Adapted from RHAP Contraceptive Pearl: Trauma Informed Pelvic Exams 2015

If the patient has never experienced a pelvic exam, take extra time and care to explain what will happen, what a speculum is, how it is inserted, and how to best position their body. Take their age and size into consideration. If appropriate and available, use a pediatric or narrow speculum. Explain that future pap tests will only involve speculum placement so they do not anticipate the additional experiences of an abortion during their next speculum exam.

It is important to routinely perform a trauma-informed exam, and not just with those who disclose a history of trauma. A pelvic exam can trigger a response related to past trauma (Gorfinkel 2021), and many people will not report or disclose previous trauma to their healthcare providers.

Establish rapport Introduce yourself and take a seat to demonstrate respect and ease anxiety.
Invest in patient’s experience Prioritize the patient’s experience. This includes observing the patient’s reactions, taking breaks as requested, and adjusting instruments/position for comfort.
Allow a support person Allow a support person such as a partner, friend, family member, or trained doula. Those receiving doula support are less likely to require additional clinic support resources, although pain and satisfaction are unchanged (Chor 2015).
Support the patient’s comfort Keep the patient’s body covered, uncovering only areas being examined. Use a smaller speculum, use lubricant. Say “footrests” instead of “stirrups” and offer frog leg position without footrests. Say “bed” instead of “table”. Minimize touching; some recommend against touching a patient’s thigh with a “warning touch.”
Review relaxation techniques Discuss distraction and breathing techniques (see Chapter 5), before starting the consent process.
Invite the patient to take control Ask what would make the exam more comfortable. Assure they have control over the pace and can stop a procedure if uncomfortable. Ask for permission to place or advance the speculum, or offer the patient to insert the speculum themselves.
Keep the patient informed Check in about patient preferences. Some like to know about each step right before it happens. Some prefer less detail. It can be helpful to say, “We’re about two-thirds through” or “This part takes about one minute.”
Use your intuition Assess what will be most helpful and follow the patient’s lead: sometimes quiet, sometimes humor, and sometimes talking about work, kids, school or goals will resonate well with a patient. Sometimes patients like to listen to music or pray.
Go at the patient’s pace If the patient asks to stop, then stop (if safe), adding “Do you need a break now? Let’s try taking some deep breaths. Let me know when you’re ready to proceed.”
Check in Check in about whether they want physical and/or emotional support during the procedure, offering an assistant’s reassurance or hand to squeeze.
Use supportive statements Say “The procedure is progressing smoothly” or “You are doing a good job focusing on your breath”


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