The Pelvic Exam through a Trauma Informed Lens (Goldberg-Boltz, 1/22/25)

A recording of the presentation is available HERE. 

Many thanks to Dr. Nicole Boltz for an excellent presentation this week on The Pelvic Exam through a Trauma-Informed Lens. This was both a practical and meaningful presentation -- one which will stick wit you as you move quickly through your clinic day.

Here are my notes:

• If you do intimate/pelvic exams, consider reading this letter: Dear Doctor: A letter from a survivor or sexual trauma to all medical professionals, by Carol Chandler

• We should all be doing universal sexual assault screening for ALL patients (do not leg bias guide you). There are many ways to do this screening that are patient-centered, but there is no one right way. Remember it may take many visits (or many years) for a patient to feel comfortable enough to disclose. Meet the patient where they are.

• The four Rs of a trauma-informed approach (SAMHSA)
• Realize: Understand the impact of trauma on people and communities
• Recognize: Identify the signs and symptoms of trauma
• Respond: Integrate knowledge about trauma into policies, procedures, and practices
• Resist re-traumatization: Take action to prevent re-traumatizing individuals

• Find humor even in the hard things we do: https://www.instagram.com/reel/C7kbKUpsuAD/?igsh=NTc4MTIwNjQ2YQ%3D%3 (this is super funny!!!!!!)

Okay, onto the Pelvic Exam:

• Prepare a safe and non-judgmental space
• ideally meet the patient prior to the exam or procedure (when dressed!)
• set the ground for empowerment: they are in charge, we go at their pace, they can stop whenever
• explain the procedure and purpose
• ask if they want to see/touch/listen to the instruments
• ask of they want a support person in the room
• ask if they want you to know anything before the exam
• ask what can be done to make the exam more comfortable
• ask for any questions
• Language, language, language
• the goal is to use non-triggering language
• empower the patient with your language (they are in charge)
• framing matters: "when/if you are able" and "you MIGHT feel" and "would you like me to proceed or shall I pause?" and "tell me when you're ready"
• consider these substitutions: exam table (instead of bed), drape (rather than sheet), foot rests (rather than stirrups), instruments (rather than device names)
• Body positions matter: for some, certain positions can be triggering. Ask which position is most comfortable for them
• in/out footrests, frog legged, on exam table
• never force legs open
• ask permission to move/touch body, considering tapping knee to get legs to drop
  
  
  
  
• During exam
• Consider distractions: toe wiggling, tapping on knees in a pattern, tapping on chest, deep breathing
• Getting dressed: After the exam, allow patient to get dressed before you discuss findings/assessment/plans. Then explain what you did, what you saw, what are the next steps.