Patients with vulvar pain will likely have significant anxiety or fear about having a vulvar exam. They may or have experienced sexual, physical, or emotional trauma during their lifetime. Many will have had traumatic experiences with the medical system. The following techniques will help the physician navigate the physical exam through a trauma informed lens, helping to create a safe environment that supports a sense of self-efficacy, dignity, and personal control.
Empower
Make it clear the patient is in control
Remind them that they can take a break any time; ask the patient what has made exams easier for them in the past & facilitate those things if possible (e.g., having a support person in the room, having a fidget toy, or deep breathing).
Use
Visual aids
Consider using a diagram to describe the steps the exam and point to the areas of the vulva that will be palpated prior to performing the exam.
Encourage
relaxation Techniques
Many patients have their own breathing techniques and relaxation techniques. Encourage them to use their own, or suggest techniques that have been effective for your patients in the past.
Allow
For extra time for the exam
Make sure you have time to incorporate aspects of trauma-informed care. If you do not, schedule the exam for a different day. Ask the patient if they are comfortable having exam today, or give them the option to book for a follow-up.
Say
Use trauma-informed language
Use language like, “move your knees to either side" instead of “spread your legs.”
Avoid
Words like “normal”
Use words like “healthy” instead.
Explain
The purpose of the physical exam
The purpose is to rule out other conditions, pain mapping, and assess the contribution of elevated pelvic floor tone) and the steps of the physical exam.
Consent
Break the exam into steps
Ask for consent to perform the exam. Explain each step of the exam prior to performing it. Ask for permission to touch before each step.
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