Trauma-Informed Gynecological Care for Sexual Trauma Survivors

Core Principles

The American College of Obstetricians and Gynecologists recommends that patients be asked about their preference for provider and chaperone gender, allowing them to maintain control and autonomy during vulnerable examinations, which is a critical principle of trauma-informed care 1, 2
Implementing trauma-informed practices, such as waiting to perform sensitive examinations until trust is established, using open communication, and explicitly asking permission, is essential for establishing therapeutic relationships and reducing distress 1, 2

The Mayo Clinic guidelines recommend using guided contact techniques, such as having the patient guide the stethoscope or speculum, allowing them to maintain a sense of control, and offering a chaperone during sensitive exams to create a safer environment 1, 2
Avoiding approaches that may elicit feelings of being attacked, such as approaching examinations from behind, is crucial for reducing trauma-like responses 1, 2

Many chronic pain syndromes in sexual assault victims co-present with dysmenorrhea, menorrhagia, and sexual dysfunction, highlighting the need for comprehensive attention to multiple interconnected health issues 1, 2
Consideration of referral to gynecologic specialists and trauma specialists is important, as a multidisciplinary approach addressing all contributors to symptoms is necessary for optimal care 1, 2

Women with a history of sexual violence and PTSD report higher levels of distress, fear, embarrassment, and pain during physical examinations compared to women without such history 3, 4
Despite the association between trauma history and somatic symptoms, trauma-focused treatments are effective and safe for patients with complex trauma histories 5, 6, 7
History of childhood sexual abuse does not appear to affect the severity of initial symptoms, symptom reduction rate, or number of sessions needed for effective trauma treatment 6, 7
Patients with somatic symptom disorder and sexual trauma history may experience more distress during physical examinations, particularly gynecological examinations for women 3, 8, 9, 10
Treatment approaches should address both the somatic symptoms and the underlying trauma, as evidence indicates that trauma-focused therapies are effective and do not lead to symptom exacerbation in this population 5, 6, 11