It can be paralyzing to try and navigate sexual wellness and other health related matters following trauma, especially when it's sexual in nature.
Nisha McKenzie PA-C, a Trauma-Informed Practitioner, Menopause Certified Practitioner, Sex Educator and Counselor, and CEO & Founder, Women's+ Health Collective, explained that trauma can show up in a multitude of ways during routine medical care such as pelvic exams.
"Sometimes responses are physical, emotional, behavioral, verbal or any mix of the above," she said. This can range from muscle guarding and tightening, to panic or dissociation, to avoiding, delaying, or showing up late for appointments, to having difficulty with decision making or overexplaining, and more.
Safety, McKenzie emphasized, is at the core of healing sexual wellness after trauma.
"People need to feel both physically and emotionally safe in an environment in order to start their healing journey," she said. "They need to know and feel they're in charge of what does and doesn't happen in an exam room. Then they can work to gently reconnect with their body; sometimes exploring things such as non-sexual or non-demand touch can be highly effective at this point, helping to foster positive, safe body sensations."
Breathwork or grounding techniques are often effective for this.
McKenzie noted the importance of working with a trauma-informed care (TIC) practitioner—someone who understands how trauma affects the body/nervous system, can prioritize a sense of safety during healing, and actively resists re-traumatization.
"A TIC practitioner will offer choices during every step of an interaction and ask for active, verbal consent prior to every next step," she explained. "TIC practitioners see patients as whole people, not just a set of symptoms, not just their trauma."
In addition to searching for terminology such as "trauma-informed," "safe space," or "consent-based care," McKenzie shared questions patients can ask to find a TIC practitioner:
'Ask when scheduling: "Do you practice trauma-informed care?" "How do you support patients who may feel anxious or triggered during exams?" or "Can I stop or pause the exam at any time?"' McKenzie advised. "A TIC practitioner will welcome these questions, not rush you, and will ask and honor your boundaries. If you feel unsafe or dismissed, it's OK to change practitioners."
McKenzie also recommends utilizing professional directories such as Psychology Today (filtering for trauma-specialized therapists) or the American Association of Sexuality Educators, Counselors, and Therapists (AASECT), in addition to seeking out local support groups which often share first-hand experience with practitioners.
From the perspective of a medical provider, McKenzie shared that creating a safe, supportive environment begins with using a respectful tone, eye contact, transparency (including scheduling, timing, billing, when lab results will actually be available, etc.), being on the same physical level as the patient, and clearly explaining thoughts and next steps prior to carrying them out.
"It's important we avoid cornering patients into disclosing their trauma right away—and it's vital we include visibility and accommodations for all abilities, sizes, religions, cultures, sobriety, languages, genders, and orientations," McKenzie advised. "We can use verbiage such as, 'I'd like to recommend ____. This is why. This is what it involves. But I'd like you to know you're in control the whole time, and you can stop at any time. How would you feel about a plan like this?' This approach vs. 'We need to do a pelvic exam' is more likely to show the patient they are truly in control."
Medical providers should also offer choices during an exam, validate a patient's concerns or fears, and even practice having the patient say "no" or use another cue to pause the exam when needed. Checking in, McKenzie said, is a crucial part of the process.
"I'll often say, 'I'd like to pause just a moment and check in with you. What are you noticing in your body right now?'' McKenzie said. "Reassurance is another important aspect: 'Thank you for sharing what you did with me today. I can only imagine how difficult this was for you.'"
Ultimately, it's important to remember that trauma can be the result of so many different experiences, with each affecting every person differently. The right TIC practitioner can be what makes all the difference in the journey back to yourself.
"Finding the right person to join you on your healing journey is not just helpful, it's essential," McKenzie said. "It takes effort, but it can create a foundation of trust where recovery and reclaiming sexual wellness can truly happen."
Written by Sarah Suydam, Managing Editor for West Michigan Woman.
This article originally appeared in the Oct/Nov '25 issue of West Michigan Woman.
