April is Sexual Assault Awareness Month. Sexual violence includes a range of actions and behaviors and happens to people of all ages, races, ethnicities, genders, sexual orientations, and incomes. It happens every day. This is a gendered form of violence: in the U.S., one in five women and one in 71 men report experiencing rape at some time in their lives.
For people with a history of sexual trauma, accessing reproductive health care, especially pelvic exams, may trigger PTSD symptoms. The Reproductive Health Access Project teaches techniques of trauma-informed care that can lead to easier pelvic exams for patients who are survivors of sexual violence.
Studies show that trauma survivors want their clinicians to ask about sexual trauma before the exam (that is, while the patient is clothed and seated). During the exam, patients prefer that the clinician listens, anticipates each step of the procedure, and affirms the patient’s control over the exam. For example, giving patients the option of self-inserting the speculum has been shown to lower patients’ anxiety and pain.
Patient-centered techniques we teach that lower anxiety include:
- Establishing rapport before the reproductive health exam. In some cases, this means doing the exam at a separate visit.
- Inviting the patient to suggest measures that will make them more comfortable with the exam.
- Allowing a support person to accompany the patient during the exam.
- Allowing a female patient to choose a female examiner if preferred.
- Before starting, informing the patient that the exam will stop if they feels uncomfortable. Assuring them that they have control over the pace.
- Telling the patient about each step of the exam right before it happens.
- Keeping the patient’s body covered, exposing only the areas being examined.
- Encouraging the patient to breathe abdominally in order to relax pelvic floor muscles.
- Resting the unopened speculum against the patient’s vagina so that they can get used to the sensation before the speculum is inserted and opened.
- Using the smallest possible speculum.
- Using lubricant.
- Offering self-insertion of the speculum.
- Offering frog-leg positioning without stirrups. Call stirrups “foot rests.”
And, most importantly, if the patient does not want to continue the exam, the clinician should stop, inquire about the patient’s needs, and proceed only when the patient is ready.
You can read our Contraceptive Pearl on Trauma-informed Pelvic Exams on our website. Learn more about sexual violence and about the April campaign to raise awareness to the issue at the National Sexual Violence Resource Center.