGs, despite evidence that sedation is safe, effective, and necessary (Blumberg K, 2011). Additionally, the use of a topical agent or numbing gel is rarely used during VCUG catheterization, despite a longstanding consensus that urethral lubrication should be used for all male and female catherizations “to reduce discomfort and minimize trauma” (Nursing Times, 2009).

“Current knowledge in pain management suggests that pain associated with medical procedures should be avoided when possible and that fear and anxiety will intensify the perception of pain…I see fear and anxiety daily when performing VCUGs.”

“Sedation and the VCUG.” Pediatr Radiol. 2012 March.

4. Lack of Preparation

Many argue that a child’s inability to understand the medical benefits of a VCUG makes age-appropriate preparation irrelevant, but this could not be further from the truth. Every patient is entitled to autonomy and dignity, regardless of age. There is always a way to prepare patients using developmentally appropriate concepts and terms. If a provider cannot set aside the time to prepare a patient for a potentially traumatic medical experience, perhaps they should not be working with patients to begin with. 

“This procedure left me unable to properly urinate, sleep, or lie on my back. The pain I would experience was not properly described to me or my parents. Somebody told me to smile for the camera—an 8-year-old child nude, immobile and catheterized under an x-ray.”

Former VCUG Patient

5. Betrayal of Patient Trust & Dignity

VCUG trauma can sow lifelong distrust in medical professionals we depend on to keep us safe. Traumatized children often exhibit behavioral problems in the medical setting and refuse medical care throughout their adult lives, even for annual wellness checks, reproductive care, immunizations, and cancer screenings.

“Children with negatively exaggerated pain memories are at risk for developing medical phobias and avoidance of medical care as adults…those who had a distressing experience can replay precisely the aspects of the procedure they found most traumatic, thereby affecting their emotional well-being in the long-term.”

“The voiding cystourethrogram: minimizing patient and parent distress in an invasive radiologic procedure.” New York: Bank Street College of Education. May 2016.

How Do We Know That VCUGs Cause Trauma?

To understand why so many patients experience VCUG trauma, it’s important to understand how VCUGs are performed—and more importantly, the primary patient demographic they are performed on.

Traumatic experiences are always in the eye of the beholder. Just because an adult radiologist does not perceive a “routine” medical examination as traumatic doesn’t mean that a defenseless toddler will feel the same.

Only by listening to patients’ voices can we understand the complex and lifelong health effects of early developmental trauma resulting from VCUGs.

Standing Up for Generations of Children Since 2023

While not every child walks away traumatized after a VCUG, the Unsilenced Movement has connected with tens of thousands of patients whose lives were irreparably harmed by the VCUG procedure—and more importantly, the lack of disclosure and informed consent perpetuated by the healthcare system.

Every parent deserves to give informed consent for their child’s medical treatment, no matter how effective or medically necessary it may be. The bottom line is that VCUGs have caused life-threatening harm to generations of children—a fact that no diagnostic value or medical benefit can justify or erase.

That’s why the Unsilenced Movement is dedicated to raising awareness about VCUG trauma and empowering former patients to make their voices heard.

Recovering from VCUG trauma? The Unsilenced Movement is here to support you at every step. Visit our website to join us in healing and advocacy.