Pelvic Exams and Trauma: Understanding the Need and Easing the Fear
- Ashley Strengholt
- Aug 26
- 3 min read
For many survivors of sexual assault or trauma, the thought of a pelvic exam can bring intense dread. It’s important to understand both why these exams may be necessary and how to approach them in a way that feels safe.
Routine pelvic exams aren’t always required, but they are recommended in certain situations based on medical history or symptoms. Reasons can include checking for infections, performing a Pap test, or investigating pelvic or lower back pain. In pregnancy, pelvic exams may be needed to:
Check cervical or pelvic size
Ensure reproductive organs are healthy
Investigate causes of bleeding
Assess the cervix before induction
Determine if your water has broken
How a Trauma-Informed Doula Can Help
As a trauma-informed doula, I work with survivors to reduce anxiety around pelvic exams in several ways:
Therapist referrals – I maintain a list of local therapists experienced in working with trauma survivors.
Prenatal planning – During prenatal appointments, we can discuss potential triggers related to pregnancy, labor, and delivery exams.
Personalized coping strategies – Together, we’ll create a plan to help you feel safe and in control.
Provider communication – I can help you communicate your needs to your care team or even speak on your behalf if desired.
Understanding the Provider’s Perspective
Just as patients have personal values and beliefs about bodily autonomy, medical providers have their own belief systems shaped by training, experiences, and professional guidelines. Doctors are also held responsible for patient outcomes, which can influence their decisions.
This is why open, respectful communication is critical. If you don’t voice your concerns, your provider may assume you’re comfortable with their plan.
Navigating Mistrust in the Medical System
In recent years, documentaries like The Business of Being Born, movements like MAHA, and countless social media voices have raised questions about healthcare practices. While healthy skepticism can be valuable, it’s also important to approach these conversations in a way that fosters collaboration rather than conflict.
Let’s look at two real-world examples.
Example 1: Collaborative Care
Scenario: A patient worries about the potential link between Pitocin, prolonged epidural use, and autism risk.
Patient: “Doctor, I’m concerned about being induced because I read a study linking Pitocin and a prolonged epidural to autism risk in certain cases. Have you seen this research?Doctor: “No, I haven’t. Could you share the study so I can review it?” Patient: “Of course! Can we also discuss alternatives if induction is necessary?”
Because the patient respectfully presented her concerns and the doctor was open to discussion, they found an alternative approach. Later, during a necessary C-section, the doctor remembered her concerns and asked permission before using Pitocin to deliver the placenta. The patient didn’t get her ideal birth but still felt respected and satisfied.
Example 2: When Beliefs Clash
Scenario: A high-risk patient requests a VBAC, but her OBGYN feels it’s unsafe.
Patient: “Doctor, I want to have a VBAC. Will you support that?” Doctor: “Given your high-risk status, I believe the risks outweigh the benefits. If you want more children, a rupture could make that impossible.” Patient: “I won’t settle for anything else.” Doctor: “I respect your choice, but I can’t continue your care under these conditions. I’ll refer you to another provider.”
The patient found another provider and had a successful VBAC—but also publicly criticized the first doctor. This highlights the double standard: patients can hold strong beliefs, but providers can too. Both deserve respect, even when parting ways.
Building a True Partnership
Working with your medical team should be a partnership built on mutual respect. Honest, calm conversations help bridge differences and ensure that both your values and your provider’s expertise are considered.
As your doula, my role is to help you communicate effectively, understand your options, and foster cooperation between you and your care team—so that, in the end, everyone wins.
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