2. Making patients, making power: medical control over those assigned female at birth

For decades, numerous scholars have emphasized the androcentric nature of medicine and its detrimental effects on the lives and health of women and individuals assigned female at birth (Ehrenreich and English Reference Ehrenreich and English2006; García‑Dauder and Pérez‑Sedeño Reference García-Dauder and Pérez-Sedeño2017; Hubbard Reference Hubbard1995; Martin Reference Martin2001; The Boston Women’s Health Collective 2006; Valls‑Llobet Reference Valls-Llobet2009). This androcentric framework has shaped a perception of these bodies as inherently flawed (Kitzinger Reference Kitzinger2006), abnormal, and thus in need of intervention, medicalization, and control. While such critiques have become foundational within health discourse, the dominant biomedical model continues to reproduce practices, narratives, and power relations that have undergone minimal transformation.

We are confronted with an authoritarian and hierarchical model that fragments and norms bodies. Wherever hierarchy and authoritarianism exist, violence soon follows. Critiques of violence within the health system are not new (Barber Reference Barber2007), nor is criticism of the iatrogenesis produced by medicine as an institution (Illich Reference Illich2015). Since the 1990s, a debate has emerged around the practice of vaginal examinations, giving rise to sustained critiques within the gynecological field (Bewley Reference Bewley1992; Cardozo Reference Cardozo1992). More recently, Cohen (Reference Cohen2025) has denounced the performance of unconsented educational pelvic exams on anesthetized patients, highlighting the collapse of legal and ethical safeguards for patient consent. Critical discussions of the right to health often end up narrowing this right to questions of access to medical services. Such a reduction sidelines other forms of care (frequently situated outside the clinical sphere) that could substantially limit the need for medical intervention and, in doing so, mitigate some of the forms of violence that emerge within health systems. This constrained understanding reinforces a profoundly individualized and biologicist model of care, one in which the social dimensions of health and illness are marginalized (Laurell Reference Laurell1982, Reference Laurell1989; Menéndez Reference Menéndez2020). A grasp of the violence embedded in healthcare provision therefore requires attention to these broader social determinants, without which the phenomenon cannot be fully understood.

Generally, studies show that women experience more violence in health services than men, and this occurs across the life course (Brüggemann et al. Reference Brüggemann, Wijma and Swahnberg2012; Levinson and Shojania Reference Levinson and Shojania2011; Schroll et al. Reference Schroll, Kjærgaard and Midtgaard2013; Söderberg et al. Reference Söderberg, Olsson and Skär2011). This situation intensifies in what is commonly called “women-specific care” (d’Oliveira et al. Reference D’Oliveira, Diniz and Schraiber2002). Although this term is problematic, because it tends to reduce women’s health to their reproductive functions (Esteban Reference Esteban1996) and denies biological and social differences in the health–disease process, it is evident that those assigned female at birth are more exposed to violence due to normative control over their bodies and sexuality (Rich Reference Rich1995), and the reproduction of misogynistic medical discourses and imaginaries that present them as physically inferior and emotionally unstable. In other words, certain anatomic and physiological differences are assigned a negative value. These practices take place within the healthcare context and are often presented as the basis for authorizing medical interventions.

In this context, we can no longer consider violence in health as occasional or isolated. It has always been there; we are now simply more capable of recognizing, naming, and reporting it. To acknowledge this means accepting that violence, particularly violence against those assigned female at birth, is a structural part of the hegemonic medical model. Similarly, this violence must be understood as part of a continuum targeting individuals assigned female at birth within our culture (Cárdenas and Salinero Reference Cárdenas and Salinero2023). The hegemonic medical model (Menéndez Reference Menéndez2020) has been identified as one of the main arenas for producing and reproducing the subordinate position of those assigned female at birth (Cárdenas and Salinero Reference Cárdenas and Salinero2024), and is characterized by a conception of health that pathologizes some natural processes, thereby authorizing their subsequent medicalization by expert doctors. This, combined with the growing conflation of health with access to medical services, has fundamentally disempowered individuals and communities from caring for their own health and addressing processes that traditionally were not medicalized (Illich Reference Illich2015). In this sense, the hegemonic medical model has enabled effective social control over the population and their bodies.

When such control is exercised without consent, disproportionately or dehumanizingly, and while ignoring subjectivities, it becomes violence, whether subtle or explicit, individual or structural. This violence causes suffering, damages the relationship with the health system that is supposed to help, and undermines trust in it. These are forms of violence that are normalized, if not legitimized, and masked by discourses of care (Cárdenas and Salinero Reference Cárdenas and Salinero2022) that present harm as help, placing responsibility on victims themselves. The intersectional nature of this violence is undeniable: not all bodies are treated equally, those assigned female at birth who are Indigenous, Afro-descendant, migrant, young or elderly, poor, or living with disabilities experience more severe and systematic violence (Castro et al. Reference Castro, Savage and Kaufman2015; Cárdenas and Salinero Reference Cárdenas and Salinero2022, Reference Cárdenas and Salinero2023; Davis Reference Davis2019; Hernández and Rangel-Flores Reference Hernández and Rangel-Flores2023; Van der Waal et al. Reference Van der Waal, Mayra, Horn and Chadwick2023). In these cases, gender, race, class, and other forms of subordination interweave, deepening inequality in access to and quality of medical care received. Medical control over bodies is not only exerted through gender but is further complicated by other structural dimensions that determine who is more susceptible to being medicalized, silenced, or violated.

3. From obstetric violence to gynecological violence: broadening the field and making the hidden visible

The reality of obstetric violence and its adverse effects on those who experience it is already well established. Numerous studies across the globe document normalized practices that systematically violate the sexual and reproductive rights of women during pregnancy, childbirth, and the postpartum period (Almonte Reference Almonte2016; Belli Reference Belli2013; Bellón Reference Bellón2015; Camacaro Reference Camacaro2009; Cohen Shabot and Korem Reference Cohen Shabot and Korem2018; Chiaroti et al. Reference Chiaroti, Schuster and Arminchiardi2008; Cladem 1998; García Núñez et al. Reference García Núñez, Guzmán Guzmán, Rates, Vargas Castillo and Ott2022; Pozzio Reference Pozzio2016; Quintanela Reference Quintanela2020; Sadler et al. Reference Sadler2016; Sena Reference Sena2016; Sesia Reference Sesia, Quattrochi and Magnone2020; Tobasía‑Hege et al. Reference Tobasía-Hege2019), as well as their impacts on individuals assigned female at birth (Colectiva contra la violencia ginecológica y obstétrica 2020; Salinero and Cárdenas Reference Salinero and Cárdenas2021; Cárdenas and Salinero Reference Cárdenas and Salinero2022, Reference Cárdenas and Salinero2023; Sampaio et al. Reference Sampaio, de Albuquerque and Thuany2019). Though grounded in Latin American theorizations, this reality has been recognized worldwide (Acharya et al. Reference Acharya, Sarangi and Subhalaxmi Behera2021; Chadwick Reference Chadwick2017, Reference Chadwick2021; Di Lello Finuoli Reference Di Lello Finuoli2024; Maciel et al. Reference Maciel, Blondel and Saurel-Cubizolles2019; Mayra et al. Reference Mayra, Sandall, Matthews and Padmadus2022; McKenzie Reference McKenzie2025; Mena-Tudela et al. Reference Mena-Tudela2020; Morena et al. Reference Morena2024; Pickles and Herring Reference Pickles and Herring2020; Pickles Reference Pickles2023; Ruiz-Berdúm and Olza Reference Ruiz-Berdúm, Olza, Leonor Perera and Pita2016; Simeneh et al. Reference Simeneh2024; Yalley et al. Reference Yalley, Jarašiūnaitė-Fedosejeva, Kömürcü-Akik and de Abreu2024). While our work draws on this body of research, we have found it necessary to expand it for various reasons that we will explain later, incorporating it into the broader space that our proposed concept of gynecological violence offers. While we do not have room to revisit the concept of obstetric violence in depth, we will focus on the differences between it and our proposed concept and on what the broader perspective of gynecological violence brings to light. What we aim to do is to make certain routine forms of violence within the medical model, particularly in the gynecological field, visible forms that occur at different life stages beyond reproduction.

Focusing exclusively on one phase of women’s life cycles risks inadvertently excluding a range of service users (transgender people, women who do not wish to reproduce, or are in non-reproductive stages), as well as practices of violence not necessarily linked to childbirth, yet commonly experienced by those assigned female at birth (non-consensual pelvic exams, coercion into routine PAP smears, pathologization and medication of natural processes such as menstruation and menopause, pressure for surgical menopause, overuse of hysterectomies, sexual abuse, normalization of pain that impedes timely recognition of endometriosis symptoms, etc.). In our research experience, all these situations are normalized, a part of daily male domination that significantly affects the lives of those who experience them. Similarly, individuals assigned female at birth who identify as transgender or non-binary and who need to undergo gynecological examinations report high levels of discomfort and mistrust when accessing services. This may be due, for example, to the hyperfeminized environment, the emphasis on reproductive medicine, or pressures to transition from one sex to another when that is not their interest (Cárdenas and Salinero Reference Cárdenas and Salinero2024; Muwnguzi et al. Reference Muwanguzi, Nabunya and Sabila2025; Oppenheim Reference Oppenheim2023). Even the materials used in pelvic exam training tend to erase patient diversity and emphasize medical authority, thereby sidelining the patient’s agency (Towle Reference Towle2022). This mismatch between the person attending the consultation and the traits expected of them can make them feel out of place, producing feelings of shame and strangeness, and may facilitate discriminatory treatment.

Moreover, part of the social acceptance gained by the concept of obstetric violence may stem from its occurrence within practices that do not fundamentally question traditional gender roles for women (their reproductive character) and which even conservative groups can endorse, given the “sacralized” nature of motherhood in our societies, a phenomenon Adrienne Rich referred to as maternal subjectivity (Reference Rich1995). Childbirth is also a more “watched” process than the opaque space of the gynecological consultation, often provided by private practitioners working alone, with no institutional oversight or accountability. We do not mean to diminish the significance of what occurs during birth, but rather to expand attention to a vast range of violent and subordinating practices affecting those assigned female at birth, but not only those who identify as women and wish to reproduce.

Ultimately, we propose a necessary widening of the spectrum of settings, services, practices, and groups affected by violence, which are overlooked when we focus solely on obstetric violence. Likewise, we argue that gynecological violence, which legitimizes a violent and hierarchical relationship between medical personnel and patients, can serve as a precursor to obstetric violence. That is, it normalizes and legitimates an abusive and dehumanizing type of interaction, leading individuals to arrive at childbirth with a diminished awareness of their rights, more willing and prepared to endure and normalize violence. Violence is learned and reproduced daily within a dehumanizing and disrespectful social model that denies patients’ integrity, objectifies them, and annihilates them. All of this serves to maintain social control and gender inequalities.

4. On the concept of violence underpinning gynecological violence

We understand violence as a form of social relationship characterized by the negation of the other. That is, these are acts that occur within regulated and norm-governed relationships between individuals, in which one party to the relationship actively denies the other, thereby inflicting psychological injury or causing harm. Defining violence as a form of social relationship highlights the active role of the individuals involved and, at the same time, prevents the act from being confined or attributed solely to a single agent within the social field. Violence, in most cases, occurs in the presence of others who act as witnesses. It is thus a triadic relationship in which the actions of one party (the perpetrator) affect the others (victims and bystanders), who in turn may respond in ways that sustain and, in some cases, reinforce these violent practices. Violence is not necessarily the act of a single agent; it can be collectively enacted, and it cannot be fully understood without linking it to the concrete interests of the agents involved, even when its usefulness extends beyond the specific relationship in which it occurs (e.g., sustaining an oppressive and unequal gender system).

From this perspective, the context is no longer a mere backdrop against which violence takes place but becomes crucial for understanding the interactions that occur in a given social setting, the norms that operate within it, and the power relations that traverse it. It constitutes a meaningful temporal and spatial situation in which social relationships are produced, interpreted, and made sense of. We will later show how these forms of violence are sustained by the existence of institutional and social contexts that do not prevent or sanction them, contexts that sometimes facilitate, promote, or even legitimize them. The presence of third parties in a violent relationship contributes, when it does not explicitly oppose it, to the legitimization and normalization of that violence.

For us, the concept of symbolic violence (Bourdieu Reference Bourdieu2021) is crucial, as it helps to make sense of deeply embedded, everyday forms of violence, through which perception and evaluation schemas are developed from the dominant side of the relationship. That is, the frameworks for accessing and interpreting reality are created by one group and imposed upon the subordinated, thereby naturalizing violence and presenting it as inevitable, justifiable, or normal. The patriarchal structure of domination constitutes the matrix within which gynecological violence emerges, either by directly legitimizing physical, psychological, or sexual assaults, or more indirectly, by legitimizing forms of moral violence (Segato Reference Segato2003), in which people assigned female at birth internalize the domination system and reproduce the inequality that it entails.

From this perspective, violence is a type of social relationship that harms or destroys a person’s physical or psychological integrity (Bufacchi Reference Bufacchi2022; Pickles Reference Pickles2024), positioning them in a state of subordination vis-à-vis the one who exercises it. Within a relational definition of violence, what is ultimately denied is the other’s recognition, their voice and their full experience of subjectivity (Gilligan Reference Gilligan2024). Hence, the effects of such violence are experienced as a relational trauma (Benjamin Reference Benjamin2012), which becomes even harder to process when masked by rhetorics of care (Salinero and Cárdenas Reference Salinero and Cárdenas2021) and presented as actions taken in the supposed interest of the person being harmed (Ehrenreich and English Reference Ehrenreich and English2010). The rhetorics of care disguise harm as help and often go as far as to blame the victim for the violence inflicted upon them. As a result of this violation of integrity or negation of subjectivity, the person experiences harm, suffering, or injury, sometimes enduring, always significant. In this way, gynecological violence deeply damages the intersubjective bond that ties us to others; it is always a negation of the other, a rupture of boundaries through the use, or threat, of force, a denial of recognition, and a major impediment to the process of identification.

5. Gynecological violence as part of the continuum of violence against women

Violence is a common experience among those assigned female at birth. Thus, gynecological violence is not an isolated event but part of a broader spectrum of interrelated behaviors. These behaviors occur within a sociocultural context that normalizes violence against women and people assigned female at birth, serving as a mechanism of social control over their bodies. Gynecological violence is much more frequent and widespread than generally assumed and, given its magnitude and consequences, represents a serious public health issue (Colectiva contra la Violencia Ginecológica y Obstétrica 2020; Salinero et al. Reference Salinero, Vargas and Cárdenas2023).

By continuum, we refer to the interconnectedness of various violent experiences across women’s lifespans, all of which (domestic violence, sexual harassment, rape, etc.) share the common aim of contributing to the social control, coercion, and subordination of women (Cárdenas and Salinero Reference Cárdenas and Salinero2023; Kelly Reference Kelly1988; Russell Reference Russell1986). Many of these experiences are lived on a daily basis and are shared by those assigned female at birth. These are often rendered invisible, as they appear “normal” or “natural,” as if they could not be otherwise. The normalization and naturalization of suffering are integrated into the daily rhythms and practices of life (Das Reference Das2015). These experiences are cumulative in nature, emotionally and psychologically, and can manifest in obvious ways (such as physical or sexual violence) or in more subtle forms of control, threat, or discrimination. All such expressions reinforce unequal power relations. In most cases, this everyday violence is experienced and confronted individually, in isolation, because it is presented as accidental, isolated, or unusual, leading to the internalization of pain and suffering as a more or less permanent aspect of one’s life. What appears as isolated or exceptional is, in reality, systematic and routine, restricting freedom and dramatically affecting the lives of many women.

We believe it is crucial to understand that this violence is not accidental. It is grounded in gender bias that is continually reintroduced in healthcare encounters with those assigned female at birth, and it occurs within a context of contestation and resistance to male power. In our societies, female bodies are effectively regulated, controlled, normativized, and shaped by a gender system that differentiates and discriminates, a system sustained by specific institutions, including the medical establishment (Martin Reference Martin2001; Federici Reference Federici2004). The body is central to lived experience, and any action imposed upon it impacts identity and one’s sense of self (Esteban Reference Esteban2004). For people assigned female at birth, the body has historically been produced as sexed, giving rise to specific health-related technologies that have no male equivalent and that accompany them throughout their lives. As Emily Martin (Reference Martin2001) has shown, Western medicine has constructed the female body as inherently dysfunctional or deviant from the male norm, thus justifying constant interventions into its physiology. This has led to the production of technologies aimed at controlling physiological processes related to sexuality (e.g., menstruation, childbirth, menopause) by pathologizing and medicalizing them—that is, by treating natural processes as potentially risky diseases in order to authorize medical intervention (Cárdenas and Salinero Reference Cárdenas and Salinero2023; Cleghorn Reference Cleghorn2021).

The notion of gynecological violence can be situated within the broader continuum of violence against women, as it constitutes yet another expression of the structural and normalized forms of harm that shape their everyday lives. While obstetric violence can be understood as one dimension of gynecological violence (particularly related to reproductive processes) its scope is narrower. Gynecological violence encompasses obstetric practices but also reveals qualitatively distinct forms of violence that occur across different stages of life, extending beyond the reproductive sphere. Importantly, it brings into focus the experiences of groups that have historically remained invisible within medical and social discourses, such as persons assigned female at birth who are not heterosexual or cisgender, and who often confront neglect, marginalization, or direct harm within gynecological care.

6. Consequences of gynecological violence and forms of coping/resistance

At a broader level, gynecological violence has led many women and people assigned female at birth to distance themselves from essential health services, either by turning to alternatives outside the hegemonic medical model or by postponing fundamental exams (even when these are part of public health policies in many countries). The fear of re-experiencing violence, being abused, or losing autonomy constitutes one of the most immediate effects of this form of violence (Cárdenas and Salinero Reference Cárdenas and Salinero2023, Reference Cárdenas and Salinero2024). This violence undermines public trust and operates in a paradoxical manner: it harms while simultaneously calling on users of gynecological and obstetric services to be responsible and to submit to an increasing number of medical procedures. We argue that the performance of such procedures (mammograms, pelvic examinations, contraceptive implants, and other routine gynecological or obstetric procedures) becomes a new gendered demand, confronting people assigned female at birth with a tension between the responsibility to care for themselves and the need to avoid spaces where they may be systematically subjected to violence. Institutionally, the erosion of respect and empathy is one of the most far-reaching consequences, creating conditions conducive to the dehumanization of relationships within the healthcare system.

At a personal level, gynecological violence causes, whether intentionally or not, deep harm to the experience of the body and sexuality as sites of pleasure, joy, and freedom (Salinero and Cárdenas Reference Salinero and Cárdenas2021; Cárdenas and Salinero Reference Cárdenas and Salinero2022). It contributes to the perpetuation of male domination and the control of bodies, extending the continuum of violence against people assigned female at birth. As discussed earlier, gynecological violence denies autonomy and recognition, producing experiences of infantilization or erasure. What is excluded and negated through gynecological violence is the capacity to pursue one’s own life projects and to decide how to live and manage one’s health autonomously. In other words, a healthcare model is shaped that disables the possibility of self-care and autonomous decision-making by replacing individuals with the figure of the expert and reducing health to mere access to medical services. The technocratic and allegedly egalitarian utopia that underpins this model is rooted in the disqualification of people from taking responsibility for their own health (Illich Reference Illich2015), legitimizing excessive medical practices and interventions upon their bodies.

As we have noted, gynecological violence, including obstetric violence, may profoundly alter the basic assumptions of individuals, affecting their self-image, self-esteem, relationships with others, and their relationships with their own bodies (Salinero Reference Salinero2021; Cárdenas and Salinero Reference Cárdenas and Salinero2022). It can also produce severe physical consequences (such as fistulas, tearing, painful sexual activity, scarring, etc., mostly related to childbirth), which often require further surgical or medical interventions to repair the damage caused by health professionals themselves. Important psychological consequences also emerge, including depression, anxiety, or emotional pain. Many women describe this experience as traumatic, that is, a deep psychic wound caused by a violent situation that threatens their integrity.

If we also consider the cultural expectations that impose silence and solitude on many people assigned female at birth in the face of such violence, the social denial of the harm they endure, the lack of support from close relationships, and the absence of effective formal mechanisms for complaint, justice, or redress, the severity of this reality becomes even more evident (Pickles and Herring Reference Pickles and Herring2020). This attempt to render invisible both the victims and the violence they experience contributes to the reproduction of existing structures, sex/gender stereotypes, and unacceptable medical practices that normalize and legitimize abuse. It is precisely here that the relational nature of this violence is revealed: it is often perpetuated through the silence of those who witness it, including health workers and medical team members, which constitutes a form of complicity and a serious breach of professional ethics.

The deep power differentials inherent in the hierarchical organization of the health system, along with the lack of explicit regulations governing doctor–patient relationships, lie at the core of this type of violence. Cultural expectations and gender roles may also facilitate its emergence or toleration, through appeals to so-called “feminine” characteristics such as the presumed tolerance to pain or the already mentioned maternal subjectivity (Rich Reference Rich1995), which imply the internalization of the expectation to endure suffering for the sake of loved ones, especially children. In this sense, gynecological violence constitutes yet another way of putting women and people assigned female at birth in their place (Cárdenas and Salinero Reference Cárdenas and Salinero2024; Cárdenas et al. Reference Cárdenas, Salinero and Silva2024), especially those who transgress traditional gender roles, assert their rights, or challenge the authority of medical professionals.

Among the consequences experienced by users of gynecological services, beyond a broad spectrum of symptoms, is the perceived loss of autonomy and the experience of objectification, with the impossibility of choice emerging as a central theme (Cárdenas and Salinero Reference Cárdenas and Salinero2024). The absence of consent for initiating procedures or treatments, as well as the disregard of patient preferences, frequently accompany this sense of disempowerment (Swahnberg et al. Reference Swahnberg, Thapar-Björkert and Berterö2007). Similarly, depersonalized care and interactions that treat the individual as merely an organ or body part are deeply disturbing and erode agency. As a result, many individuals feel erased, and their knowledge is ignored and invalidated. Knowledge resides solely with the clinical staff. The client becomes a patient, an exposed, naked body to be examined. Such a relationship is only possible because of the excessive hierarchy embedded in the interaction, causing those seeking care to feel dismissed, infantilized, and even violated.

When the medical gaze focuses on an organ or body part rather than the person as a whole, the actions carried out may not be perceived as violent or at least not with the same intensity. Throughout their lives, many women are subjected to both minor and major rituals of humiliation that, by legitimizing violence, reinforce power asymmetries and prejudice. Knowledge is located exclusively on one side of the relationship, and punishment arises in response to transgression. Those who ask too many questions, who challenge medical decisions, or who denounce discriminatory attitudes within healthcare teams are punished (Cárdenas and Salinero Reference Cárdenas and Salinero2023, Reference Cárdenas and Salinero2024). In such dynamics, violence remains ever-present: a disapproving gesture or an inappropriate comment may quickly escalate into a painful procedure (Castro Reference Castro2019). As if this were not enough, victims are often blamed for what happens to them, made responsible for the violence they suffer. This violence is so normalized that, even when recognized, it is often regarded as inherent to this form of “care.” The existing power asymmetries within the medical staff act as a strong mechanism that prevents health personnel from filing complaints, leading to ethical lapses (Brüggeman and Swahnberg Reference Brüggemann and Swahnberg2014; Swahnberg et al. Reference Swahnberg, Zbokowski and Wijma2010).

Thus, the potential transgression of bodily boundaries and privacy constantly hovers over the relationship between the medical staff and the client (Cárdenas and Salinero Reference Cárdenas and Salinero2023). To fully understand this issue, it is necessary to consider the specific context of gynecological consultations. People assigned female at birth are often naked and with their genitals exposed before a stranger, a situation that places them in a position of particular vulnerability. The gynecological examination has been described as inherently stressful and anxiety-inducing (O’Laughlin et al. Reference O’Laughlin2021). For many women, the experience evokes fear of abuse or recalls past traumatic experiences inside or outside of the medical setting. Inappropriate touches, obscene comments about their bodies or genitals, being asked to undress without justification, or being pressured to undergo pelvic exams unrelated to the reason for their visit are not isolated incidents (Cárdenas and Salinero Reference Cárdenas and Salinero2024; Cárdenas et al. Reference Cárdenas, Salinero and Silva2024; Swahnberg et al. Reference Swahnberg, Wijma and Siwe2011). These situations trigger deep fears and memories of previous trauma in many women and people assigned female at birth (Iraola et al. Reference Iraola, Jean-Pierre and Chariot2024). In fact, a pelvic exam performed without explicit consent constitutes sexual assault in and of itself (Hendricks and Seybold Reference Hendricks and Seybold2022). Over the past years, we have collected dozens of testimonies recounting experiences of sexual abuse during gynecological consultations, as well as other severe forms of explicitly sexual violence perpetrated in contexts where patients are exposed and often overwhelmed by shame and fear. These narratives were gathered through different strategies, including in-depth interviews, focus groups, and, in some cases, open-ended responses to questionnaires. Several of these accounts have been published and analyzed in our previous work (see Cárdenas and Salinero Reference Salinero2021, Reference Cárdenas and Salinero2024). Such abuse constitutes a direct violation of the trust placed in health professionals and is facilitated by the power they hold due to their institutional authority, social prestige, and the lack of clear guidelines regulating appropriate conduct in these interactions (in some contexts, such rules do not exist, and in others, even when they do, they are ineffective in preventing violence). Furthermore, reporting these incidents and providing evidence is often exceedingly difficult for victims, which contributes to their vulnerability and sense of helplessness.

We argue that the deep emotional and physical impact of gynecological violence remains largely underexplored. These experiences can leave lasting psychological and physical scars that, in many cases, never fully heal. The consequences of lost autonomy, violence, and sexual abuse in gynecological settings are far-reaching: they affect self-image, self-esteem, one’s relationship with their body and sexuality, as well as their social relationships (Salinero Reference Salinero2024). They can also cause long-term physical injuries and persistent psychological effects such as sadness, fear, guilt, self-blame, insecurity, and shame (Cárdenas and Salinero Reference Salinero2021, Reference Cárdenas and Salinero2023, Reference Cárdenas and Salinero2024).

In the face of the high likelihood of experiencing this violence at least once in their lifetime, many women have adopted specific coping strategies. One of the most common involves attending medical appointments accompanied by trusted individuals who can offer emotional support and help ensure safety (particularly in contexts where violence is a real possibility). In the case of LGBTIQA+ individuals, this strategy is often complemented by the development of lists of queer-friendly professionals as well as those to be avoided under any circumstances. These strategies are frequently accompanied by cispassing techniques, attempts to be perceived as cisgender through specific appearances, behaviors, or gender expressions (to minimize the risk of discrimination or violence in healthcare settings). Cispassing, in itself, may also constitute a form of violence (Cárdenas and Salinero Reference Cárdenas and Salinero2024), reflecting the structural challenges that sexual and gender minorities face in accessing safe and respectful care (Basualto et al. Reference Basualto, Zúñiga and Cárdenas2023; Cárdenas et al. Reference Cárdenas, Salinero and Silva2024).

A second coping strategy involves addressing the situation directly, expressing dissatisfaction and setting boundaries. This requires making an effort to speak up during the appointment, sometimes by interrupting or refusing treatment. However, not everyone is able to rely on this form of resistance, whether due to emotional readiness or practical constraints (such as economic limitations or urgent medical needs) that may lead individuals to overlook or tolerate violence even when they recognize it as such.

A third form of coping involves behavioral or cognitive avoidance and denial. Its function is to disconnect or distance oneself from stressful interactions. The goal is to disengage or detach from the distressing experience. In this context, it may manifest as the decision not to attend gynecological appointments, or, when doing so, to mentally dissociate from the procedure, severing the experience from one’s own body.

Additionally, we have identified more collective or community-oriented coping strategies that go beyond emotional or instrumental support. These include active participation in activist groups or militant spaces where survivors are supported, their experiences collectively processed, and those who have suffered violence are defended. This kind of action provides a sense of purpose and may also include direct action practices such as public denunciations, protests, boycotts, or escraches of perpetrators in contexts where impunity persists. These actions aim to safeguard one’s narratives from social prejudice, expose perpetrators, and raise public awareness about the events that occurred. They represent self-organized responses to the lack of adequate institutional mechanisms to address such violence, and they aim to transform future conditions using the means available.