Understanding VCUG Trauma
A Trauma-Informed Guide for VCUG Patients, Parents, & Providers
In this trauma-informed guide, we break down the potentially traumatic elements of the VCUG procedure and its long-term impacts on patient health, safety, and development.
A voiding cystourethrogram or VCUG is the “gold standard” for diagnosing kidney reflux in children. It uses fluoroscopy (X-rays) to visualize how urine moves through a person’s bladder and out of the body.
Why Is VCUG Traumatic?
The traumatic effects of VCUGs have been well-documented for decades. While minor improvements have been made to the procedure in terms of imaging safety, the test itself remains unchanged since its introduction in the mid-20th century.
Despite the high rate of PTSD among former patients, the long-term psychological effects of VCUGs have never been studied or acknowledged by the medical community, leaving countless individuals and their families to navigate life-altering adverse health outcomes without the guidance, information, and support they deserve.
VCUGs are known to result in two primary types of trauma:
Medical Trauma
Medical trauma is a strong emotional or psychological response to a medical experience that feels scary, painful, or overwhelming. It occurs when a patient feels unsafe, unheard, or out of control. Such medical experience can have lasting effects, including anxiety around doctors, difficulty seeking or accepting future medical care, and symptoms like nightmares or emotional distress.
The correlation between medical trauma and PTSD cannot be overstated. In the case of VCUGs, a 2022 pilot study revealed that 20% of former patients “will never” seek pap smears, 15% will never seek gynecological care, and 11% will never seek urological care, compared to 1%, 2%, and 5% of patients in the control group.
Sexual Trauma
Sexual trauma refers to emotional or psychological harm caused by non-consensual contact with a person's private parts, especially when it feels invasive, frightening, or beyond their control. During a pediatric VCUG, sexual trauma commonly occurs when a child is exposed, touched, or catheterized in ways that feel violating—often without full understanding, consent, or the ability to say no.
Though the VCUG test is described as medically necessary, it is frequently carried out in settings where children are forcibly restrained by adults, ordered to remain still, and expected to comply regardless of fear, pain, or discomfort. These experiences can lead to long-term impacts, including shame, anxiety, distrust of authority, suicidality, difficulty with medical care, and post-traumatic stress, that persist well into adulthood.
Effects of VCUG Trauma
While not every patient experiences VCUG trauma, pediatric VCUG has been linked to adverse health outcomes for patients of all ages, genders, and backgrounds. The harm is not limited to the U.S. and Canada, but affects patients globally. Below are common effects associated with the VCUG procedure:
Short-Term Effects
Many children react to VCUGs with intense fear, shame, and physical distress. Common short-term signs include bedwetting or stopping urination, nightmares, agitation or withdrawal, and dissociative episodes in clinical settings.
Long-Term Effects
The impacts of VCUG can last a lifetime. Common effects include PTSD (flashbacks, hypervigilance), an inability to seek medical care, distrust of clinicians and authority figures, fear of sex and intimacy, vaginismus, and pelvic floor dysfunction.
Many long-term symptoms can also be linked to adverse childhood experiences (ACE), such as chronic illnesses, chronic pain, and mental health issues like depression, anxiety, and suicidality.
What Is a VCUG Like?
VCUG trauma is not an isolated event, but a systematic issue that has harmed generations of patients. Parents often suffer secondary trauma as a result of their child’s procedure, as they are often unprepared for what to expect.
Even medical professionals are traumatized in the exam room, as evidenced by research from UC Davis psychologist Gail Goodman. After filming children’s reactions to VCUGs, Dr. Goodman described the experience as “traumatizing for us researchers” and “tried to bring attention to it at a conference, how bad it was for kids emotionally, and the people in the audience couldn’t even watch the videotape.”
A 2004 study found “a high rate of similarity” between VCUG and child sexual abuse (CSA): “Even the doctors administering the procedure admit that in many ways the VCUG procedure is similar to sexual assault on a child. The VCUG is not an elective procedure for the children.”
Real-Life VCUG Experiences
VCUG Patients
“It’s been 20 years since I had a physical. [I would rather] break all the bones in my body before I get another catheter.”
“I had this done at 6 (I’m 48 now). I’m still embarrassed and traumatized. I vividly remember everything about that day. It’s caused me to avoid going to the doctor unless I’m dying.”
“The first time I [had a VCUG] they used the wrong sized catheter and ripped my urethra. I was bleeding all over and my mom flipped out. After that, they never let her in the room.”
“I remember everything. I was 10. I didn’t understand and was terrified. Had my first pelvic exam at 12. I sobbed and screamed the whole time.”
“I was 11. They wouldn’t let my mom in and I had 4 people holding me down. My mom said she heard me screaming down the hall and they finally let her come in.”
“Asked my mom about it and explained having a recurring nightmare of watching the procedure into my twenties. She was horrified.”
“I had this done in second grade because of a bad kidney infection. I was in therapy all of third grade because of it. I can remember every detail of it.”
“I had them multiple times a year until I was in second/third grade. Sometimes my mom and dad couldn’t stand to be in the room because of my screaming.”
“I disassociated so hard that I was outside my body because I have memories of seeing them hold me down.”
“It’s one of the few things I vividly remember from my childhood. They didn’t even tell me that’s what they were going to do to me.”
“I was 5 and had it done several times. They would give me nothing for pain and it took several nurses and two doctors to hold me down.”
VCUG Parents
“They needed to wrestle [my daughter] to the floor. It was very traumatizing for all of us.”
“You don’t want to operate on your 2-year-old if there’s a chance you won’t have to. But every instance we had of that test was horrible.”
“I’m so glad I came across this. So many people have gaslit me about my child’s trauma with medical procedures. I can see the effects though, so many years later. No one else believes me.”
“My daughter had one. I was allowed in the room, and I was traumatized with her. I forever feel guilt for letting this happen even though it was ‘necessary’.”
“We could not truly give informed consent for this test because NO ONE warned us of all the risks. We were lied to, and when some of us parents mentioned that our kids seemed a little traumatized, we were gaslit and told that improvements had been made to make the test more comfortable.”
Healthcare Professionals
“I’m an ER tech and even assisting the nurses with straight caths is nauseating. I have to look away every time. I can’t imagine what VCUG is like for the patients.”
“With or without sedation, we just don’t have the data. We don’t know how many children are affected.”
“I’m an X-ray tech and I’ve been lucky to avoid performing these in my 15 years. I simply couldn’t handle the sounds.”