Do gynecologists inquire about a patient's history of sexual trauma?

From the Guidelines

Gynecologists should ask about sexual trauma history as part of a comprehensive health assessment, as recommended by the CDC and the U.S. Office of Population Affairs 1. This questioning is essential to provide quality care, especially in family planning services. The medical history might provide information on signs of current or past violence, and if not, providers should ask clients about relationship issues that might be potential barriers to contraceptive use or other health services. Some key points to consider when asking about sexual trauma history include:

• Past sexual trauma can impact current physical and mental health, influence comfort during examinations, affect sexual function, and may require specific approaches to care.
• Understanding a patient's history helps the provider deliver more sensitive, appropriate care and avoid potentially retraumatizing experiences.
• Patients always have the right to decline answering these questions, and good providers create a safe, non-judgmental environment for disclosure.
• If a patient has experienced trauma, the gynecologist can modify the examination approach, provide appropriate referrals to mental health professionals, and ensure follow-up care addresses both physical and emotional needs, as suggested by the recommendations of the CDC and the U.S. Office of Population Affairs 1. Key aspects of care for patients with a history of sexual trauma include:
• Referral for appropriate care, such as mental health services or support groups.
• Modification of the examination approach to minimize discomfort or trauma.
• Ensuring follow-up care addresses both physical and emotional needs.
• Creating a safe, non-judgmental environment for disclosure and care.

From the Research

Gynecologist Inquiry about Sexual Trauma History

• Gynecologists may ask about sexual trauma history as part of a patient's assessment, as it can have significant implications for their health and well-being 2.
• Screening for sexual trauma in a gynecologic oncology setting can help identify patients who may be at increased risk of developing cancer, particularly cervical cancer 2.
• A study found that 12% of patients screened for sexual trauma in a gynecologic oncology clinic disclosed a history of sexual abuse, with the majority of cases occurring during childhood or early teens 2.
• Providers may use various models, such as the five Ps and ExPLISSIT, to organize their approach to sexual health histories and create a safe space for patients to discuss sensitive topics 3.
• Patients with a history of sexual trauma may experience increased emotional distress during medical exams and treatment, highlighting the importance of trauma-informed care in gynecologic settings 4.

Prevalence of Mental Disorders in Survivors of Sexual Assault

• Survivors of sexual assault are at increased risk of developing mental disorders, including depressive disorders and posttraumatic stress disorder (PTSD) 5.
• A meta-analysis found that most mental disorders were more prevalent in survivors of sexual assault, with depressive disorders and PTSD being especially prevalent 5.
• Gynecologists and other healthcare providers should be prepared to address these mental health concerns in patients with a history of sexual trauma 5.

Importance of Trauma-Informed Care

• Trauma-informed care is essential in gynecologic settings, as it can help reduce emotional distress and improve patient outcomes 2, 4.
• Providers should be trained to identify individual implicit bias around sexuality and sexual topics, adverse childhood experiences, and trauma-informed care 3.
• Creating a safe and nonjudgmental space for patients to discuss their sexual health and trauma history is crucial for providing effective care 3.