Dr. Colleen Stockdale presented information about trauma-informed care and its application when evaluating vulvovaginal disorders.
Colleen Stockdale, MD, MS, clinical professor of obstetrics and gynecology at the University of Iowa
First, Stockdale described the principles of trauma-informed care. Trauma may be physical or psychological, including sexual violence, intimate partner violence, adverse childhood experiences, neglect, loss, war and conflict, poverty, community violence, discrimination, medical trauma, and natural disasters. Trauma-informed care is a universal framework coined in 2001 acknowledging that patients have histories of trauma. It promotes positive outcomes by emphasizing physical, psychological, and emotional safety and enhances well-being by empowering individuals to define their needs and goals.
An estimated 90% of patients have experienced some kind of trauma; the same event can be traumatic for one person but not another. Providers cannot assume which of their patients has experienced trauma. The best way to identify trauma exposure is to ask. Stockdale’s clinic asks patients multiple times about their trauma history: in a form they fill out before their visit, during the nurse’s intake, and during the doctor’s visit. Patients may or may not disclose a trauma history. Signs of trauma that appear in medical settings include: avoidance of procedures (e.g., Pap smear, colonoscopy, dental care); vague, generalized symptoms (e.g., chronic headache, pelvic pain); appearing nervous or distracted during a visit; and non-adherence to treatment.
Second, Stockdale discussed the application of trauma-informed care during a vulvovaginal exam. The goal is to provide a safe, comfortable experience for all patients regardless of trauma history by establishing trust and minimizing exposure to shame and vulnerability. Before the exam, providers should check for non-verbal cues of discomfort, explain what they are going to do and make it standard across patients, identify any concerns, and ask for permission to move forward.
The American College of Obstetrics and Gynecology requires chaperones during sensitive exams to protect providers and make patients feel more comfortable. Realistically, Stockdale performs sensitive exams with a chaperone half of the time but wishes a chaperone were always available.
During the exam, providers should introduce each step of the exam and why they’re doing it. Providers should stay within the patient’s eyesight. During a vulvovaginal exam, this means keeping the patient elevated on the exam table rather than flat so they can see the provider. Providers should continually ask permission and check in with the patient, use professional touch, and be efficient. They should use simple clinical language that avoids judgement such as “healthy” rather than “normal,” and “examine” or “evaluate” rather than “feel” or “touch.”
After the exam, providers should offer a sensitive closure by discussing results and asking for any questions. Providers may also consider patient self-collection if appropriate. If patients choose to self-collect a specimen, providers must give specific instructions to ensure proper sampling. The FDA recently approved patient-self collection for cervical cancer screening, reducing barriers to care.
Third, Stockdale described her approach to patients with vulvar symptoms. Patients often believe vulvar symptoms are normal and accept them rather than seeking help. They may try multiple remedies to make themselves better, which often exacerbates symptoms. Stockdale asks all patients about previous providers, testing, and treatments, and reviews skin care guidelines to reduce irritation. She uses a mirror or pictures to demonstrate where to apply treatment; if treatment is not working as expected, she asks patients to demonstrate where they apply it.
Stockdale emphasized that ointments are better than creams to avoid alcohol in the base that may cause irritation. If patients have irritation from an ointment, they can dilute it with Vaseline, coconut oil, or their base of choice. They should avoid lanolin, as it can cause irritation. Stockdale gives all patients a peri-bottle, a tube of Vaseline, and a tube of zinc 20% to try; other options for peri care include a bidet or hand-held shower wand.
Mark your calendar: The DF Clinical Symposium returns January 27–31, 2027.