ERcast: Clinical Perspectives Podcast Preview
The summary below is from an episode of ERcast: Clinical Perspectives
Trauma-informed genitourinary exams start from a simple clinical assumption: many patients have prior trauma, whether disclosed or not. In pelvic, rectal, and other sensitive exams, patient control, explicit consent, careful draping, and neutral language can reduce distress while preserving diagnostic quality.
Trauma-Informed GU Exam Principles
- Universal trauma-informed mindset: The safest default is to assume prior trauma may be present, because shame and stigma often prevent disclosure during pelvic, rectal, and other sensitive exams.
- Intentional control language: Loss of control is a core trauma theme, so explicitly hand control back: patients should know they can pause, reposition, or stop the exam at any point.
- Affirmative consent check: Clear consent should be obtained before proceeding with the exam, and consent is revocable throughout rather than a one-time permission at the doorway.
- Neutral clinical wording: Language shapes the encounter as much as technique; terms like exam table and drape help desexualize the interaction. We lay out practical talk tracks in the episode.
- Minimal exposure technique: Liberal draping with exposure of only the necessary body part is a basic comfort intervention that lowers vulnerability during sensitive examinations.
- Post-exam redressing pause: After the exam, step out and let the patient get dressed before discussing the plan, a small workflow change that can meaningfully restore dignity.
Practical Exam Modifications
- Chaperone as standard practice: Sensitive body-part exams should be performed with a chaperone present, supporting patient safety, comfort, and clear professional boundaries.
- Narrate before each step: Describe what you are about to do before you do it, which reduces surprise and gives the patient another opportunity to consent, pause, or decline.
- Side-position bimanual approach: For bimanual exams, stepping to the side rather than standing between the patient's legs can make the interaction feel less sexualized and less triggering.
- Self-swab sampling option: Self-collected swabs for STI testing and wet mount evaluation are accurate and should be offered when appropriate, especially for patients seeking more control.
- Self-insertion and self-exposure: Speculum self-insertion and patient-assisted exposure for rectal or perianal exams can improve comfort and often give a better view. We get into where this fits in the chapter.
- Immediate stop for distress: If a patient becomes visibly uncomfortable, stop immediately, acknowledge the distress, and offer a break or termination of the exam rather than pushing through.
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References:
- Wright D, et al. Speculum ‘self-insertion’: a pilot study. Journal of Clinical Nursing. 2005; 14(9): 1098-2111. PMID: 16164528
- Adult Manifestations of Childhood Sexual Abuse. American College of Obstetricians and Gynecologists website. Updated August 2011, Accessed February 2015.
- Ravi A, et al. Providing Trauma-Informed Care. Am Fam Physician. 2017;95(10):655-657. PMID: 28671409
Faculty
- Matthieu DeClerck, MD
Dr. Matthieu DeClerck is a board-certified emergency medicine physician based in Southern California. He completed his emergency medicine residency at Los Angeles County+USC Medical Center. Dr. DeClerck has experience practicing in both emergency department and urgent care settings and has a particular interest in wilderness and austere medicine. He has been involved in medical education and hands-on training, with a focus on applying core emergency medicine principles in real-world and resource-limited environments.
- Mizuho Morrison, DO
Dr. Mizuho Morrison is a board-certified Emergency Medicine physician practicing in Southern California. She played a leadership role in FeminEM, helping develop and support its speaker coaching program, and occasionally contributes to Rebel EM. Additionally, Mizuho is an entrepreneur, co-founding 3MD| Three Mommy Doctors, a medical device company that redesigned first-aid kits for children. She lives in Orange County, CA, with her two children.
- Andy Barnett, MD
