powered by:
save your skin foundation
trauma-informed gynecological care: creating safer spaces for sexual assault survivors
4 minute read
gynecological care can be particularly sensitive for survivors because examinations and procedures may involve physical touch, intimate examinations and situations where patients may feel vulnerable.
adobe stock
stay up to date on this topic
routine gynecological care is an important part of preventive health, helping detect potential health concerns early, providing recommended screenings and supporting reproductive and sexual health. yet for many, booking that appointment can be anything but routine.
nearly one in three women in canada have experienced sexual assault. according to statistics canada, an estimated 4.7 million women have experienced sexual assault since the age of 15. for many survivors, gynecological care can be anxiety-inducing or even retraumatizing, creating barriers to essential health services.
increasing access to trauma-informed gynecological care could help bridge that gap, making routine care safer, more accessible and more compassionate for survivors. the 2026 report “integrating trauma-informed approaches into obstetrics and gynecology medical education: a framework for safer learning and care,” argues that the sensitive nature of gynecological care makes trauma-informed training particularly important, outlining a need for approaches that prioritize sensitive communication, history-taking and examinations
what is trauma-informed gynecological care?
for many survivors, the fear of being retraumatized can pose a barrier to routine gynecological care and preventive health services. trauma-informed gynecology care recognizes that a patient’s past experiences with sexual violence, abuse or other form of trauma can influence how they experience medical settings.
the practice is patient-centred, highlighting shared decision making, promoting safety and empowerment and healing within patient-physician relationships. research suggests that trauma can have lasting effects on a patient’s health and engagement with health care, making physical and emotional safety an important part of trauma-informed care.
advertisement
for naomi thulien, researcher, nurse practitioner and co-founder of breakwater clinic, a toronto clinic serving young women who have experienced homelessness, trauma-informed care starts with recognizing how experiences of trauma can shape a person’s relationship with healthcare.
thulien spent 13 years working at covenant house toronto crisis shelter, where she saw firsthand how trauma, homelessness and barriers to healthcare could intersect with young people. she said her experience there, along with her research on youth transitioning out of homelessness, ultimately led her to create breakwater clinic in 2021. the clinic provides free, trauma-informed primary care to young women who have experienced homelessness.
at breakwater, thulien has built the clinic around the needs she saw in her work, offering services including sti testing and treatment, birth-control counselling, gender-affirming care and cervical cancer screening.
“whatever i can do, when i see you in the clinic, from the minute you walk in the door, to make you feel safe, in control and empowered—that’s what trauma-informed care means to me,” said thulien.
she explains that trauma-informed care also means giving patients control over their care, helping providers meet them where they’re at. thulien offers a range of options and allows them to decide what they feel comfortable with.
for example, a patient may decline bloodwork or a swab but feel comfortable taking medication instead. rather than insisting on the full recommended course of testing, thulien said she works with the patient to determine what they are comfortable doing that day, with the possibility of revisiting other options later.
“the goal is to leave the door open and keep the patient connected to care,” said thulien.
advertisement
maintaining connections to care can also be a challenge. in a 2025 report, the office of the federal ombudsperson for victims of crime found that therapists and service providers reported 37 per cent of survivors withdrawing from therapy or support programs.
why it matters in gynecology
gynecological care can be particularly sensitive for survivors because examinations and procedures may involve physical touch, intimate examinations and situations where patients may feel vulnerable. these examinations can trigger flashbacks and increase anxiety symptoms among people who have experienced sexual assault. a history of sexual violence can reduce the likelihood of receiving timely genital or gynecological examinations.
for some survivors, that vulnerability can become a barrier to seeking or continuing care. thulien said patients may prefer to avoid care than sit through lengthy appointments, or answer repetitive, retraumatizing questions.
for thulien, her focus is on balancing clinical guidelines with the individual needs and comfort of each patient.
“there’s the guidelines, the gold standard of what we should do when somebody has experienced sexual assault, and then there’s meeting them wherever they’re at.”
trauma-informed approaches can also give patients greater control over the pace and nature of their care, which can reduce retraumatization and support patient autonomy.
access to services in canada
while trauma-informed approaches are increasingly recognized in gynecological care, access to providers who explicitly offer trauma-informed services can vary across the country.
some clinics specifically identify trauma-informed care as part of their practice, while others offer services or accommodations that may be relevant to survivors, such as trauma-informed pap tests, sexual assault care or patient-centered gynecological services.
advertisement
for those looking to find or learn more about trauma-informed gynecological care, the following national organizations and resources can help connect patients with providers and offer guidance on trauma-informed approaches to care:
- missinformed: a canadian gynecology clinic finder that allows users to filter providers by trauma-informed care, alongside other factors such as lgbtq+ friendliness and accessibility.
- society of obstetricians and gynaecologists of canada (sogc): canada’s national obstetrics and gynecology organization, which provides clinical guidance and resources promoting trauma- and violence-informed approaches, including informed consent and patient autonomy in gynecological care.
- canadian association of community health centres (cachc/accsc): a national sexual and reproductive health project focused on expanding culturally safe, trauma-informed srh care and resources across canadian community health centres.
share story
