What Trauma-Informed Pelvic Care Actually Looks Like And Why It Changes Outcomes

There's a moment in this episode where Dr Sula describes her own experience of urodynamic testing. She was alone. Nobody explained what was happening. She was handed a backless gown, connected to equipment, told to cough, told to sit on a transparent toilet. When the test was done, she was shown the door to a bathroom that opened directly onto a waiting room full of people, with no regard for the significant pain she was in.

That experience isn't an anomaly and the issue isn’t just that it was unpleasant (to put it lightly). In reality, environments like that have measurable physiological consequences, particularly for people whose nervous systems are already sensitised.

Why the Environment is Part of the Treatment

Trauma informed pelvic care isn't a specialist overlay that only applies to patients who disclose a history of trauma. It's a baseline standard of care that acknowledges something straightforward: pelvic examinations and bladder procedures are among the most intimate clinical encounters there are, and how they're conducted directly affects how the body responds.

The nerve network of the pelvic region is extraordinarily dense. When it's disordered, there is nothing else you can think about. Add to that the cultural weight of taboo, the loss of privacy, the power imbalance of a clinical setting, and the history many patients carry of not being believed, and you have conditions that are primed to amplify threat rather than reduce it.

"Trauma-informed care doesn't mean that we have to be the psychologist. It means treating everyone that comes through your door as if they have some trauma they have not yet told you about." ~ Jilly Bond

One Question That Changes Everything

Elise De's approach to trauma informed pelvic care in practice is disarmingly simple. Before every examination, she asks one question: is there anything you want me to do to make you more comfortable? No requirement to disclose. No assumption made. Just permission, offered openly, before anything begins.

That question costs nothing. It takes seconds. And it shifts the dynamic of the entire appointment, giving patients agency in a situation that can otherwise feel entirely out of their control.

"Is there anything you want me to do to make you more comfortable during the exam?" ~ Elise De

The contrast between Sula's urodynamics experience and what she later witnessed in a well-run clinic in Nashville – women visibly at ease, talked through every step, procedures handled with full communication throughout – illustrates just how wide that gap can be. Same test. Entirely different experience. Entirely different physiological outcome.

What Patients Can Do

Neurourology and pelvic health physiotherapy have produced practical tools that make procedures genuinely less traumatic, like taking paracetamol beforehand, heat packs, specific release techniques for urethral spasm, rescue interventions for those who flare afterwards. These aren't complex. Many simply aren't being communicated.

For people navigating the system, Elise's recommendation is a concise, updated one-page document covering symptoms, investigations, treatments tried, and consultations to date. Not to perform being a good patient, but because it makes the most of limited appointment time and keeps the focus on what actually needs to happen next.

Jilly's PhD research into body perception in pelvic pain adds another layer to this: people with pelvic pain don't lack awareness of the affected area, they experience disconnection from it. That distinction reshapes what good rehabilitation looks like, and why the manual techniques used in pelvic physiotherapy work through mechanisms that go well beyond the physical.

The bladder brain connection, trauma informed pelvic care, the language clinicians use, the questions they ask, all of it shapes not just how people feel in the appointment, but how they heal afterwards.

Listen to the full conversation with Elise De and Jilly Bond now.

Resources and research discussed here.