Creating Safety; Trauma Aware PAP Exams & IUD Insertions

I’m really passionate about offering PAP exams and IUD insertions and I’m going to share why! These procedures are often sensitive for a variety of reasons – many people have a history of sexual trauma, painful or unsafe experiences with past medical providers, emotional birthing experiences, or an otherwise complex relationship with that very intimate part of the body.

“Our issues are in our tissues” says Buddhist teacher and psychologist Tara Brach and I very much see that to be true. We hold experiences, tensions, and traumas in our physical body, especially in our pelvis. Sometimes or even often, a PAP/IUD procedure can bring this up. I bring a trauma informed approach to these procedures, meaning I am able to meet and hold this part of the experience too.

At the beginning of the procedure I always ask “Is there any reason this exam will be sensitive for you? Is there anything you want me to know?” This question, when asked genuinely, often brings tears to my patients’ eyes. Of course, if not we can proceed as a matter of fact, but when there is something there acknowledging it helps take away some of the charge. My aim is that all my patients walk away feeling held and settled in their nervous systems, rather than activated or violated or gross in some way they can’t quite put a finger on.

During both of these procedures I make a point of communicating clearly what to expect right from the beginning. I then also let the patient know what is about to happen at each point in the process (this is especially important since you can’t see what is happening during most of it). Creating predictability is a simple way to build trust make sure a person (and their body) feels safe. I never force the speculum insertion but always ensure the person is relaxed and comfortable before proceeding.

I do everything I can to make sure my patient is comfortable. We use sheets instead of crinkly table paper. We use heating pads on the treatment table as well as blankets as needed to stay cozy in the winter. Instead of stirrups, which can leave one feeling trapped and vulnerable, we simply use pillows.

Regarding IUDs specifically, a patient-centred approach means to me making sure the individual has choice and agency in the process – we decide together the type of IUD that will be best. I offer cervical dilating agents which can help ease the insertion process. I perform insertions with a nerve block (i.e. a numbing agent) which is not typically done as a standard practice but significantly helps reduce pain and discomfort during insertion. It’s a game changer.

The medical model is often not patient-centred, and these procedures in particular can be so so sensitive. I am passionate about offering these exams because I know I can offer a positive, gentle, and even deeply healing experience.