What Trauma Informed Pelvic Care Actually Looks Like and Why It Should Be Standard

Nearly half of people presenting to a urology clinic screen positive for PTSD. That number comes from data gathered in the clinic that Shelli and psychologist Lindsay McKernan run together. It is not a statistic about edge cases or complex presentations. It is a statistic about the room.

Trauma informed pelvic care, in that context, is not a specialist add-on for a small subset of patients. It is simply what good care looks like.

Psychological Hand Hygiene

Dr Katy Hansen has a phrase for this that is worth sitting with: trauma informed care as psychological hand hygiene. It is not only infectious disease specialists who wash their hands, everyone does, because the risk of harm is present regardless of the patient in front of you.

"Trauma informed care is like you just sort of approach the world as like, hey, let's try to be safe and not re-traumatising. And you don't have to know whether they have trauma or not to do that." ~ Dr Katy Hansen

The pelvic region carries particular vulnerability. It is already an area associated with shame, pain, a history of not being believed, and, for many patients, a history of procedures that felt frightening or violating. Adding an exam into that environment without first establishing safety is not neutral. It has consequences.

What It Looks Like in Practice

Shelli and Lindsay's integrated clinic model builds trauma informed pelvic care into the structure from the beginning. Two providers. One room. One shared conversation. A history taken together, with space for both the medical and the psychological picture to emerge at the same pace.

"If they're not ready for the exam at that visit, we won't do the exam. We can plan it for another time if we feel like it's necessary." ~ Shelli Burton

That sentence is simple. What it represents is significant. The exam happens when the patient is ready, not when the appointment slot runs out. Before any examination or physiotherapy begins, some patients receive a diazepam suppository protocol: a month of nightly use to reduce the physiological threat response in the area before any hands-on intervention takes place.

The Fawn Response and the Yellow Flag

Pelvic pain and mental health intersect in ways that are not always visible on the surface. One of the most important observations in this episode is about patients who seem entirely compliant: saying yes to everything, willing to do anything, appearing cooperative and engaged. Dr Katy Hansen describes this as a yellow flag rather than a green one.

"It's not like a red flag, but it's a little yellow flag for me when we get to the end of the consult and the person says, I'll do anything." ~ Dr Katy Hansen

The fawn response is a protective pattern where the person tries to be the perfect patient in the hope of getting better care. This can look exactly like genuine engagement while masking the fact that the person is not actually telling you what they need. Noticing it changes what questions to ask next.

What Clinicians Outside Integrated Teams Can Do

Trauma informed pelvic care does not require a co-located psychologist. A five-minute phone call to a physio. An email to a psychologist with the patient's consent. A letter that goes beyond diagnosis to include context and impact. These things take minutes and open up a fundamentally different kind of care.

Listen to the full conversation with Dr Katy Hansen and Shelli to hear the full model and what any clinician can take into their practice from it tomorrow.

Resources can be found here.