An estimated 64 per cent of adults in Canada report experiencing at least one potentially psychologically traumatic event during their lifetime, and in the United States, research suggests the figure may be closer to 90 per cent.
Trauma-informed care (TIC) is a holistic approach to health care that acknowledges the potential impact of patients’ experiences of trauma and actively aims to prevent exacerbating or causing new trauma in the medical setting.
Importantly, this can lead to more positive experiences and improved health outcomes for patients who may otherwise avoid or reluctantly show up for treatments and preventive screening, which is especially critical for cervical cancer. It offers benefits for providers, too.
However, TIC is not yet standardized in pelvic medicine in Canada or the U.S., and practice varies significantly by profession. This is why my co-authors Lauren Walker, an adjunct associate professor in the departments of oncology and psychology at the University of Calgary, and Krystyna Holland, a pelvic floor physical therapist operating out of Denver, Colorado, are developing a new clinical practice tool to bring TIC into pelvic health care.
They first assembled a multidisciplinary team representing obstetrics and gynecology, urology, urogynecology, midwifery, labour and delivery, pelvic floor physical therapy, oncology, family medicine and sexual assault response practitioners to advise on clinical recommendations.
Through patient interviews, they identified examples of positive and negative pelvic health care experiences. Positive experiences ranged from, “…they didn’t make me feel bad for needing that help,” to “…it made me feel better…to have power in my decision making.” Negative comments included things like, “I was in excruciating, excruciating pain,” and “I felt like a specimen.”
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Evidence suggests the widespread adoption of TIC practices could potentially improve access to care and quality of care for all patients. Therefore, the project’s main goal is to ensure all pelvic health-care practitioners consider the vulnerabilities associated with trauma experiences and minimize harm.
Medical trauma and pelvic health
According to the International Society for Traumatic Stress Studies (ISTSS), medical trauma is defined as a set of psychological and physiological responses to pain, injury, serious illness, medical procedures and frightening treatment experiences. The organization estimates that 20 to 80 per cent of children and adults may even experience post-traumatic stress disorder (PTSD) following medical events and procedures.
Often described as being “stored in the body,” trauma responses can be triggered through medical examinations. This can be through pelvic exams, which may be experienced as invasive because of their intimate nature, but also even in more mild contexts, such as disrobing.
Some populations may be more vulnerable than others. For example, research shows that women with chronic pelvic pain (CPP) are more likely to have experienced higher rates of abuse and trauma, and as such the likelihood of retraumatizing in this population is high.
Certain specialties within health care that are at an increased risk of retraumatizing patients with trauma histories include gyne-oncology care (diagnosing and treating cancers of the female reproductive system), peri- and postnatal care (before and after p