A doctor's waiting room. Photo: PATRICIA DE MELO MOREIRA/AFP/GettyImages
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Martha hadn’t let anyone touch her for years and she wasn’t about to start now

A history of sexual assault prevented Martha from seeking an examination from a gynaecologist.

Martha made an appointment soon after moving to our area, seeking antibiotics for a malodorous vaginal discharge. It was a recurrent problem, she told me, and her previous doctor used to give her courses of metronidazole, which would clear it up just fine, albeit only temporarily.

In her late thirties, she wore baggy combats and had several piercings. There was a palpable tension about her. I reassured her that she could see a female GP if she’d prefer, or could have a chaperone present for any examination. That wouldn’t be necessary, she told me, because she couldn’t allow anyone – male or female – to examine her. We talked a bit more and she told me about the sexual abuse she’d experienced as a child. She had managed one sexual relationship many years ago, but it had lasted just six months before foundering on her extreme phobia of intimate contact.

I had every sympathy with her old GP. Faced with an inability to investigate her problem properly, he and Martha had fallen into a pragmatic conspiracy. Metronidazole brought short-term relief, so that was what she kept being given. I was uneasy, though. I explained that we needed somehow to check her cervix, which necessitates vaginal examination. After a lot of careful negotiation, she agreed to an urgent referral.

I briefed the loveliest female gynaecologist on our patch, who handled things with great sensitivity. Ultimately, though, Martha couldn’t permit examination, so an urgent MRI scan was arranged instead. The news was not good: there was a huge tumour at the neck of the womb, extending into the pelvis. If this was cervical cancer then it was far beyond the curable stage, but an operation could ameliorate horrendous symptoms from tumour progression. A lymphoma was also a possibility, and this would be more treatable.

Either way, Martha was facing a stark choice: to enter a programme of surgery, radiotherapy and subsequent follow-up checks, which would necessitate doctors examining her in ways she found intolerable; or to suffer an imminent and extremely unpleasant death.

Given months, if not years, a psychologist might have been able to help her overcome her phobia. But there was no time. Terrified, Martha fled to a town some distance away. But she remained in phone contact, and I did my best to support her as she tried to confront her living nightmare. She developed debilitating panic attacks. The last time we spoke, she mentioned how her breathing had become difficult, a classic physical symptom of morbid anxiety.

The next day she collapsed and died. The post-mortem showed a blood clot in a leg vein – something more common in cancer patients, especially when a large pelvic mass impedes blood flow. A piece of clot had broken off into her circulation and lodged in her lungs, with fatal results.

I will never know whether her breathing difficulty was really anxiety-related, or if it had been due to an earlier, smaller piece of clot. Her tumour was confirmed as advanced cervical cancer; she was never going to survive. That was the main crumb of comfort in the whole tragedy – that her inevitable death had been swift and her dignity had been preserved.

Cervical cancer is sexually transmitted and may well have been caused by a virus contracted from her abuser. It is readily preventable by smear tests but the psychological sequelae of the abuse were such that Martha could never contemplate being screened. Sexual abuse in childhood wrecks lives, and in Martha’s case it ended hers prematurely.

A friend of hers came to see me after the funeral. She told me that Martha had mentioned the way I and my gynaecologist colleague had related to her – one of the few times in her life she had felt fully respected. By the time we met Martha it was too late to save her, but the other crumb of comfort is that she found doctors who did their utmost to treat her with the dignity to which every person should be entitled. 

For more information about cervical screening especially for women who have experienced sexual violence, see mybodybackproject.com

This article first appeared in the 09 April 2015 issue of the New Statesman, The Anniversary Issue 2015

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Voters are turning against Brexit but the Lib Dems aren't benefiting

Labour's pro-Brexit stance is not preventing it from winning the support of Remainers. Will that change?

More than a year after the UK voted for Brexit, there has been little sign of buyer's remorse. The public, including around a third of Remainers, are largely of the view that the government should "get on with it".

But as real wages are squeezed (owing to the Brexit-linked inflationary spike) there are tentative signs that the mood is changing. In the event of a second referendum, an Opinium/Observer poll found, 47 per cent would vote Remain, compared to 44 per cent for Leave. Support for a repeat vote is also increasing. Forty one per cent of the public now favour a second referendum (with 48 per cent opposed), compared to 33 per cent last December. 

The Liberal Democrats have made halting Brexit their raison d'être. But as public opinion turns, there is no sign they are benefiting. Since the election, Vince Cable's party has yet to exceed single figures in the polls, scoring a lowly 6 per cent in the Opinium survey (down from 7.4 per cent at the election). 

What accounts for this disparity? After their near-extinction in 2015, the Lib Dems remain either toxic or irrelevant to many voters. Labour, by contrast, despite its pro-Brexit stance, has hoovered up Remainers (55 per cent back Jeremy Corbyn's party). 

In some cases, this reflects voters' other priorities. Remainers are prepared to support Labour on account of the party's stances on austerity, housing and education. Corbyn, meanwhile, is a eurosceptic whose internationalism and pro-migration reputation endear him to EU supporters. Other Remainers rewarded Labour MPs who voted against Article 50, rebelling against the leadership's stance. 

But the trend also partly reflects ignorance. By saying little on the subject of Brexit, Corbyn and Labour allowed Remainers to assume the best. Though there is little evidence that voters will abandon Corbyn over his EU stance, the potential exists.

For this reason, the proposal of a new party will continue to recur. By challenging Labour over Brexit, without the toxicity of Lib Dems, it would sharpen the choice before voters. Though it would not win an election, a new party could force Corbyn to soften his stance on Brexit or to offer a second referendum (mirroring Ukip's effect on the Conservatives).

The greatest problem for the project is that it lacks support where it counts: among MPs. For reasons of tribalism and strategy, there is no emergent "Gang of Four" ready to helm a new party. In the absence of a new convulsion, the UK may turn against Brexit without the anti-Brexiteers benefiting. 

George Eaton is political editor of the New Statesman.