The Trauma-Informed Pelvic Floor Exam

INTRODUCTION: Trauma refers to experiences that elicit intense physical and psychological stress reactions, stemming from events perceived as physically or emotionally harmful or threatening. These experiences can include adverse childhood events, various forms of abuse (physical, sexual, and emotional), poverty, discrimination, and medical procedures. In gynecology, pelvic exams can be particularly triggering, highlighting the importance of trauma-informed care. While pelvic exams are common, they are significant events in our patients’ lives, with the potential to either contribute to trauma or foster trust within the physician-patient relationship. In this video, we will explore the pelvic exam through a trauma-informed lens and discuss strategies for approaching both the initial visit and the exam itself. We will provide a roadmap for implementing trauma-informed practices both before and during the visit. This will include a detailed tutorial on conducting a thorough pelvic floor examination, incorporating a comfortable, thoughtful, and effective approach to performing a comprehensive musculoskeletal exam. OBJECTIVE: To provide guidance on approaching the pelvic exam through a trauma-informed lens, we aim to implement best practices for both the initial visit and the pelvic exam itself. METHODS: This video will highlight the importance of trauma-informed care and provide comprehensive strategies for implementing trauma-informed practices before and during the patient visit. RESULTS: N/A. CONCLUSIONS: Trauma-informed care is a holistic approach that acknowledges the widespread impact of trauma on health and emphasizes patient-centeredness to foster trust and empower patients. It involves understanding, recognizing, and responding to the effects of various types of trauma without necessitating that clinicians seek disclosures or become experts in trauma treatment. While existing literature highlights patients’ preferences for trauma-informed pelvic care, data on clinicians' knowledge and adherence to these practices is limited. Therefore, this video serves as an informational resource for conducting a trauma-informed initial visit.