Pelvic exams can be uncomfortable—even distressing—for many patients. That’s why adopting a trauma-informed care approach is essential. It means recognizing how common trauma is and shaping your care to prioritize safety, empowerment, and trust. When done thoughtfully, a pelvic exam can become more than just a clinical necessity—it can be a meaningful moment of connection and support.
Start With Transparent, Intentional Communication
A trauma-informed pelvic exam starts before the gloves go on. Begin by clearly explaining why the exam is needed and how it fits into the patient’s care plan. Don’t assume they know what a pap smear is or why it matters. Ground your explanation in respect and clarity—it builds trust.
If it’s their first pelvic exam, take the time to walk them through the process. Show them the speculum, describe how they’ll be positioned, and let them know what to expect. Visual aids or anatomical models can help make the conversation more accessible.
Ask open-ended questions to understand their comfort level and past experiences. Try:
“Some people have had tough experiences with pelvic exams. Is there anything you’d like me to know so we can make this one as comfortable as possible?”
Create a Calmer, More Respectful Exam Environment
The exam room matters. Sitting at eye level for the initial conversation (while the patient is still clothed) helps reduce power dynamics and puts patients more at ease.
You can also offer small comforts that go a long way—music, a blanket, or inviting a support person into the room. You can normalize these options by saying:
“A lot of my patients find breathing exercises or music helpful—would you like to try that today?”
These small shifts show that the patient’s comfort is just as important as the clinical task at hand.
Consider Alternative Exam Positions and Techniques
The standard foot-in-stirrups position isn’t always the best or only option. Side-lying or frog-leg positions can reduce discomfort—especially for patients with chronic pain, mobility issues, or trauma histories.
For some patients, self-insertion of the speculum offers more control and less anxiety. It’s a common practice in other countries but underused in the U.S. Offering this option signals trust and agency.
Consent and Comfort: The Cornerstones of Care
Ongoing, enthusiastic consent should guide every step. Use language that reassures autonomy:
“Nothing happens without your say-so. You can ask me to pause or stop at any time.”
Keep the patient covered except for the area being examined. Before insertion, rest the speculum gently against the skin and walk them through what you’re doing.
Encourage deep, abdominal breathing or other grounding techniques to help the pelvic floor relax. Try strength-based reframing, like:
“These muscles might tighten because they’re strong—that’s totally normal.”
Know How to Respond to Distress
If your patient shows signs of distress or dissociation, stop the exam. Grounding strategies—like naming items in the room or focusing on the breath—can help. But remember: dissociation is sometimes a protective coping mechanism. Don’t force presence. Let the patient guide when and how to proceed.
Stay calm, patient, and communicative. Re-establishing safety is more important than completing the exam.
Wrap Up With Respect and Clear Next Steps
End the visit with feedback and empowerment. Instead of saying, “That wasn’t so bad, right?” try:
“Is there anything I could do differently next time to help you feel more comfortable?”
Explain what happens next:
“You’ll get pap results in about five days. I’ll call if anything needs follow-up—otherwise, the results will be in your chart.”
This debrief helps the patient leave feeling seen, respected, and in control.
Making Pelvic Exams Feel Safer—for Everyone
Trauma-informed pelvic exams aren’t just a checklist—they’re a mindset. When you center communication, comfort, and collaboration, you turn a vulnerable procedure into an act of care. And that kind of medicine? That’s what builds lasting trust.
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