How Can We Make Pelvic Exams Easier for Trauma Survivors?

Q      Carleen in Portland asks: I’m a physiotherapist specializing in women’s health, and many of my patients are referred for pelvic floor work. I’ve noticed that pelvic exams can be particularly challenging for patients who’ve experienced sexual violence. Beyond clear communication around informed consent and what to expect, what can I do to make these exams easier for the women I work with?

​A   Alison: I’m glad you brought this up. Pelvic exams can be inherently stressful, particularly for patients who have experienced trauma.

Let’s start with your intake form. Since pelvic exams are a routine part of your practice, it may be helpful to include a section about them on your intake form. You can ask new patients if they’ve had pelvic exams in the past and, if so, what they would like you to know about their experiences. Were the exams comfortable for them? Challenging? If they were challenging, did they find any specific strategy or approach helpful? By understanding what has worked for your patients in the past, you can offer more personalized care rather than relying on a one-size-fits-all approach.

It’s also important for patients to know that they don’t have to face challenging appointments alone. You can address this on your intake form by letting clients know they are welcome to bring a support person to their appointment. To ensure clarity, explain how the exam room is structured to accommodate a support person while still maintaining your patient’s privacy.

The interview portion of the appointment provides a key opportunity to empower your patient by letting them know they’re in control of the pace. If they need to take a break or defer part of the exam to another day, those options are available. Before starting the pelvic exam, establish a nonverbal signal (like raising a hand) that your patient can use if they need to pause or stop the exam. This proactive approach can make a significant difference in your patients' experiences, fostering a sense of safety and control. This, in turn, can help ease anxieties, particularly for survivors, and improve their overall experience of accessing care.
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One of the inherent challenges of pelvic exams is the exposure from the waist down. This can feel vulnerable for most people and may be particularly triggering for survivors of sexual violence. I worked with a patient who used to wear a pair of thick, long socks whenever she had to undergo a pelvic exam. These socks reached well above mid-thigh and helped her feel less exposed, allowing her to focus on her breathing and stay calmer during the exam. You might consider keeping a selection of long socks in your clinic for clients to use, similar to how some physiotherapists provide gym shorts. If you decide to offer long socks for pelvic exams, they can be sanitized after each use following the same protocol as other clinic laundry, such as table linens and towels.